Thromboelastography assists in the diagnosis of "hematuria in children"

01

foreword

Thrombelastography is a coagulation response based on a whole blood model, which can comprehensively reflect the interaction of coagulation factors, fibrinogen and platelet.

02

case after

A 10-year-old child, female, was admitted to the hospital due to the chief complaint of "low back pain for 5 days.

On admission, the relevant tests and examinations were complete.

Table 1 Changes in indicators of children

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The doctor reported the critical value by telephone and communicated with the clini.

In order to exclude abnormal results caused by factors such as unsatisfactory specimen collection, it is recommended to re-collect venous blood for re-examination immediatel.

However, the department currently does not carry out the detection of coagulation factor items, and it takes a long time to submit the third-party inspection for inspectio.

We thought of thromboelastography, and the parameter R of thromboelastography could reflect the activity level of coagulation factors in this patien.

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Figure 1 Thromboelastometry in children - general test

Telephone communication with the doctor in charge, according to the information of HAEMONETICS company and related literature reports on children [2], it is clear that the activity of coagulation factors in children is low, and it is recommended to immediately supplement fresh frozen plasma and vitamin K to improve the factor deficiency stat.

The child received fresh frozen plasma 200ml and intramuscular injection of 10mg vitamin K on the same day, and the four coagulation items were rechecked on the second da.

The child continued to infuse fresh frozen plasma 200ml and 10mg vitamin .

03

case analysis

The coagulation results submitted by the patient showed no coagulation in PT and APTT, while FIB and TT were norma.

Pre-examination factors such as unsmooth specimen collection, incorrect collection sequence, venous indwelling catheter instead of venipuncture, and untimely submission for examination, et.

In this case, when the full set of coagulation factors could not be detected immediately, thromboelastography was used instea.

The child in this case had clinical bleeding manifestations such as oozing blood at the puncture site and hematuria; the coagulation results showed no agglutination in PT and APTT, while FIB and TT were normal; the clinical application of vitamin K was effective; there was no history of childhood bleeding and family bleeding disorders According to the diagnostic criteria[3], it is highly suspected that the child has acquired vitamin K-dependent coagulation factor deficiency; the most common cause is the misuse of the second-generation dicoumarin rodenticide, or the contamination of the environment due to rat poiso.

04

Summarize

Modern hemostasis theory has clarified the importance of platelets that provide phospholipid surfaces and endothelial cells as a platform for the synthesis/degradation of coagulation factor.

Thrombelastography provides quantitative parameters that can simultaneously reflect primary and secondary hemostasis and fibrinolysis status by detecting whole blood samples in vitro, and can comprehensively evaluate coagulation functio.

05

Expert Reviews

This case reminds us that in addition to clinical manifestations and medical history, laboratory tests are particularly important for the diagnosis of children with bleeding symptoms such as hematuri.
This case benefited from the combined use of routine screening of coagulation function and thromboelastography to quickly identify the cause of abnormal coagulation, allowing the child to receive timely and effective symptomatic treatmen.
At the same time, for abnormal test results, we must cultivate our own clinical thinking and help clinical problem-solvin.

(Review expert: He Baoming, Chief Technician, Director of Laboratory Department of Hanzhong Central Hospital)

references

[1] Special Committee on Thrombosis and Hemostasis of Chinese Research Hospital Associatio.
Chinese Expert Consensus on Operation Procedure and Interpretation of Results of Activated Partial Thromboplastin Time Prolonged Mixed Plasma Correction Test [J.
Chinese Journal of Laboratory Medicine, 2021, 44(8):

[2] KANE, LAUREN C, WOODWARD, et a.
Thromboelastography-does it impact bloodcomponent transfusion in pediatric heart surgery? [J.
Journal of Surgical Research, 2016, 200(1): 21-

[3] Yin Jie, Wang Zhaoyu.
The clinical significance of vitamin K-dependent coagulation factors [J.
Journal of Clinical Internal Medicine, 2020, 37(1):