Fresh and citrated whole-blood specimens can produce different thromboelastography results in patients on extracorporeal membrane oxygenation.

Am J Clin Pathol 2013 Aug;140(2):165-9

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.

Objectives: To compare thromboelastography (TEG) tracings obtained from fresh and citrated whole-blood samples in patients on extracorporeal membrane oxygenation (ECMO) or after cardiopulmonary bypass and in healthy volunteers.

Methods: Samples of fresh and citrated whole blood were analyzed for 25 patients and 4 healthy volunteers. Thromboelastography analysis was performed in both plain and heparinase cups.

Results: In 5 of 6 patients on ECMO, use of citrated samples resulted in apparent partial or complete heparin reversal. In TEG tracings from patients following cardiopulmonary bypass, there was a slight hypercoagulable appearance in the citrated sample. No differences were noted between fresh and citrated samples from healthy volunteers whose blood was spiked with heparin.

Conclusions: In some patients on ECMO, use of samples collected in sodium citrate tubes for TEG analysis results in significant artifacts, which could lead to heparin overdosing in these patients.

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http://dx.doi.org/10.1309/AJCPYIQ9JNNSEN4QDOI Listing
August 2013
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References

(Supplied by CrossRef)
Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery
Shore-Lesserson et al.
Anesth Analg 1999
Citrate storage affects thrombelastograph analysis
Camenzind et al.
Anesthesiology 2000
Thromboelastography: a reliable test?
Vig et al.
Blood Coagul Fibrinolysis 2001
Artifact hyperfibrinolysis in thromboelastography with the use of a heparinase cup
Moreland et al.
Arch Pathol Lab Med 2010

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