Moorlag Martijn, Schurgers Evelien, Krishnamoorthy Ganeshram, Bouwhuis Anne, Lindhout Theo, Kelchtermans Hilde, Lance Marcus D, de Laat Bas
Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands.
Synapse Research Institute, Maastricht, the Netherlands.
J Appl Lab Med. 2017 May 1;1(6):613-625. doi: 10.1373/jalm.2016.022335.
Measuring thrombin generation (TG) in plasma increasingly gained attention as a diagnostic tool in the field of thrombosis and hemostasis. To include the contribution of all blood cells, recently, the whole blood TG method was developed.
We changed the calculation method of the standard calibrated automated thrombography (CAT) to a method only taking into account the data until the peak of TG, thereby considerably reducing the time from blood draw to result. By redesigning the method, the blood volume per test was reduced to 15 μL.
For all TG parameters, the interassay variation proved to be below 15%. The interindividual variation of all parameters was comparable to the CAT method. Thirty-three patients undergoing cardiothoracic surgery were included to investigate whether our assay correlates with postoperative blood loss. On dividing patients into severe and mild bleeders, significant differences between both groups were found for the peak endogenous thrombin potential (peakETP) and peak values determined by our near-patient device. Importantly, patients with a peakETP below the median experienced significantly more blood loss compared to those with a peakETP above the median. A similar division based on the peak as well as the body mass index of the patient yielded similar significant differences. A combination of the peakETP, the body mass index, and the lag time even resulted in a better predictor of blood loss compared to each parameter separately.
Our adapted whole blood TG assay can be used near patients and is indicative for the amount of blood loss post cardiothoracic surgery.
血浆中凝血酶生成（TG）的检测作为血栓形成和止血领域的一种诊断工具，越来越受到关注。最近，为了纳入所有血细胞的作用，全血TG检测方法得以开发。
我们将标准校准自动血栓形成检测法（CAT）的计算方法改为仅考虑TG峰值之前的数据的方法，从而显著缩短了从采血到得出结果的时间。通过重新设计该方法，每次检测的血量减少至15μL。
对于所有TG参数，批间变异被证明低于15%。所有参数的个体间变异与CAT方法相当。纳入33例接受心胸外科手术的患者，以研究我们的检测方法是否与术后失血量相关。将患者分为严重出血者和轻度出血者，两组之间在内源性凝血酶峰值电位（peakETP）以及我们的床旁检测设备测定的峰值方面存在显著差异。重要的是，peakETP低于中位数的患者与peakETP高于中位数的患者相比，失血量显著更多。基于峰值以及患者体重指数进行的类似分组也产生了类似的显著差异。与单独的每个参数相比，将peakETP、体重指数和延迟时间相结合甚至能更好地预测失血量。
我们改良的全血TG检测方法可在床旁使用，并且可指示心胸外科手术后的失血量。
