Routine haemostasis testing before transplanted kidney biopsy: a cohort study

Gerhardus J. A. J. M. Kuiper*, Maarten H. L. Christiaans, Monique H. J. . M. Mullens, Hugo ten Cate, Karly Hamulyak, Yvonne M. C. Henskens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Kidney biopsy can result in bleeding complications. Prebiopsy testing using bleeding time (BT) is controversial. New whole blood haemostasis tests, such as platelet function analyser-100 (PFA-100) and multiple electrode aggregometry (MEA), might perform better. We postulated that PFA-100 would be suitable to replace BT prebiopsy. In 154 patients, transplanted kidney biopsies were performed after measurement of bleeding time, PFA-100, MEA and mean platelet volume (MPV). Bleeding outcome (haemoglobin (Hb) drop, haematuria (+/- bladder catheterization), ultrasound finding of a bleeding, need for (non)surgical intervention and/or transfusion) after the biopsy was correlated to each test. Male-female ratio was 2:1. 50% had a surveillance biopsy at either three or 12months. Around 17% (had) used acetylsalicylic acid (ASA) prebiopsy. Of 17 bleeding events, one subject needed a transfusion. Most bleeding events were Hb reductions over 1mmol/l and all resolved uneventful. BT, PFA-100, MEA and MPV did not predict a bleeding outcome; prior ASA use however could (odds ratio 3.19; 95%-CI 1.06 to 9.61). Diagnostic performance data and Bland-Altman analysis showed that BT could not be substituted by PFA-100. ASA use was the best determinant of bleeding after kidney biopsy. Routine haemostasis testing prebiopsy has no added value.
Original languageEnglish
Pages (from-to)302-312
Number of pages11
JournalTransplant International
Volume31
Issue number3
DOIs
Publication statusPublished - 1 Mar 2018

Keywords

  • coagulation
  • kidney biopsy
  • platelet function
  • point-of-care
  • screening
  • PERCUTANEOUS RENAL BIOPSY
  • PLATELET-FUNCTION ANALYZER
  • BLEEDING-TIME TEST
  • COMPLICATIONS
  • SAFETY
  • DYSFUNCTION
  • EXPERIENCE
  • MANAGEMENT
  • HEMATURIA
  • CHILDREN

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