Ann Lab Med 2017; 37(6): 484-493  
Benefits of Thromboelastography and Thrombin Generation Assay for Bleeding Prediction in Patients With Thrombocytopenia or Hematologic Malignancies
Seon Young Kim, M.D.1,*, Ja Yoon Gu, B.S.1,2, Hyun Ju Yoo, M.S.1,2, Ji-Eun Kim, Ph.D.1,2, Seonpyo Jang, M.D.3, Sooyeon Choe, M.D.3, Youngil Koh, M.D.3, Inho Kim, M.D.3, and Hyun Kyung Kim, M.D.1,2
Departments of Laboratory Medicine1 and Internal Medicine3, Seoul National University College of Medicine, Seoul; Cancer Research Institute2, Seoul National University College of Medicine, Seoul, Korea
Correspondence to: Hyun Kyung Kim
Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
Tel: +82-2-2072-0853 Fax: +82-2-747-0359 E-mail: lukekhk@snu.ac.kr
Co-corresponding author: Inho Kim
Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehang-ro, Jongno-gu, Seoul 03080, Korea
Tel: +82-2-2072-0834 Fax: +82-2-764-2199 E-mail: kim_dajung@hanmail.net
*The current affiliation of Seon Young Kim is the Department of Laboratory Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
Received: January 3, 2017; Revised: March 2, 2017; Accepted: July 10, 2017; Published online: November 1, 2017.
© The Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Thromboelastography (TEG) provides comprehensive information on the whole blood clot formation phases, whereas thrombin generation assay (TGA) reveals the endogenous thrombin levels in plasma. We investigated the potential significance of TEG and TGA parameters for prediction of clinical bleeding in hematologic patients on the basis of the patient’s platelet levels.
Methods: TEG and TGA were performed in 126 patients with thrombocytopenia or hematologic malignancies. The bleeding tendencies were stratified on the basis of the World Health Organization bleeding grade.
Results: Maximum amplitude (MA) and clot formation in TEG and endogenous thrombin potential (ETP) in TGA showed significant associations with high bleeding grades (P=0.001 and P=0.011, respectively). In patients with platelet counts ≤10×109/L, low MA values were strongly associated with a high bleeding risk. For bleeding prediction, the area under the curve (AUC) of MA (0.857) and ETP (0.809) in patients with severe thrombocytopenia tended to be higher than that of platelets (0.740) in all patients. Patients with platelet counts ≤10×109/L displayed the highest AUC of the combined MA and ETP (0.929).
Conclusions: Both TEG and TGA were considered to be good predictors of clinical bleeding in patients with severe thrombocytopenia. Combination of the ETP and MA values resulted in a more sensitive bleeding risk prediction in those with severe thrombocytopenia.
Keywords: Thromboelastography, Thrombin generation assay, Bleeding risk, Platelet count, Hematologic malignancy


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