Highlights
- •Transfusion dependent thalassemia patients have a hypercoagulable status compared to age matched reference range.
- •Annual blood transfusion requirement was found to have a negative correlation with the hypercoagulable status.
- •Screening thalassemia patients with TEG may help to identify high risk thrombotic group.
Abstract
Background
Thromboembolic events are rare but one of the fatal complications in thalassemia.
Assessment of the hypercoagulable state is not done regularly, and we have assessed
the utility of Thromboelastography (TEG) for monitoring the activation of the coagulation
pathway in patients with thalassemia.
Methodology
A prospective single-center cohort study was conducted in a tertiary care set-up.
Transfusion Dependent Thalassemia patients registered with the pediatric unit were
screened for hypercoagulability using TEG during six months of the study period and
followed up for three years for the development of thromboembolic events. Patient
demographics, history of splenectomy, Serum ferritin levels and annual red cell transfusion
requirement (mL/kg/year) were assessed. TEG parameters used were R time, K time, alpha
angle, Maximum amplitude, Clot index, and Lysis 30. The thrombin generation test (V
Curve) obtained from the first-degree derivate of the TEG velocity curve was also
used for analysis.
Results
A total of 34 patients were recruited during the six months study period with an average
age of 10.6 years ( ± 5.47). The average pre-transfusion hemoglobin level and the
volume of packed red cells received were 7.24 g/dL and 152.82 mL/kg/year respectively.
The TEG tracing was suggestive of a hypercoagulable state in 58.82% of patients. The
mean values of angle (70.74), MA (64.16), CI (2.65) and TG (774.43) in TDT patients
compared to age matched reference range (62.81, 57.99, 0.8, 577.83 respectively) was
suggestive of prothrombotic changes. Annual blood transfusion requirement was negatively
correlated with hypercoagulable status (‐0.344, CI= -0.68 to 0.08). One out of 34
patients developed corona radiata infarct (with annual blood requirement; 112.7 mL/kg/Year).
The risk to develop a hypercoagulable state appeared to be higher when the volume
of RBCs transfused was less than 154 mL/kg/Year.
Conclusion
TDT patients are at risk of developing thromboembolism, and screening with TEG may
be useful to identify those at high risk.
Keywords
Abbreviations:
TEG (Thromboelastography), TDT (Transfusion Dependent Thalasemia), NTDT (Non Transfusion Dependent Thalassemia), TE (Thromboembolic Events), TM (Thalassemia Major), TI (Thalassemia Intermedia), MA (Maximum Amplitude), CI (Clot Index), MRTG (Maximum Rate of Thrombus Generation), TMRTG (Time to Maximum Rate of Thrombus Generation), TG (Thrombus Generated)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 18, 2022
Accepted:
October 14,
2022
Received in revised form:
October 10,
2022
Received:
April 4,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
