Utility of thromboelastography versus routine coagulation tests for assessment of hypocoagulable state in patients undergoing cardiac bypass surgery

Introduction: Peri-operative monitoring of coagulation is important to diagnose potential cause of hemorrhage, to manage coagulopathy and guide treatment with blood products in patients undergoing cardiac surgery with cardiopulmonary bypass. This study was done to evaluate usefulness of Thromboelastography (TEG) and routine coagulation tests (RCT) in assessing hemostatic changes and predicting postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: Fifty adult patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled in this prospective study. Preoperative and post-operative samples were collected for routine coagulation tests and TEG. Regression analysis and test of significance using Pearson's correlation coefficient was performed to assess correlation between routine coagulation tests and corresponding TEG parameters .Regression analysis was done to study relation between blood loss at 24 hours and various coagulation parameters. Results: The Routine coagulation test i.e. PT, INR, APTT showed no significant correlation with corresponding TEG parameters in pre-operative samples. However platelet count significantly correlated (p = 0.004) with MA values in postoperative samples. A significant correlation (p = 0.001) was seen between fibrinogen levels and alpha angles as well as with MA in both baseline preoperative and postoperative samples. TEG parameters R time and MA in postoperative samples were the only parameters that predicted bleeders with fair accuracy. Conclusion: Though the techniques of RCT and TEG are different, a few RCT e.g. platelet count and fibrinogen correlated with corresponding TEG parameters i.e. MA and Alpha angle. TEG parameters (R time and MA in postoperative samples) were able to predict blood loss better than RCT.

Bone marrow biopsy in Hodgkin's disease.

Bone marrow biopsies of 58 untreated patients with Hodgkin's disease were evaluated. Marrow involvement was seen in 36.2 % cases. Positive marrow biopsies were seen mainly in patients with clinical stages III and IV. Bone marrow involvement was most common in patients with less than 15 years of age and in males. HD patients with mixed cellularity had highest incidence of marrow involvement while none of the patients with lymphocytic predominance showed BM involvement. Focal infiltration was found to be more common. Bone marrow aspiration smears were negative in majority of cases with positive marrow biopsies. Thus BM trephine biopsy is a simple tool for assessment of disease spread.

Bone marrow involvement by metastatic solid tumors.

A five year experience with bone marrow aspirates and biopsies positive for metastatic carcinoma is reviewed. Marrow examination in 25 cases detected metastasis. The common primary tumors with marrow metastasis were neuroblastoma, carcinoma breast and prostate. In 56% cases primary site could not be ascertained from bone marrow as metastatic tumor showed undifferentiated morphology. The study demonstrates the usefulness of combining trephine biopsy with aspirate examination for increased detection of bone marrow metastasis.