• Anna Wieland Greguare-Sander, Walter A Wuillemin, and Michael Nagler.
• From the Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, Lucerne (AWGS, WAW), University Institute of Clinical Chemistry, Inselspital, Bern University Hospital (MN), and Department of Biomedical Research, University of Bern, Bern, Switzerland (WAW, MN).
• Eur J Anaesthesiol. 2019 Jun 1; 36 (6): 457-465.

BackgroundMajor guidelines emphasise the potential of visco-elastic methods to overcome the limitations of conventional laboratory assays in the peri-operative setting. Their sensitivity regarding mild bleeding disorders (MBDs), the most common bleeding disorders in the general population, is however unknown.ObjectiveThe aim of this study was to investigate the sensitivity of thromboelastometry for diagnosis of MBD.DesignA single-centre prospective cohort study.SettingHaematology outpatient unit of a tertiary general hospital in Central Switzerland.PatientsAll consecutive patients referred over a 32-month period with a suspected bleeding disorder were included and thromboelastometry was conducted using a ROTEM delta (EXTEM, INTEM and FIBTEM). Diagnostic work-up was performed according to current guidelines including the ISTH bleeding assessment tool (ISTH BAT).Main Outcome MeasuresDistribution of clotting time (CT) and maximum clot firmness (MCF) results in relation to the presence of MBD.ResultsTwo hundred and seventeen patients were assessed; the median [IQR] age was 39 years [28 to 57]; 151 patients were women (70%). MBD was diagnosed in 97 patients (45%), no MBD was found in 100 patients (46%) and a systemic disorder recognised in 20 patients (9%). Presence of MBD was not associated with a significant difference in thromboelastometry variables (0.2 s in CT EXTEM, 95% CI -2.3 to 2.7; -0.2 mm in MCF EXTEM, 95% CI -1.8 to 1.5; -0.7 s in CT INTEM, 95% CI -12.6 to 11.2; 0.6 mm in MCF INTEM, 95% CI -1.2 to 1.3; 0.8 mm in MCF FIBTEM, 95% CI -1.6 to 1.4) and most results were within the established reference ranges.ConclusionOur data did not support the use of thromboelastometry as a diagnostic tool in patients with MBD.

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