PB0615 - Racial and age-specific differences in Rotational Thromboelastometry (ROTEM) and conventional coagulation laboratory tests in a healthy pediatric population

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Marium Malik, MD

Attending Physician
Cleveland Clinic Children's, Cleveland, Ohio
Cleveland, Ohio, United States

Co-Author(s)

MA

Maha Al-Ghafry

Attending Physician
Johns Hopkins All Children’s Hospital, St Petersburg, Florida
St Petersburg, Florida, United States
ML

Maribel Lema

Resident
Cohen Childrens Medical Center, Northwell Health, Queens, NY
New York, New York, United States
VN

Vijay Nandi

Head, Laboratory of Data Analytic Services
New York Blood Center
New York, New York, United States
Vera Ignjatovic, PhD, MBA

Professor of Pediatrics
Johns Hopkins All Children's Institute for Clinical and Translational Research; Department of Pediatrics, School of Medicine, Johns Hopkins University, United States
St Petersburg, Florida, United States
SA

Suchitra Acharya

Attending Physician
Cohen Children’s Medical Center, Northwell Health, Queens, New York
New York, New York, United States

Background: ROTEM is a whole blood viscoelastic analyzer providing a global assessment from clot initiation to lysis. Reference Intervals (RI) for such specialized testing are limited in pediatric patients and have not accounted for potential variations with race, which may affect diagnosis and management in patients with concern for bleeding and clotting diathesis. Prior studies have shown that adult Black/African American race tend to have higher levels of procoagulant proteins.

Aims: To investigate the relationship of race and age on ROTEM and conventional coagulation laboratory tests.

Methods: Prospective data from 105 racially diverse, healthy pediatric population at a children’s hospital (ages 1-21 years) was included. Consent/assent and self-identified race data was collected. Median with 2.5%ile and 97.5%ile was generated for ROTEM and conventional coagulation tests (PT, aPTT , fibrinogen, platelet count, FXIII antigen/activity) with p-value set at < 0.001. Fisher's Exact test and ANOVA were implemented to examine sex and age associations with race. Linear regression models were generated to assess age and ROTEM/coagulation laboratory values, in aggregate and stratified by race.

Results: One hundred and five study participants self-identified as: 38.1 % Black/African American (B/AA) (n =40), 21.9% Asian (n=23), 15.2% White (n=16), 24.8% Other (n=26). A positive association of age with FIBTEM A10 (R2=0.154, p=0.0001) and MCF (R2=0.157, p=0.0001) was noted. Fibrinogen levels increased with age (R2=0.189, p< 0.0001). In subset analyses, age was negatively associated with EXTEM CFT and positively associated with EXTEM/INTEM A10 and MCF for B/AA (Fig. 1). Only B/AA race exhibited positive associations between age and FIBTEM A10 and MCF (Fig. 2).

Conclusion(s): This is the first study showcasing racially based differences for a major laboratory test (fibrinogen), and a key ROTEM parameter (FIBTEM). Establishing race specific RI can have significant clinical and public health implications for more accurate diagnosis and tailored treatment, overall improving quality of patient care.