• J Pekelharing, A Furck, W Banya, D Macrae, and S J Davidson.
• Department of Paediatric Cardiac Intensive Care, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK.
• Int J Lab Hematol. 2014 Aug 1;36(4):465-71.

IntroductionFollowing paediatric cardiac surgery using cardiopulmonary bypass (CPB), there is a risk of significant postoperative bleeding. A number of risk factors are associated with postoperative bleeding including; age, complexity of the surgery, dilution and consumption of clotting factors. We conducted a prospective audit comparing different coagulation tests used following paediatric CPB to determine whether thromboelastography (TEG) on the intensive care unit or routine laboratory coagulation assays including fibrinogen are better at assessing bleeding and bleeding risk.MethodsTests on arrival in paediatric intensive care unit (PICU) included the following: fibrinogen, prothrombin time, activated partial thromboplastin time, full blood count and TEG. Bleeding was measured in the first 1-4 h via chest drain loss. Bleeding was considered significant if ≥5 ml/kg/h.ResultsOf 107 patients admitted to PICU, 23/107 were considered to be bleeding during the first hour. Fibrinogen concentration had the best correlation with the amount of first-hour blood loss (r(s) = 0.52), followed by APTT (r(s) = 0.44) and TEG MA (r(s) = 0.34). TEG parameter TEG MA correlated with platelet count (r(s) = 0.68) and fibrinogen (r(s) = 0.66).ConclusionsThromboelastography did not show better correlation with postoperative bleeding than conventional clotting tests. TEG parameter maximum amplitude correlates with platelet count and fibrinogen.© 2013 John Wiley & Sons Ltd.

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