Impact of a 15-minute incubation on citrated TEG (thromboelastography) results in adult surgical patients-a prospective observational study.

IF 2.3 4区医学 Q2 PATHOLOGY

American journal of clinical pathology Pub Date : 2026-09-03 DOI:10.1093/ajcp/aqag096

Hong Hong, Andrew Hasenzahl, Mohamed Abdel-Fattah, Shivani Dobhal, Vladimir Volel, Tylis Chang

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引用次数: 0

Abstract

Objectives: The thromboelastography (TEG) 6s Global Hemostasis Cartridge package insert recommends a 15-minute incubation of citrated blood prior to testing; however, most centers run samples immediately. Limited data are available to evaluate how incubation affects results and thus influences hemostatic transfusion decisions.

Methods: In this single-center prospective study, 35 adult surgical and critical care patients were enrolled. Paired citrated samples were tested immediately upon laboratory arrival vs after a 15-minute benchtop incubation at room temperature. Primary endpoints included changes in citrated kaolin-reaction time (CK-R), kaolin with heparinase-reaction time (CKH-R), citrated kaolin-maximum amplitude (CK-MA), Citrated Rapid Thromboelastography Maximum Amplitude (CRT-MA), and citrated functional fibrinogen-maximum amplitude (CFF-MA) (fibrin-fibrinogen contribution). Paired t tests were used for analysis, and percent differences were calculated as [(Incubated - Immediate) / Incubated] × 100%. Categorical interpretation shifts (low/normal/high) were also assessed.

Results: A 15-minute incubation significantly shortened CK-R (8.5 ± 3.4 vs 7.4 ± 3.1 minutes; P < .01) and CKH-R (7.2 ± 2.7 vs 6.9 ± 2.5 minutes; P < .01), with mean percent changes of -17% and -12%, respectively. CK-MA decreased marginally (57.0 ± 16.0 vs 56.2 ± 12.4 mm; P < .01), while CFF-MA remained unchanged (P = .976). Notably, 23% of CK-R results shifted interpretation categories after incubation, whereas no CFF-MA categories changed.

Conclusions: A 15-minute incubation significantly shortens CK-R/CKH-R and marginally decreases CK-MA, potentially normalizing hyper- or hypocoagulable readings. Omitting incubation risks misclassification and inappropriate plasma/prothrombin complex concentrate administration. Strict adherence to the manufacturer's incubation protocol is recommended except in emergencies, and local transfusion algorithms should specify whether "immediate" or "incubated" TEG cutoffs apply.

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15分钟的潜伏期对成人外科患者柠檬酸TEG（血栓弹性成像）结果的影响——一项前瞻性观察研究。

目的：血栓弹性成像（TEG） 6s全球止血药盒包装说明书建议在测试前将柠檬酸血培养15分钟；然而，大多数中心立即运行样本。有限的数据可用于评估潜伏如何影响结果，从而影响止血输血的决定。方法：在这项单中心前瞻性研究中，纳入35例成人外科和危重症患者。配对的柠檬酸样品在到达实验室后立即进行测试，与在室温下进行15分钟的台式孵育后进行测试。主要终点包括柠檬酸高岭土反应时间（CK-R）、高岭土与肝素酶反应时间（CKH-R）、柠檬酸高岭土最大振幅（CK-MA）、柠檬酸快速血栓弹性成像最大振幅（CRT-MA）和柠檬酸功能性纤维蛋白原最大振幅（CFF-MA）（纤维蛋白-纤维蛋白原贡献）的变化。配对t检验用于分析，差异百分比计算为[（孵育-即刻）/孵育]× 100%。分类解释移位（低/正常/高）也被评估。结果：15分钟孵育显著缩短CK-R（8.5±3.4 vs 7.4±3.1 min, P < 0.01）和CKH-R(7.2±2.7 vs 6.9±2.5 min, P < 0.01)，平均变化百分比分别为-17%和-12%。CK-MA略有下降（57.0±16.0 vs 56.2±12.4 mm; P < 0.01），而CFF-MA保持不变（P = .976）。值得注意的是，23%的CK-R结果在孵育后改变了解释类别，而CFF-MA类别没有改变。结论：15分钟的孵育显著缩短了CK-R/CKH-R，并略微降低了CK-MA，可能使高凝或低凝读数正常化。忽略潜伏期存在分类错误和血浆/凝血酶原浓缩物给药不当的风险。除紧急情况外，建议严格遵守制造商的孵育方案，本地输血算法应明确适用“立即”或“孵育”TEG截止。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of clinical pathology 医学-病理学

CiteScore

7.70

自引率

2.90%

发文量

367

审稿时长

3-6 weeks

期刊介绍： The American Journal of Clinical Pathology (AJCP) is the official journal of the American Society for Clinical Pathology and the Academy of Clinical Laboratory Physicians and Scientists. It is a leading international journal for publication of articles concerning novel anatomic pathology and laboratory medicine observations on human disease. AJCP emphasizes articles that focus on the application of evolving technologies for the diagnosis and characterization of diseases and conditions, as well as those that have a direct link toward improving patient care.