Abstract：
Viscoelastic testing has been used in adult hematologic malignancies in conjunction with conventional coagulation tests (CCTs) to predict coagulopathies and tailor blood product replacement. However, there is a paucity of similar pediatric studies.
Analyze and correlate leukemia-associated coagulopathy in newly diagnosed pediatric leukemia patients using CCT\'s and Rotational Thromboelastometry (ROTEM).
Pediatric patients with newly diagnosed acute leukemia underwent testing with ROTEM and CCTs on days 0, 15 and 29 of induction chemotherapy.
Sixty-two patients were enrolled. At presentation, 54.8 % of patients had platelets <50 K/μL, 73 % had prolonged PT, 1.6 % had fibrinogen <150 mg/dL. Fifteen patients (24.2 %) had WHO grade 1 bleeding and two patients (3 %) had WHO grade 4 bleeding. EXTEM/INTEM values at presentation (day 0) reflected hypocoagulability, however FIBTEM revealed hypercoagulability. Patients showed a progressive hypocoagulability in all ROTEM assays by day 15 (day 0 vs day 15, p < 0.001), with improvement by day 29 (day 15 vs day 29, p < 0.001). Day 0 ROTEM parameters were comparable to day 29. Fibrinogen strongly correlated with ROTEM at all three time points (p < 0.0001), along with platelet count with moderate correlations (p < 0.001).
Fibrinogen and platelets appear to be the drivers of leukemia associated coagulopathy in the pediatric population, suggesting the utility of using CCTs and ROTEM in this population to better evaluate hemostatic function and guide blood product replacement.
Analyze and correlate leukemia-associated coagulopathy in newly diagnosed pediatric leukemia patients using CCT\'s and Rotational Thromboelastometry (ROTEM).
Pediatric patients with newly diagnosed acute leukemia underwent testing with ROTEM and CCTs on days 0, 15 and 29 of induction chemotherapy.
Sixty-two patients were enrolled. At presentation, 54.8 % of patients had platelets <50 K/μL, 73 % had prolonged PT, 1.6 % had fibrinogen <150 mg/dL. Fifteen patients (24.2 %) had WHO grade 1 bleeding and two patients (3 %) had WHO grade 4 bleeding. EXTEM/INTEM values at presentation (day 0) reflected hypocoagulability, however FIBTEM revealed hypercoagulability. Patients showed a progressive hypocoagulability in all ROTEM assays by day 15 (day 0 vs day 15, p < 0.001), with improvement by day 29 (day 15 vs day 29, p < 0.001). Day 0 ROTEM parameters were comparable to day 29. Fibrinogen strongly correlated with ROTEM at all three time points (p < 0.0001), along with platelet count with moderate correlations (p < 0.001).
Fibrinogen and platelets appear to be the drivers of leukemia associated coagulopathy in the pediatric population, suggesting the utility of using CCTs and ROTEM in this population to better evaluate hemostatic function and guide blood product replacement.
摘要：
背景：粘弹性测试已与常规凝血测试（CCT）结合用于成人血液系统恶性肿瘤，以预测凝血病并定制血液制品替代。然而,类似的儿科研究很少。
目的：使用CCT和旋转血栓弹力图（ROTEM）分析新诊断的小儿白血病患者的白血病相关性凝血病。
方法：初诊急性白血病患儿在诱导化疗第0、15和29天接受ROTEM和CCT检测。
结果：纳入62例患者。在介绍时,54.8%的患者血小板<50K/μL,73%的人PT延长，1.6%的纤维蛋白原<150mg/dL。15例患者（24.2%）发生WHO1级出血，2例患者（3%）发生WHO4级出血。演示时（第0天）的EXTEM/INTEM值反映了低凝状态，然而FIBTEM显示高凝状态。到第15天，患者在所有ROTEM分析中表现出进行性低凝状态（第0天与第15天，p<0.001），到第29天改善（第15天vs第29天，p<0.001）。第0天ROTEM参数与第29天相当。在所有三个时间点，纤维蛋白原与ROTEM强烈相关（p<0.0001），与血小板计数呈中等相关性(p<0.001)。
结论：纤维蛋白原和血小板似乎是小儿白血病相关凝血病的驱动因素，建议在该人群中使用CCT和ROTEM来更好地评估止血功能并指导血液制品替代。
目的：使用CCT和旋转血栓弹力图（ROTEM）分析新诊断的小儿白血病患者的白血病相关性凝血病。
方法：初诊急性白血病患儿在诱导化疗第0、15和29天接受ROTEM和CCT检测。
结果：纳入62例患者。在介绍时,54.8%的患者血小板<50K/μL,73%的人PT延长，1.6%的纤维蛋白原<150mg/dL。15例患者（24.2%）发生WHO1级出血，2例患者（3%）发生WHO4级出血。演示时（第0天）的EXTEM/INTEM值反映了低凝状态，然而FIBTEM显示高凝状态。到第15天，患者在所有ROTEM分析中表现出进行性低凝状态（第0天与第15天，p<0.001），到第29天改善（第15天vs第29天，p<0.001）。第0天ROTEM参数与第29天相当。在所有三个时间点，纤维蛋白原与ROTEM强烈相关（p<0.0001），与血小板计数呈中等相关性(p<0.001)。
结论：纤维蛋白原和血小板似乎是小儿白血病相关凝血病的驱动因素，建议在该人群中使用CCT和ROTEM来更好地评估止血功能并指导血液制品替代。
