A Case Series of Thromboelastography (TEG) to Describe Patterns of Uremic Thrombocytopathy in Pediatric Kidney Dysfunction

Introduction: Renal azotemia can contribute to platelet dysfunction and subsequent bleeding risk. Thromboelastography (TEG) is commonly used to evaluate bleeding risk in patients with liver pathology and trauma, however, TEGs role in kidney dysfunction is unclear. We report TEG results in a case series of children with kidney dysfunction and describe TEG changes after dialysis. Case Description: TEGs were collected from 8 patients (10 TEG samples). Ages ranged from 15 days to 18 years old, 3 had AKI and 5 had ESKD. All had urea (BUN) ≥50 mg/dL at first TEG sample. We found no significant relationship between BUN and markers of platelet inhibition (adenosine diphosphate, ADP% inhibition) nor clotting strength (maximum amplitude, MA) (Fig 1). In 2 patients with pre/post hemodialysis (HD) TEGs, we saw an increase in inhibition and decrease in clot strength after dialysis (Fig 2). This paradoxical increase in clot inhibition and decrease in clot strength is of unclear etiology but may represent correction of a previously hypercoagulable state. Discussion: The absence of an identifiable relationship between urea and ADP% inhibition/MA in this case series may be secondary to the heterogeneity of the cohort (age, underlying disease process, azotemia duration). The paradox of increased clot inhibition and decreased clot strength with urea reduction may relate to decreased fibrinogen/vonWillebrand factor due to dialysis. Our case series is in accord with existing literature, which suggests TEG may have limited use in diagnosing uremic platelet dysfunction. Future longitudinal studies may clarify the utility of TEG to create hemostatic profiles for patients with kidney dysfunction.