Abstract Number: PB0509
Meeting: ISTH 2020 Congress
Background: Hemophilia A and B are inherited bleeding disorders caused by deficiencies of factor VIII (FVIII) and IX (FIX), respectively. Hemophilia treatment is based on the prophylactic replacement of the deficient factor. The most common method used for measuring FVIII and FIX is the one-stage clotting assay (OSCA) based on the activated partial thromboplastin time (APTT). Rotational thromboelastometry (ROTEM) is an alternative to assess hemostasis in vitro. Unlike APTT, which requires trained personnel, the ROTEM sigma is a fully automated point-of-care (POC) instrument.
Aims: The main aim of this study was to assess whether deficiencies of FVIII and FIX can be detected by ROTEM sigma.
Methods: Contact activation (formerly known as intrinsic) pathway activated ROTEM (INTEM) and APTT were assessed in plasma samples with different FVIII and FIX concentrations (ranging from 0% to 50%). INTEM and OSCA (using HemosIL SynthASil) were performed on a ROTEM sigma and ACL TOP 550 instruments, respectively (Instrumentation Laboratory, Bedford, MA).
Results: For FVIII, using Spearman’s analysis, a very strong correlation was detected between results of APTT and INTEM clotting time (CT), r=0.986 (p< 0.0001). There was also a very strong correlation between APTT and INTEM CT results for FIX deficient plasma r=0.978 (p< 0.0001). Both INTEM and APTT were not sensitive for FVIII and FIX levels below 0.5%.
Conclusions: In conclusion, ROTEM sigma can be used as a POC tool to assess FVIII and FIX activity in hemophilia patients. This approach may facilitate the management of hemophilia patients in outpatient settings. Moreover, compared to conventional methodologies, ROTEM provides more information on a patient’s hemostatic status, including platelet and fibrinogen contribution to clot firmness and clot stability. Further studies are needed in hemophilia to determine the feasibility of ROTEM sigma for routine monitoring of clinical effectiveness.
To cite this abstract in AMA style:Kholmukhamedov A, Benhar B, Chea B, Al Sawad R, Schwaiger M, Bottenus R, Winkler A. Rotational Thromboelastometry – A Point of Care Tool to Assess Bleeding Risks in Hemophilia A and B [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/rotational-thromboelastometry-a-point-of-care-tool-to-assess-bleeding-risks-in-hemophilia-a-and-b/. Accessed October 2, 2023.
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