Etheresia Pretorius1, Albe C Swanepoel2, Sulette DeVilliers3, Janette Bester3. 1. Department of Physiological Sciences, Stellenbosch University, 7602, South Africa. Electronic address: resiap@sun.ac.za. 2. Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia 0007, South Africa. Electronic address: Albe.swanepoel@up.ac.za. 3. Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia 0007, South Africa.
Abstract
BACKGROUND: Clotting parameters are informative of overall haematological healthiness of an individual. Particularly, clotting parameters can be used as a measure of the degree of pathology of the coagulation system. Thromboelastography (TEG) is a well-known technique that is an important point-of-care method, as well as research method. Scanning electron microscopy (SEM) is a novel research method, but with possible clinical application. However, there are no clear standardized guidelines for TEG and SEM result interpretation. MATERIALS AND METHODS: We have an extensive database of results from TEG of hypercoagulable, hypocoagulable and healthy whole blood (WB) and platelet poor plasma (PPP). These results were generated using citrated PPP or WB, followed by the addition of CaCl2, to initiate clot formation. We also have an extensive and comprehensive database of thousands of clot micrographs, prepared for SEM. We reanalysed all our data to compile a user-friendly guideline for TEG and SEM. We also discuss the effects of different storage times on both WB and PPP. RESULTS: We provide a quick and informative guide that discusses each TEG parameter, in both WB and PPP. Increases or decreases in the various parameters are indicative of either hyper- or hypocoagulability. We also show how hypo- and hypercoagulable clots look like, compared with healthy clots, using SEM analysis of clots created by adding thrombin to PPP. CONCLUSION: For optimal and speedy interpretation of a patient's coagulation status, it is essential for the clinician to make an informed and precise decision regarding clotting propensity. We believe this guideline will add to the standardization of TEG parameters, and ultimately contribute to the treatment of patients. These guidelines will also allow researchers to standardize their data interpretations and ultimately allow for the use of a global and inclusive database that might be included in precision medicine approaches.
BACKGROUND: Clotting parameters are informative of overall haematological healthiness of an individual. Particularly, clotting parameters can be used as a measure of the degree of pathology of the coagulation system. Thromboelastography (TEG) is a well-known technique that is an important point-of-care method, as well as research method. Scanning electron microscopy (SEM) is a novel research method, but with possible clinical application. However, there are no clear standardized guidelines for TEG and SEM result interpretation. MATERIALS AND METHODS: We have an extensive database of results from TEG of hypercoagulable, hypocoagulable and healthy whole blood (WB) and platelet poor plasma (PPP). These results were generated using citrated PPP or WB, followed by the addition of CaCl2, to initiate clot formation. We also have an extensive and comprehensive database of thousands of clot micrographs, prepared for SEM. We reanalysed all our data to compile a user-friendly guideline for TEG and SEM. We also discuss the effects of different storage times on both WB and PPP. RESULTS: We provide a quick and informative guide that discusses each TEG parameter, in both WB and PPP. Increases or decreases in the various parameters are indicative of either hyper- or hypocoagulability. We also show how hypo- and hypercoagulable clots look like, compared with healthy clots, using SEM analysis of clots created by adding thrombin to PPP. CONCLUSION: For optimal and speedy interpretation of a patient's coagulation status, it is essential for the clinician to make an informed and precise decision regarding clotting propensity. We believe this guideline will add to the standardization of TEG parameters, and ultimately contribute to the treatment of patients. These guidelines will also allow researchers to standardize their data interpretations and ultimately allow for the use of a global and inclusive database that might be included in precision medicine approaches.
Authors: Etheresia Pretorius; Martin J Page; Lisa Hendricks; Nondumiso B Nkosi; Sven R Benson; Douglas B Kell Journal: J R Soc Interface Date: 2018-02 Impact factor: 4.118
Authors: Greta M de Waal; Willem J S de Villiers; Timothy Forgan; Timothy Roberts; Etheresia Pretorius Journal: Sci Rep Date: 2020-05-29 Impact factor: 4.379
Authors: Johannes A Bezuidenhout; Chantelle Venter; Timothy J Roberts; Gareth Tarr; Douglas B Kell; Etheresia Pretorius Journal: Front Immunol Date: 2020-12-04 Impact factor: 7.561
Authors: Philip C Spinella; Kimberly A Thomas; Isaiah R Turnbull; Anja Fuchs; Kelly Bochicchio; Douglas Schuerer; Stacey Reese; Adrian A Coleoglou Centeno; Christopher B Horn; Jack Baty; Susan M Shea; M Adam Meledeo; Anthony E Pusateri; Jerrold H Levy; Andrew P Cap; Grant V Bochicchio Journal: Front Immunol Date: 2020-09-08 Impact factor: 7.561