Assessment of the phenotypic severity of hemophilia A: using rotational thromboelastometry (ROTEM) and APTT-clot waveform analysis

Deepika Gupta; Vandana Arya; Jasmita Dass; Nitin Gupta; Manas Kalra; Anupam Sachdeva; Jyoti Kotwal

doi:10.1007/s44313-024-00018-6

Assessment of the phenotypic severity of hemophilia A: using rotational thromboelastometry (ROTEM) and APTT-clot waveform analysis

Blood Res. 2024 May 14;59(1):19. doi: 10.1007/s44313-024-00018-6.

Authors

Deepika Gupta¹, Vandana Arya¹, Jasmita Dass², Nitin Gupta¹, Manas Kalra³, Anupam Sachdeva³, Jyoti Kotwal⁴

Affiliations

¹ Department of Hematology, Sir Gangaram Hospital, Old Rajinder Nagar, New Delhi, 110060, India.
² Department of Lab Hematology, All India Institute of Medical Sciences, New Delhi, India.
³ Department of Pediatric Hemato Oncology, Sir Gangaram Hospital, New Delhi, India.
⁴ Department of Hematology, Sir Gangaram Hospital, Old Rajinder Nagar, New Delhi, 110060, India. drjyotikotwal@gmail.com.

Abstract

Background: Hemophilia A (HA) is an X-linked inherited bleeding disorder caused by reduced factor VIII (FVIII) levels. Approximately 10-15% of patients with severe HA (SHA) do not present with the anticipated bleeding pattern. Here, we assessed the phenotypic severity of hemophilia A using rotational thromboelastometry (ROTEM) and activated partial thromboplastin time-clot waveform analysis (APTT-CWA).

Methods: Patients diagnosed with hemophilia A were enrolled. Clinical phenotype assignment was performed according to the published literature, and patients were classified into four phenotypic subgroups. The whole blood sample was first run on ROTEM in INTEM mode using platelet-poor plasma, APTT was run, and the APTT-CWA graph was simultaneously recorded.

Results: A total of 66 patients were recruited for this study. Statistically significant differences were observed between the four phenotypically categorized groups using ROTEM and APTT-CWA. On comparing patients with mild/moderate-to-severe phenotypes (Group II) with SHA without inhibitors (Group IV), no significant difference was found for all parameters of ROTEM or APTT-CWA. The MCF, MA30, MAXV, and Alpha angle values using ROTEM were found to be the lowest in patients with SHA with inhibitors, which helped differentiate them from those with SHA without inhibitors. However, these two groups could not be differentiated using the APTT-CWA parameters.

Conclusion: ROTEM can be used to distinguish patients with SHA with inhibitors from those with SHA without inhibitors using a combination of parameters with high sensitivity and specificity. However, APTT-CWA cannot be used to differentiate these patient groups.

Keywords: APTT-CWA; Bethesda assay; Bleeding disorder; Hemophilia A; Phenotype severity; ROTEM.