PB0603 - Beyond the Count: Revealing Platelet Dysfunction in Pediatric Trauma

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Ronit Kar, BS

Research Fellow
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Co-Author(s)

KM

Katrina Morgan

Postdoctoral Scholar
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
EF

Erin Feeney

Postdoctoral Scholar
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
JK

Jack Killinger

Research Technician
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
Devin Dishong

Research Fellow
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
Katelin C. Rahn, BS

PhD Candidate
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
GB

Grace Ballentine

Undergraduate Researcher
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgfh, Pennsylvania, United States
PS

Philip Spinella

Co-Director
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
Matthew D. Neal, MD, FACS

Vice Chair of Surgery, Academic Training; Watson Chair and Professor of Surgery
University of Pittsburgh, Pittsburgh, PA, USA
Pittsburgh, Pennsylvania, United States
BG

Barbara Gaines

Division Chief of Pediatric Surgery; Edwin Ide Smith, M.D. Distinguished Professor
Department of Surgery, UT Southwestern Medical Center
Dallas, Texas, United States
CL

Christine Leeper

Assistant Professor of Surgery and Critical Care Medicine; Associate Director
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
Susan Shea

Assistant Professor
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Background: Trauma is the leading cause of death in children, with trauma-induced coagulopathy (TIC) being a critical, yet under-explored area in pediatric care. Existing hemostatic assays are inadequate for evaluating post-traumatic platelet dysfunction in children, highlighting a significant knowledge gap in pediatric TIC management.

Aims: This study used a microfluidic thrombosis assay to understand differences in platelet adhesion and aggregation between injured and healthy pediatric patients.

Methods: We enrolled a convenience sample of 19 severely injured children after highest trauma level activation and 4 healthy controls undergoing outpatient imaging at a level one pediatric trauma center. Blood samples were collected on arrival for rapid thromboelastography (TEG), conventional coagulation tests, and a microfluidic assay involving a stenotic channel (initial shear = 3500/s) and real-time microscopy with platelet-specific fluorescent labeling (anti-CD41). Results were compared with clinical data. Microfluidic and TEG data are reported as mean±SD.

Results: The cohort was 70% male with a median (IQR) age of 6 (4-10) years-old, median (IQR) ISS of 17 (8-27.5), and 70% blunt mechanism. In total, 6/19 (31.6%) presented with shock (age-adjusted hypotension for < 4-years-old and pediatric age-adjusted shock index for >4-years-old) at arrival, and 8/19 (42.1%) required transfusions within 6 hours of admission. The 24-hour mortality rate was 2/19 (10.5%). The microfluidic assay revealed significantly lower platelet deposition in trauma patients compared to controls (1.19 ± 0.25 vs. 3. 14 ± 0.84 maximum MFI fold change; p< 0.0001). Despite this, TEG metrics appeared normal (MA = 59.5 ± 6.5 mm; R = 0.82 ± 0.84 min) as did platelet count (313 ± 105 x10^3 cells/µL).

Conclusion(s): A microfluidic assay shows functional platelet deficits in pediatric trauma patients that were not readily apparent through platelet count or conventional TEG metrics. These insights into platelet dysfunction may be crucial in refining our understanding and management of TIC in pediatric populations.