PB1175 - Resonant acoustic rheometry (RAR) for the characterization of hemostatic properties compared to von Clauss fibrinogen and TEG 6s functional fibrinogen

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Connor M. Bunch, MD

Resident Physician
Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
Detroit, Michigan, United States

Co-Author(s)

WL

Weiping Li

Post-doctoral Research Fellow
Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
Ann Arbor, Michigan, United States
SZ

Sufyan Zackariya

Research Associate
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
Detroit, Michigan, United States
HB

Hallie Buckner

Research Associate
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
Detroit, Michigan, United States
SP

Shivani S. Patel

Research Associate
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
Detroit, Michigan, United States
CC

Christine Chien

Research Associate
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
Detroit, Michigan, United States
JT

Jacob Tuttle

Research Associate
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
Detroit, Michigan, United States
SH

Saadeddine Haidar

Resident Physician
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
Detroit, Michigan, United States
MW

Matthew Walsh

Engineering Consultant
Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, USA
Mishawaka, Indiana, United States
CD

Cheri X. Deng

Co-investigator/Professor of Biomedical Engineering
Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
Ann Arbor, Michigan, United States
JS

Jan P. Stegemann

Co-investigator/Professor of Biomedical Engineering
Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
Ann Arbor, Michigan, United States
BC

Bernard C. Cook

Co-investigator/Director of Clinical Chemistries Laboratory
Department of Pathology, Henry Ford Hospital, Detroit, Michigan, USA
Detroit, Michigan, United States
HK

Hau C. Kwaan

Professor of Hematology and Oncology
Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Chicago, Illinois, United States
JM

Joseph B. Miller

Co-investigator/Clinical Associate Professor of Emergency Medicine
Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
Detroit, Michigan, United States
MW

Mark M. Walsh

Co-investigator/Clinical Assistant Professor of Medicine
Department of Emergency Medicine, Indiana University School of Medicine, South Bend Campus, South Bend, IN, USA
Mishawaka, Indiana, United States

Background: Disordered hemostasis associated with life-threatening hemorrhage is commonly encountered in severe trauma, pregnancy complications, major cardiac surgery, and liver failure/transplantation. Clinicians in these settings are seeking a bedside global hemostasis test to rapidly diagnose aberrant clot formation and termination to guide reversal with individualized ratios of blood products. Resonant acoustic rheometry (RAR) is an ultrasound-based blood characterization technique which offers key advantages over current sheer rheometric assays in terms of speed, throughput, reduced sample volume, and increased information content.

Aims: Develop a point-of-care global hemostasis test to rapidly guide fibrinogen concentrates and antifibrinolytic therapies in patients with hypofibrinogenemia and hyperfibrinolysis, respectively.

Methods: RAR was conducted on a convenience sample of 38 plasma samples which had concomitant clinical plasma Clauss fibrinogen and whole blood TEG 6s Global Hemostasis® results. The citrated kaolin assay ([CK], activators calcium chloride 0.8 M and Kaolin 0.004% w/w) and citrated rapid thromboelastography assay ([CRT], activators calcium chloride 0.8 M, Kaolin 2% w/w, and Tissue Factor 2 μg/mL) were performed with RAR for each sample. Pearson correlation coefficients were calculated.

Results: Patients included those hospitalized for major surgery (60.5%), trauma (5.3%), liver failure/transplantation (23.7%), or other (10.5%). Clauss fibrinogen demonstrated strong correlation to the RAR CK final resonance frequency (FRF) (r=0.657, p< 0.0001, n=38), moderate correlation to the RAR CK frequency change (FC) (r=0.573, p=0.0034, n=24), strong correlation to the RAR CRT FRF (r=0.614, p< 0.0001, n=38), and moderate correlation to the RAR CRT FC (r=0.588, p=0.005, n=21). TEG 6s functional fibrinogen demonstrated strong correlation to RAR CK FRF (r=0.814, p< 0.0001, n=38) and strong correlation to RAR CRT FRF (r=0.733, p< 0.0001, n=38).

Conclusion(s): RAR parameters FRF and FC correlate well to the Clauss fibrinogen and TEG 6s functional fibrinogen. Future study with whole blood will further elucidate RAR's bedside sensitivity to fibrinogen content and fibrinolysis in bleeding patients.