Clot characterization by multidisciplinary approach: biochemical and imaging parameters in a hypocoagulative setting. A pilot study.

  • Francesco Marongiu Hemostasis and Thrombosis Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Dimitrios Marco Ntoukas Hemostasis and Thrombosis Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Luigi Barberini Department of Medical Sciences and Public Health, University of Cagliari, Italy. https://orcid.org/0000-0002-3815-0392
  • Maria Filomena Ruberto Hemostasis and Thrombosis Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy. https://orcid.org/0000-0001-9491-1734
  • Maria Sebastiana Piras Hemostasis and Thrombosis Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Maria Conti Liver Unit, Department of Internal Medicine, University Hospital of Cagliari, Italy.
  • Maria Luisa Di Martino Internal Medicine Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Mario Mura Internal Medicine Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Silvia Marongiu Internal Medicine Unit, SS Trinità Hospital, Azienda Tutela della Salute, Cagliari, Italy.
  • Maria Luigia Vannini Hemostasis and Thrombosis Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Mattia Lillu Internal Medicine Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Monica Piras Anatomic-Pathology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Daniela Fanni Anatomic-Pathology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Lara Fenu Hemostasis and Thrombosis Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  • Carmen Porcu
  • Doris Barcellona | doris.barcellona@unica.it Hemostasis and Thrombosis Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy. https://orcid.org/0000-0002-0823-3357
  • Gavino Faa SHRO Temple University, Philadelphia, PA, United States.
  • Terenzio Congiu Anatomic-Pathology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy.

Abstract

Background: Clot characterization is, to the present days, a multimodal approach: scanning the clot by electron microscopy (SEM) is helpful for the visualization of fibrin structure along with laboratory parameters such as the clot waveform analysis (CWA) and thrombin generation in different settings of clot abnormalities. This study aimed to assess whether the coagulative parameters were consistent with the clot images texture acquired by SEM, and therefore to propose a more generalist and integrative approach to clots classification.
Design and Methods: In this pilot study, the examined population consists of eight healthy subjects, seven patients affected by Acquired Hemophilia A (AHA) and seven patients treated with Vitamin K Antagonists (VKAs), similar for age and gender. We studied the velocity and acceleration (1st and 2nd derivative of the aPTT) of clot formation (CWA), the thrombin generation, and the clots' scanning by SEM. Images acquired with SEM were then analyzed with the MATLAB software with the "Texture Analysis" methods to perform classification. Among the various texture parameters, we reported Contrast and Energy.
Results: Significant differences among healthy subjects, patients with AHA and those treated with VKAs were detected for the coagulative parameters. We found no differences between VKAs and AHA patients. Contrast and energy highlighted a significant difference among the three groups in agreement with the laboratory's parameters. We found no significant differences between VKAs and AHA patients.
Conclusions: The use of SEM, CWA and thrombin generation parameters may be a starting point for studies aimed to demonstrate the general characteristics of clot formation in different clinical conditions with a multiparametric approach.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Author Biographies

Daniela Fanni, Anatomic-Pathology Unit, Department of Medical Sciences and Public Health, University of Cagliari

SHRO Temple University, Philadelphia, PA, USA

Doris Barcellona, Hemostasis and Thrombosis Unit, Department of Medical Sciences and Public Health, University of Cagliari

SHRO Temple University, Philadelphia, PA, USA

Gavino Faa, SHRO Temple University, Philadelphia, PA

Anatomic-Pathology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Italy

References

Antoniak S. The coagulation system in host defense. Res Pract Thromb Haemost 2018;2:549-57. DOI: https://doi.org/10.1002/rth2.12109

Grover SP, Mackman N. Tissue factor: an essential mediator of hemostasis and trigger of thrombosis. Arterioscler Thromb Vasc Biol 2018;38:709‐25. DOI: https://doi.org/10.1161/ATVBAHA.117.309846

Barcellona D, Marongiu F. The hemostatic system. 1st part. J Pediatr Neonat Individual Med 2020;9:e090106.

