Antonio Paul: When a Low Platelet Count Does Not Mean Weak Clotting
Antonio Paul, Head of ACTIMoS- Advanced Center for Transplant Immunology and Molecular Science, shared a post on LinkedIn:
”Platelets: 80,000/µL.
Chronic liver disease.
Aneurysmal intracranial bleed.
Multiple platelet transfusions already given.
The platelet count remained low.
But should we keep transfusing just to correct the number?
Viscoelastic hemostatic assay gave us the functional picture:
- R: 6.5 min — normal clot initiation
- MA: 58.1 mm — preserved overall clot strength
- CFF-MA: 23.3 mm — adequate fibrin contribution
- LY30: 0 percent — no evidence of increased fibrinolysis
In CLD, thrombocytopenia may partly reflect hypersplenism and splenic sequestration.
Despite a platelet count of 80,000/µL, this patient’s functional clot strength was preserved.
Integrating TEG with the clinical picture helped us avoid another empiric platelet transfusion merely to chase a number.
Complex clinical scenarios remind us why functional assays matter.
Numbers tell us what is low.
Functional assays help tell us whether haemostasis is actually impaired.
Platelet count does not equal clot strength
In Patient Blood Management, sometimes better testing guides us not only what to transfuse — but when not to transfuse.”
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