Yoon Uzung
Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA.
Semin Cardiothorac Vasc Anesth. 2023 Sep;27(3):199-207. doi: 10.1177/10892532231151528. Epub 2023 Jan 11.
Thromboelastography is a viscoelastic test of whole blood hemostasis. Currently, no reference value exists for native whole blood and recalcified citrated blood without activators. The aim of this study was to compare the results of ROTEM tests using fresh native blood without decalcification "TRUE-NATEM" with those using decalcified citrated blood "NATEM" and provide reference values for each. Inclusion criteria were healthy adult volunteers (18-65 years). Exclusion criteria were any medical condition or medication affecting coagulation. Native whole blood testing was defined as "TRUE-NATEM-test." For recalcified citrated blood testing, the NATEM function was used on ROTEM. The reference value for TRUE-NATEM was CT: 872-1595s, A10: 14-34 mm, A20: 26-48 mm, CFT: 314-839s, MCF: 34-55 mm, and alpha angle: 17-40°. The reference value for NATEM was CT: 757-1327s, A10: 19-43 mm, A20: 33-55 mm, CFT: 219-615s, MCF: 37-61 mm, alpha angle: 24-51°, and ML: 0-3%. When comparing the reference value of NATEM to TRUE-NATEM, the CT and CFT values are decreased and the MCF and alpha angle are increased. The recalcification process of citrated blood in NATEM shows significant activation of coagulation. Female healthy volunteers had enhanced coagulation when activators were used. Age-related statistical difference was seen when activators were used. Ethnicity did not show any difference on the ROTEM values. We determined the reference value for native whole blood and recalcified whole blood using ROTEM®. A significant discrepancy in native whole blood and recalcified citrated blood coagulation was found. Our study underlines the importance of native whole blood as the gold standard reference value in coagulation.
血栓弹力图是一种对全血止血功能的粘弹性检测。目前，对于未加激活剂的天然全血和重新钙化的枸橼酸盐血，尚无参考值。本研究的目的是比较使用未经脱钙的新鲜天然血进行ROTEM检测（“TRUE-NATEM”）的结果与使用脱钙枸橼酸盐血进行ROTEM检测（“NATEM”）的结果，并为每种检测提供参考值。纳入标准为健康成年志愿者（18 - 65岁）。排除标准为任何影响凝血的疾病状况或药物。天然全血检测定义为“TRUE-NATEM检测”。对于重新钙化的枸橼酸盐血检测，在ROTEM上使用NATEM功能。TRUE-NATEM的参考值为：凝血时间（CT）：872 - 1595秒，10分钟振幅（A10）：14 - 34毫米，20分钟振幅（A20）：26 - 48毫米，凝血形成时间（CFT）：314 - 839秒，最大凝血块硬度（MCF）：34 - 55毫米，以及α角：17 - 40°。NATEM的参考值为：CT：757 - 1327秒，A10：19 - 43毫米，A20：33 - 55毫米，CFT：219 - 615秒，MCF：37 - 61毫米，α角：24 - 51°，以及溶解率（ML）：0 - 3%。将NATEM的参考值与TRUE-NATEM进行比较时，CT和CFT值降低，而MCF和α角增加。NATEM中枸橼酸盐血的重新钙化过程显示出凝血的显著激活。使用激活剂时，女性健康志愿者的凝血增强。使用激活剂时观察到与年龄相关的统计学差异。种族在ROTEM值上未显示任何差异。我们使用ROTEM®确定了天然全血和重新钙化全血的参考值。发现天然全血和重新钙化的枸橼酸盐血凝血存在显著差异。我们的研究强调了天然全血作为凝血金标准参考值的重要性。
