Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 1;8(2):102362.
doi: 10.1016/j.rpth.2024.102362. eCollection 2024 Feb.

Fibrinogen contribution to clot strength in patients with sepsis and hematologic malignancies and thrombocytopenia-a prospective, single-center, analytical, cross-sectional study

Tomaz Crochemore  1   2   3 , Ecaterina Scarlatescu  4 , Klaus Görlinger  5   6 , Marcia Del Piccolo Rocha  2 , João Carlos de Campos Guerra  7   8 , Dirceu Hamilton Cordeiro Campêlo  8 , Valdir Fernandes de Aranda  7 , Lucélia Ricardi  7 , Glaucia Santana Gomes  7 , Raquel Alves de Moura  7 , Fernanda Ferraz Assir  9 , Gabriela Rodrigues Rocco de Sá  8 , Marcus D Lance  10 , Nelson Hamerschlak  8
Affiliations

Fibrinogen contribution to clot strength in patients with sepsis and hematologic malignancies and thrombocytopenia-a prospective, single-center, analytical, cross-sectional study

Tomaz Crochemore et al. Res Pract Thromb Haemost. .

Abstract

Background: Patients with hematological malignancies (HM) frequently present thrombocytopenia and higher risk of bleeding. Although transfusion is associated with higher risk of adverse events and poor outcomes, prophylactic transfusion of platelets is a common practice to prevent hemorrhagic complications. Thromboelastometry has been considered a better predictor for bleeding than isolated platelet counts in different settings. In early stages of sepsis, hypercoagulability may occur due to higher fibrinogen levels.

Objectives: To evaluate the behavior of coagulation in patients with HM who develop sepsis and to verify whether a higher concentration of fibrinogen is associated with a proportional increase in maximum clot firmness (MCF) even in the presence of severe thrombocytopenia.

Methods: We performed a unicentric analytical cross-sectional study with 60 adult patients with HM and severe thrombocytopenia, of whom 30 had sepsis (sepsis group) and 30 had no infections (control group). Coagulation conventional tests and specific coagulation tests, including thromboelastometry, were performed. The main outcome evaluated was MCF.

Results: Higher levels of fibrinogen and MCF were found in sepsis group. Both fibrinogen and platelets contributed to MCF. The relative contribution of fibrin was significantly higher (60.5 ± 12.8% vs 43.6 ± 9.7%; P < .001) and that of platelets was significantly lower (39.5 ± 12.8% vs 56.4 ± 9.7%; P < .001) in the sepsis group compared with the control group.

Conclusion: Patients with sepsis and HM presented higher concentrations of fibrinogen than uninfected patients, resulting in greater MCF amplitudes even in the presence of thrombocytopenia.

Keywords: hematological malignancies; platelet transfusion; sepsis; thrombocytopenia; thromboelastometry.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study flowchart. HM, hematological malignancies; ICU, intensive care unit; CCT, conventional coagulation tests; TEM, thromboelastometry; TGA, thrombin generation assay.
Figure 2
Figure 2
Representation of rotational thromboelastometry (ROTEM) tracing (TEMogram). A(x), amplitude in the variable time (x); CFT, clotting formation time; CT, clotting time; LI30, maximum lysis in 30 minutes; MCF, maximum clot firmness; ML, maximum lysis.
See this image and copyright information in PMC

References

    1. Shaw J.L., Nielson C.M., Park J.K., Marongiu A., Soff G.A. The incidence of thrombocytopenia in adult patients receiving chemotherapy for solid tumors or hematologic malignancies. Eur J Haematol. 2021;106:662–672. - PMC - PubMed
    1. Vinholt P.J. The role of platelets in bleeding in patients with thrombocytopenia and hematological disease. Clin Chem Lab Med. 2019;57:1808–1817. - PubMed
    1. Levy J.H., Neal M.D., Herman J.H. Bacterial contamination of platelets for transfusion: strategies for prevention. Crit Care. 2018;22:271. doi: 10.1186/s13054-018-2212-9. - DOI - PMC - PubMed
    1. Blajchman M.A., Goldman M. Bacterial contamination of platelet concentrates: incidence, significance, and prevention. Semin Hematol. 2001;38:20–26. - PubMed
    1. Mathai J. Problem of bacterial contamination in platelet concentrates. Transfus Apher Sci. 2009;41:139–144. - PubMed

LinkOut - more resources