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Utility of thromboelastography platelet mapping in bleeding disorders – An experience from Eastern India

Background and Objectives: Thromboelastography platelet mapping (TEG-PM) is primarily used to monitor the effectiveness of antiplatelet medications by assessing the inhibition of thromboxane A2 and adenosine diphosphate (ADP) receptors. The objective of this study was to understand the utility of TEG-PM assay in suspected cases of bleeding disorders. Materials and Methods: A total of 20 suspected cases of bleeding disorders were tested by TEG-PM assay as a primary screening test. The percentage of platelet aggregation to agonist was calculated by: ([MAADP/AA– MAFibrin]/[MAThrombin– MAFibrin] × 100) and inhibition by: (100% – % aggregation). The cutoff was defined as >50% inhibition for each agonist. Light transmittance aggregometry (LTA) was performed when the inhibition was >50% both with ADP and arachidonic acid (AA). Results: Ten out of 20 patients were showing an inhibition >50% with ADP and 5 among 20 had an inhibition >50% with AA. Among four patients who had >50% inhibition with both agonists, two cases were diagnosed as Glanzmann's thrombasthenia by LTA and one case was diagnosed as Wiskott–Aldrich syndrome by genetic analysis. Final diagnosis was not made in one case as LTA was inconclusive. Conclusion: We believe that TEG-PM assay may be introduced in preliminary algorithm for the diagnosis of bleeding disorders where facility such as LTA is not easily available.