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Abstract
Background. Whole blood viscoelastic tests such as the fibrin-based thromboelastometry (ROTEM®) test FIBTEM are increasingly used in the perioperative setting to quickly identify deficits in fibrin quality, and to guide hemostatic therapy. The recently developed FibScreen2 test of the ReoRox® method, based on free oscillation rheometry, also provides an evaluation of fibrin clot quality. To date, little information is available on the performance of this test in hemodiluted blood, by comparison to FIBTEM. Methods. Whole blood samples from eight healthy volunteers were analyzed using FIBTEM and Fibscreen2. Native and diluted (to 33% and 50% using saline, gelatin or hydroxyethyl starch [HES]) samples were analyzed. Clot strength parameters, including FIBTEM maximum clot firmness (MCF), FIBTEM maximum clot elasticity (MCE) and Fibscreen2 maximum elasticity (G'max), were measured. Results. In repeatedly measured samples from two volunteers, FIBTEM MCF and Fibscreen2 G'max revealed a coefficient of variation (CV) of 5.3 vs. 16.3% and 5.6 vs. 31.7% for each volunteer, respectively. Hemodilution decreased clot strength. Both Fibscreen2 G'max and FIBTEM parameters decreased proportionally to the dilution ratio when saline was used. The observed reductions in FIBTEM and Fibscreen2 parameters were more severe in samples diluted with gelatin and HES, compared to saline. Finally, a regression analysis between FIBTEM MCE and Fibscreen2 G'max revealed a poor goodness of fit (r2 = 0.37, p < 0.0001). Conclusions. ReoRox® Fibscreen2 test has a high coefficient of variation, and its application in various hemodilution conditions showed limited comparability with the ROTEM® FIBTEM test.
Acknowledgements
Editorial assistance with manuscript preparation was provided by medical writers at Meridian HealthComms (Plumley, UK), funded by CSL Behring.
Ethical approval
This study received approval of the local Ethics Committee (E-1231 Votum), Sebastian-Stief-Gasse 2, 5020, Salzburg, Austria.
Contributions of authors
CS and HS designed the study and performed the experiments. CS and CJS performed the statistical analysis. All authors analyzed and interpreted the results. CS and CJS drafted the manuscript. HS, MR, and US critically revised the manuscript for important intellectual content. All authors attest to the integrity of the original data and the analysis reported in this manuscript. The final manuscript was approved by all authors, who all qualify for authorship.
Declaration of interest: Cristina Solomon is an employee of CSL Behring and previously received speaker honoraria and research support from Tem International and CSL Behring, and travel support from Haemoscope Ltd (former manufacturer of TEG®). Herbert Schöchl has received study grants and speaker fees from CSL Behring and Tem International. Marco Ranucci received speaker honoraria and research support from CSL Behring and Grifols, speaker honoraria from Medtronic and Haemoscope, research support from Tem International, and was on the steering committee of a FXIII study (until 2010) for Novo Nordisk. Ulf Schött has received grants from CSL Behring. Christoph J. Schlimp has received research support and speaker fees from CSL Behring, and research support from Tem International. The authors report no other conflicts of interest. The authors alone are responsible for the content and writing of the paper.