PB0157 - Viscoelastic tests as screening in congenital hemorrhagic disease, cases report. Instituto Nacional de Pediatria, Mexico City, Mexico

Background: The diagnosis of hemorrhagic disease in pediatric patients can be a challenge, viscoelastic tests, although still not standardized as screening for hemorrhagic disease, can be a useful diagnostic tool in patients with thrombocytopathies, even von Willebrand Disease (vWD).

Aims: Using Viscoelastic Tests as a Screening Tool in Patients With Hemorrhagic Disease

Methods: We describe two cases

Results: A 1-year-old male suffered tongue trauma secondary to shrimp ingestion, presented a purplish coloration on the tongue with an increase in size, and volume, referring pain. The dentist punctured his tongue causing a lingual hematoma, he was referred to ER.
PT 13’’ APTT 37’’ Fib 237 ROTEM: FIBTEM CT 66ses A5 10 mm EXTEM normal vWF Ag 49 vWfAct 45
CD41 100% CD61 100% CD42 100%
Diagnosis vWD 1

A 7-year-old male was referred to ER, epistaxis, required a transfusion of erythrocyte concentrate.
The ROTEM in FIBTEM with CT in 70 sec, A5 12mm, EXTEM A5 18mm CFT of 369 sec
TP 13’’ APTT 29’’ INR 1.48 FIB 340, Platelet glycoproteins CD41 0% CD61 0% CD42 100%
Hb 10.6, Hto 33%, leukocytes 8,100, neutrophils 3,600, lymphocytes 42%, monocytes 12%, platelets 300,000. VCM 75 CMHB 23 CCMHB 31 RDW 30.
Diagnosis Glanzmann's thrombasthenia

Conclusion(s): Although viscoelastic tests are not yet standardized in the study of patients with congenital hemorrhagic disease, we can rely on them in the pediatric age, being a test that requires a small amount of blood, with immediate results that can make us suspect a platelet phase pathology. Undoubtedly, more evidence is needed to support its use and usefulness, ROTEM with EXTEM and FIBTEM being an approach, the description suggests that A5 in EXTEM, FIBTEM could be a tool in the thrombocytopathy diagnosis, there is some literature that the useful in INTEM in the diagnosis of vWD, further studies are need to confirm this.