Point-of-Care Testing in Diagnosis and Management of Haemostatic Disorders

Point-of-care testing (POCT) refers to diagnostic tests performed at or near the site of patient care, offering rapid and accurate results that support timely clinical decision-making. These tests, ranging from simple dipsticks to sophisticated automated devices, are designed to satisfy the REASSURED criteria outlined by the World Health Organization (WHO). This is particularly crucial in the management of haemostatic disorders, which involve abnormalities in blood clotting and include conditions like Haemophilia, thrombophilia, Disseminated Intravascular Coagulation (DIC), and liver disease. In this chapter, we highlight the role of key POCTs in diagnosing and managing haemostatic disorders, specifically using Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM). These viscoelastic assays assess real-time clot formation, stability, and dissolution, helping to guide treatment decisions in conditions like Haemophilia A, trauma-induced coagulopathy, and liver disease. Furthermore, POCT devices for Prothrombin Time (PT)/INR and D-dimer are emphasized for their utility in monitoring anticoagulation therapy, thrombotic risk, and bleeding. The chapter includes clinical cases demonstrating the application of ROTEM–NATEM in monitoring haemophilia patients on different doses of Emicizumab prophylaxis. Despite their high cost and the need for trained personnel, these technologies provide real-time, dynamic evaluations of clot formation, stability, and dissolution, assisting in the management of conditions like Haemophilia, trauma-induced coagulopathy, liver disease, and obstetric bleeding disorders. Additionally, the chapter explores the application of these devices in perioperative settings, highlighting their role in guiding transfusions and adjusting therapies in a personalized manner. Ultimately, this chapter underscores the importance of POCT in improving the diagnosis, monitoring, and management of haemostatic disorders, ultimately leading to more personalized and timely interventions.