HAEMATOLOGY
fibrinogen contribution to clot stiffness for decision-making in these circumstances is seen to be better represented by the Quantra findings. Figure 2 shows the strong correlation between FCS and plasma fibrinogen in the preoperative stage, with moderate correlation in the other two stages. Again, this is mainly due to the haematocrit factor. Higher FCS values are reported due to lower Hct (Fig 1)
4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0
0 0.1 0.2 0.3 Haematocrit Figure 1. Effect of haematocrit on fibrinogen and FCS.
Samples All
Pre
Mid Post
n
29 10 9
10
Pearson r-value 0.46
0.71 0.57 0.51
ALL
7 6 5 4 3 2 1 0
0 PRE
7 6 5 4 3 2 1 0
0 0.5
y=0.3381x + 1.5032 r2
=0.4982
7 6 5 4 3 2 1 0
1.0 1.5 2.0 2.5 Fibrinogen (g/L) Figure 2. Correlation of FCS versus fibrinogen. Parameters PCS vs. PLT-I
Samples (n) All (29)
PCS vs. PLT-O All (29) PCS vs. PLT-F
Mid (9) PRE
35 30 25 20 15 10 5 0
0 50 100 150
y=0.0587x + 4.6962 r2
=0.5846
25 20 15 10 5 0
200 250 Platelet count (x1000/L) Figure 3. Correlation between PCS and platelet count. 88 I
WWW.CLINICALSERVICESJOURNAL.COM NOVEMBER 2019 300 350 400 0 50 All (29)
PCS vs. PLT-F Pre (10) PCS vs. PLT-F
PCS vs. PLT-F Post (10)
Pearson r-value 0.77
0.78 0.85
0.76 0.77 0.91
ALL
35 30 25 20 15 10 5 0
0 MID
y=0.0598x + 4.1063 r2
=0.5875
25 20 15 10 5 0
100 150 200 Platelet count (x1000/L) 250 300 0 50 100 50 100 150 200
y=0.065x + 3.2037 r2
=0.7147 3.0 3.5 4.0 4.5 0
y=0.7324x + 1.7229 r2
=0.3209 MID
4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0
0.5 1.0 1.5 Fibrinogen (g/L) 2.0 2.5 3.0 0
y=0.9377x + 1.3152 r2
=0.26 0.5
y=0.7057x + 0.8189 r2
=0.2145 0.4
and on the mid- and post-surgery stages 2.0 g/L plasma fibrinogen corresponds to FCS values of 2.7 and 2.2 hPa, respectively. In contrast, at baseline a plasma fibrinogen level of 2.0 g/L corresponds to an FCS of 1.2 hPa. Lowering the Hct increases fibrin clot stiffness. At constant plasma fibrinogen on an absolute level, more fibrinogen is available at a lower Hct, so FCS is closer to what occurs in vivo. This could therefore
r2 =0.0682
7.0 6.0 5.0 4.0 3.0 2.0 1.0 0
0.5 0 0.1 0.2 0.3 Haematocrit
reduce potential overuse of cryoprecipitate, which is currently dependent on laboratory plasma Clauss fibrinogen results.
Excellent correlation: PCS and platelet count
The laboratory also wanted to know whether or not the Quantra could address existing cardiac challenges experienced with other POC systems in relation to patients with low
r2
=0.2005
0.4
0.5
1.0
1.5
2.0
2.5 Fibrinogen (g/L) POST
3.0
3.5
4.0
4.5
0.5
1.0
1.5 Fibrinogen (g/L)
2.0
2.5
3.0
250 Platelet count (x1000/L) POST
300
350
400
y=0.0735x + 1.8206 r2
=0.8294 150 200 Platelet count (x1000/L) 250 300
PCS (hPa)
FCS (hPa)
Fibrinogen (g/L)
PCS (hPa)
FCS (hPa)
PCS (hPa) FCS (hPa) FCS (hPa)
PCS (hPa)
FCS (hPa)
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