Undas A. How to assess fibrinogen levels and fibrin clot properties in clinical practice? Semin Thromb Hemost 2016;42:381-8. DOI: https://doi.org/10.1055/s-0036-1579636

Ząbczyk M, Undas A. Plasma fibrin clot structure and thromboembolism: clinical implications. Pol Arch Intern Med 2017;127:873-81. DOI: https://doi.org/10.20452/pamw.4165

Kessler CM, Knöbl P. Acquired haemophilia: an overview for clinical practice. Eur J Haematol 2015;95(S81):36-44. DOI: https://doi.org/10.1111/ejh.12689

Ageno W, Gallus AS, Wittkowsky A, et al. Oral anticoagulant therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e44S-e88S. DOI: https://doi.org/10.1378/chest.11-2292

Hemker HC, Giesen P, Al Dieri R, et al. Calibrated automated thrombin generation measurement in clotting plasma. Pathophysiol Haemost Thromb 2003;33:4-15. DOI: https://doi.org/10.1159/000071636

Solano C, Zerafa P, Bird R. A study of atypical APTT derivative curves on the ACL TOP coagulation analyzer. Int J Lab Hematol 2011;33:67-78. DOI: https://doi.org/10.1111/j.1751-553X.2010.01248.x

Shima M, Thachil J, Nair SC, Srivastava A. Scientific and standardization committee. towards standardization of clot waveform analysis and recommendations for its clinical applications. J Thromb Haemost 2013;11:1417‐20. DOI: https://doi.org/10.1111/jth.12287

MATLAB, 2018. 9.7.0.1190202 (R2019b). Natick: The MathWorks Inc.

Mohanaiah P, Sathyanarayana P, GuruKumar L. Image texture feature extraction using GLCM approach. Intern J Scient Res Pub 2013;3:1-5.

Gonzales RC, Woods RE, Eddins SL. Digital image processing using MATLAB. 3rd ed. Gatesmark Publishing; 2020.

Pieters M, Undas A, Marchi R, et al. An international study on the standardization of fibrin clot permeability measurement: Methodological considerations and implications for healthy control values. J Thromb Haemost 2012;10:2179-81. DOI: https://doi.org/10.1111/j.1538-7836.2012.04883.x

Dahlbäck B. Blood coagulation. Lancet 2020;355:627-1632. DOI: https://doi.org/10.1016/S0140-6736(00)02225-X

Kruse-Jarres R, Kempton CL, Baudo F, et al. Acquired hemophilia A: Updated review of evidence and treatment guidance. Am J Hematol 2017;92:695-705. DOI: https://doi.org/10.1002/ajh.24777

Knoebl P, Marco P, Baudo F, et al. Demographic and clinical data in acquired hemophilia A: Results from the European Acquired Haemophilia Registry (EACH2). J Thromb Haemost 2012;10:622-31. DOI: https://doi.org/10.1111/j.1538-7836.2012.04654.x

Palareti G, Antonucci E, Migliaccio L, et al. Vitamin K antagonist therapy: Changes in the treated populations and in management results in Italian anticoagulation clinics compared with those recorded 20 years ago. Intern Emerg Med 2017;12:1109-19. DOI: https://doi.org/10.1007/s11739-017-1678-9

Published
2021-05-25
Info
Issue
Section
Original Articles
Keywords:
Clot pathologies, scanning electron microscopy, SEM, texture analysis, clot waveform analysis, CWA
Statistics
  • Abstract views: 297

  • PDF: 149
How to Cite
Marongiu, F., Ntoukas, D. M., Barberini, L., Ruberto, M. F., Piras, M. S., Conti, M., Di Martino, M. L., Mura, M., Marongiu, S., Vannini, M. L., Lillu, M., Piras, M., Fanni, D., Fenu, L., Porcu, C., Barcellona, D., Faa, G., & Congiu, T. (2021). Clot characterization by multidisciplinary approach: biochemical and imaging parameters in a hypocoagulative setting. A pilot study. Journal of Public Health Research. https://doi.org/10.4081/jphr.2021.2358