Association of Fibrinogen and ROTEM Parameters with Age and Race in a Diverse Pediatric Population: A Single Center Study

Authors: Malik, M; Al-Ghafry, M; Lema, M; Nandi, V; Ignjatovic, V; Shore-Lessersson, L; Acharya, SS

Affiliations: Department of Pediatric Hematology, Oncology and Blood & Marrow Transplant Program, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Cancer and Blood Disorders Institute, Johns Hopkins All Children’s Hospital, St Petersburg, Florida, USA. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA. Laboratory Data Analytic Services, New York Blood Center, New York, USA. Johns Hopkins All Children’s Institute for Clinical and Translational Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, USA. Northwell, Manhasset, NY, North Shore University Hospital, Division of Anesthesiology, USA. Northwell, New Hyde Park, NY, Cohen Children’s Medical Center, Division of Pediatric Hematology, Oncology and Stem Cell Transplant, USA.

Publication: Journal of thrombosis and haemostasis; 2025

ABSTRACT: INTRODUCTION: Rotational Thromboelastometry (ROTEM) is a whole blood viscoelastic analyzer providing a global assessment of coagulation. Reference Intervals (RIs) for ROTEM are limited in pediatrics, often not accounting for race. Moreover, discrete RIs may be misleading. Our objective was to investigate the relationship between age (as a continuous variable) and race on ROTEM and conventional coagulation tests (CCTs). METHODS: Prospective data from 105 racially diverse pediatric subjects (ages 1-21 years) were collected. ROTEM and CCTs (PT, aPTT and fibrinogen) were obtained. The cohort was analyzed as a whole and then stratified by race. RESULTS: There was a positive association with age and fibrinogen levels (R(2)=0.189, p<0.0001), FIBTEM A10 (R(2)=0.154, p=0.0001) and FIBTEM MCF (R(2)=0.157, p=0.0001) in the entire cohort. For race stratification, only Black/African American (B/AA) subjects showed negative association with age for EXTEM CFT, but positive association for EXTEM/INTEM A10 and MCF (p-value <0.001), and FIBTEM A10 and FIBTEM MCF (p-value <0.001), revealing a propensity for a prothrombotic state in B/AA. CONCLUSION: This study reports race-specific, age-related differences in fibrinogen and ROTEM, and describes ROTEM parameters as continuous variables by age. Inclusion of a diverse population in establishing race-specific pediatric RIs has clinical and public health relevance for more accurate diagnosis and personalized treatment.