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PEDIATRIC ANESTHESIOLOGY

Reference Values for Kaolin-Activated Thromboelastography in Healthy Children

Kah-Lok Chan^*, Robyn G. Summerhayes, BSc (Hons)^*, Vera Ignjatovic, PhD^*, Stephen B. Horton, PhD, FACBS^||, and Paul T. Monagle, MD, FRACP, FRCPA, FCCP^*

From the *Department of Clinical Hematology, Royal Children’s Hospital; Department of Pathology, The University of Melbourne; Murdoch Children’s Research Institute; Cardiac Surgical Unit, Royal Children’s Hospital; and ||Department of Pediatrics, The University of Melbourne, Melbourne, Australia.

Address correspondence and reprint requests to Dr Vera Ignjatovic, PhD, Department of Pathology, The University of Melbourne, Parkville, Victoria, 3010, Australia. Address e-mail to verai{at}unimelb.edu.au.

Abstract

BACKGROUND: The hemostatic system of children changes with age and differs significantly from the hemostatic system of adults. Age-specific reference values are therefore required for most hemostatic variables. Thromboelastography (TEG®) is a point-of-care coagulation test that may provide superior evaluation and management of coagulopathies after cardiac surgery, when large-dose unfractionated heparin is administered for cardiopulmonary bypass. In this study, we established reference values for kaolin-activated TEG in healthy children, to facilitate accurate interpretation of pediatric TEG results.

METHODS: Kaolin-activated TEG was performed on 100 healthy children undergoing elective day surgery and 25 healthy adult volunteers. The following TEG variables were recorded: reaction time, coagulation time, angle, maximum amplitude, percentage lysis 30 min after maximum amplitude was reached, and the coagulation index. Differences between age-groups were evaluated using analysis of variance.

RESULTS: Age-specific reference values for kaolin-activated TEG in healthy children between 1 mo and 16 yr of age are presented. No significant differences between children and adults were observed.

CONCLUSIONS: TEG results, from a particular clinical setting, must be compared to age-specific, as well as analyzer- and activator-specific, reference values to allow for correct interpretation of the results. Reference values provided here will be of use in acute clinical situations where a practical monitor of hemostasis is required.

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