Advances in Viscoelastic Coagulation Monitoring

Bleeding due to maturational and acquired coagulation disorders is seen frequently in premature/critically ill neonates.Viscoelastic coagulation monitoring (VCM) has been an exciting advance in the evaluation of blood clot formation, stabilization, and dissolution.Unlike the conventional evaluation of prothrombin time/international normalized ratio and activated partial thromboplastin time that are performed on plasma and do not provide information about platelets and fibrin cross-linking, viscoelastic tests (VETs) analyze whole blood and provide a global overview of the adequacy of clotting factors, fibrinogen, platelet function, red blood cells, and fibrinolytic processes.In the past few years, several cartridge-based devices have become available that do not need controlled pipetting.One VCM utilizes a miniature sensor without any moving mechanical parts to measure clot stiffness.It analyzes the coagulation state in a whole blood sample with a low-amplitude rotational or oscillatory force in less than 1 hour; it is portable, easy to use, and the small blood volume can be obtained from a heel stick.In this brief communication, the authors report VCM findings from a 1-day-old premature infant with hypofibrinogenemia and from a 5-day-old control of comparable gestational age.The altered parameters suggested suboptimal clot strength.These newer cartridge-based methods are being continuously improved; some instruments maintain the core VET principles of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) but are being advanced with microfluidic cartridges and resonance-based detection instead of the rotating cup/pin of legacy devices, reducing sample handling and operator workload.Another ultrasound-based method measures the stiffness/shear modulus of whole blood as it clots.To reiterate, VETs can potentially improve hemostatic management, reduce unnecessary transfusions, and enhance patient outcomes.Further evaluation is definitely needed, but these tests could make a difference in the management of premature/critically ill infants.