# Total thrombus formation analysis in patients with myeloid neoplasia and thrombocytopenia

## TL;DR

This study explores a new method to assess blood clotting in cancer patients with low platelet counts, finding that it can predict the need for platelet transfusions better than platelet count alone.

## Contribution

The study introduces T-TAS HD-Chip as a novel tool for evaluating hemostasis in thrombocytopenic myeloid neoplasia patients.

## Key findings

- T-TAS HD-Chip detected occlusion only in patients with platelet counts >20×10⁹/L.
- Parenteral nutrition significantly influenced T-TAS occlusion outcomes.
- T-TAS AUC predicted the need for future platelet transfusions more effectively than platelet count.

## Abstract

Patients with hematologic malignancies often require platelet transfusions, but platelet count alone does not sufficiently predict bleeding risk. T-TAS HD-Chip is designed to evaluate the hemostatic function in whole blood samples from thrombocytopenic patients. This study aimed to investigate T-TAS HD-chip in thrombocytopenic patients with myeloid neoplasia. Samples from thrombocytopenic patients with myeloid neoplasia were prospectively collected. The area under the curve (AUC), occlusion start time and occlusion time of T-TAS, platelet count, von Willebrand factor and thrombin generation were measured, and the association of these markers with platelet transfusion, parenteral nutrition and bleeding events was evaluated. A total of 67 samples were collected from 28 patients. No occlusion in T-TAS was detected in samples with platelet counts ≤20 × 109 per liter but 17 of 35 samples with platelet counts > 20 × 109 per liter showed occlusion, p < 0.001. In samples from patients with platelet counts > 20 × 109 per liter, 26.3% with parenteral nutrition showed complete occlusion, compared to 75% without parenteral nutrition, p = 0.007. Platelet count and T-TAS AUC were significantly higher one hour after platelet transfusion. T-TAS AUC but not platelet count 12–24 h after transfusion was lower in patients requiring next transfusion within < 5 days compared to those with later transfusions. Our data suggest that occlusion in T-TAS HD-Chip in patients with myeloid neoplasia does not occur in patients with platelet counts ≤20 × 109 per liter. Parenteral nutrition seems to interfere with the occlusion of T-TAS HD chip. T-TAS may be able to predict the need for further platelet transfusions.

The online version contains supplementary material available at 10.1007/s00277-025-06679-2.