Ann Lab Med 2017; 37(3): 204-212  https://doi.org/10.3343/alm.2017.37.3.204
Thromboelastographic Evaluation of Coagulation in Patients With Liver Disease
Kyung-Hwa Shin, M.D.1, In-Suk Kim, M.D.2, Hyun Ji Lee, M.D.2, Hyung-Hoi Kim, M.D.1, Chulhun L. Chang, M.D.2, Young Mi Hong, M.D.3, Ki Tae Yoon, M.D.3, and Mong Cho, M.D.3
Department of Laboratory Medicine1, Pusan National University School of Medicine and Biomedical Research Institute Research Institute, Pusan National University Hospital, Busan; Department of Laboratory Medicine2, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan; Department of Internal Medicine3, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
Correspondence to: In-Suk Kim
Department of Laboratory Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Beomeo-ri, Mulgeum-eup, Yangsan 50612, Korea
Tel: +82-55-360-1878
Fax: +82-55-360-1880
E-mail: iskim0710@gmail.com
Received: May 31, 2016; Revised: September 14, 2016; Accepted: January 23, 2017; Published online: May 1, 2017.
© The Korean Society for Laboratory Medicine. All rights reserved.

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Abstract
Background: The aims of this study were to investigate the parameters of thromboelastography (TEG) for evaluating coagulopathy and to reveal an association with disease severity and/or transfusion requirement in patients with chronic liver disease (CLD) in a clinical laboratory setting.
Methods: We enrolled two groups of adult patients with cirrhotic (N=123) and non-cirrhotic liver disease (N=52), as well as 84 healthy controls. Reaction time (R), kinetic time (K), α-angle (α), maximal amplitude (MA), and coagulation index (CI) were measured with kaolin-activated citrated blood with the TEG 5000 system (Haemonetics Corporation, USA). Platelet count, prothrombin time international normalized ratio (PT INR), albumin, bilirubin, and creatinine were simultaneously measured. The CLD severity was calculated by using the Child-Pugh (C-P) and Model for End-stage Liver Disease (MELD) scores. Transfusion history was also reviewed.
Results: All TEG parameters, PT INR, and platelet count in the cirrhotic group showed significant differences from those in other groups. At least one or more abnormal TEG parameters were identified in 17.3% and 44.7% of patients in the non-cirrhotic and cirrhotic group, respectively. Patients with cirrhotic disease had hypocoagulability. A weak correlation between R and PT INR (r=0.173) was noted. The TEG parameters could not predict CLD severity using the C-P and MELD scores. Patients with normal TEG parameters did not receive transfusion.
Conclusions: Clinical application of TEG measurements in CLD can be informative for investigating coagulopathy or predicting the risk of bleeding. Further studies are warranted.
Keywords: Thromboelastography, Coagulation, Transfusion, Liver disease


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