Thromboelastography-guided platelet transfusion and associations with utilization and outcomes in patients with hematologic malignancies.

Abstract

6590 Background: Thromboelastography (TEG) is a viscoelastic assay assessing clot formation and global hemostasis. In patients with hematologic malignancies, transfusion support is essential, yet evidence guiding optimal transfusion strategies is limited. This study evaluated transfusion utilization and outcomes associated with TEG use in hematologic oncology patients. Methods: We conducted a retrospective cohort study at a tertiary care hospital (October 2022–2025) including hospitalized patients with acute and chronic leukemias or multiple myeloma who received blood product transfusions. Primary outcomes were platelet transfusion utilization (standardized units) and platelet response. Secondary outcomes included hospital length of stay (LOS) and in-hospital mortality. Welch’s t-test and chi-square testing were used, with multivariable regression adjusting for demographic and clinical covariates. Results: Among 975 platelet transfusion episodes, 68 (5.3%) were TEG-guided. Unadjusted analyses showed slightly lower platelet utilization with TEG-guided transfusions compared with standard care (1.03 vs 1.06 units, p<0.001). Platelet count increments did not differ significantly (Δ 17.9 vs 16.3, p=0.57). TEG-guided patients had longer LOS (39.8 vs 31.9 days, p<0.001) and higher in-hospital mortality (p<0.001), reflecting greater illness severity. After adjustment, differences in utilization, platelet response, and LOS were no longer significant. TEG use remained strongly associated with in-hospital mortality (adjusted OR 29.8, 95% CI 8.83–100.77, p<0.001). Conclusions: TEG use in hospitalized patients with hematologic malignancies receiving platelet transfusions was uncommon and not associated with improved transfusion efficiency or platelet response. TEG-guided transfusions occurred primarily in high-acuity settings with prolonged hospitalization and increased mortality, suggesting TEG functions more as a marker of illness severity than a routine tool for optimizing platelet transfusion. Further studies are needed to clarify its role in malignant hematology care. Platelet transfusion outcomes by TEG use in hematological malignancy encounters. Outcome TEG guided (n=68) Non-TEG guided (n=1214) P Value (unadjusted) P value (adjusted) Number of encounters 68 1214 --- --- Standardized platelet units, mean 1.03 1.06 0.14 0.34 Platelet count response (DELTA), mean 17.9 16.3 0.57 0.93 Length of stay, mean days 39.8 31.9 <0.001 0.51 In-hospital mortality, % 94.1 44.7 <0.001 0.0008 Adjusted p values from multivariable regression models including demographics, malignancy subtype, baseline platelet count, transfusion dose, care location, transfusion priority, and timing variables. DELTA = post-pre platelet count.