From Meg Hardin. George, The surgical services in our hospital are requesting that we look into purchasing the Thromboelastograph (TEG) or Rotational Thromboelastometry System (ROTEM) in order to decrease blood utilization. TEG representatives tell surgical services that they can receive results with in 2 minutes of the blood being placed on the analyzer. I know nothing (except what I read) about these analyzers and was wondering if any of your readers who use TEG or ROTEM could give me some information? I thank everyone in advance for their time with this question.
Category: Global Hemostasis Assays
From Ning Tang: Hi, George, I come from a clinical laboratory in China. We met a confusing case today and want to get your suggestion: A patient had a prolonged prothrombin time (PT, 20s), partial thromboplastin time (APTT, PTT, 52s) and thrombin time (TT, 127s). Fibrinogen activity is within reference interval (by both Clauss method and TEG), also the patient shows slight bleeding symptoms, is this dysfibrinogenemia? How to confirm it? Thanks for your help!
Here is a puzzling case sent by Crystal Azevedo: Hi George! I have a question for you from one of my pathologists. 24 hours after an uneventful coronary bypass procedure a 51 kg patient developed acute hemorrhage. A post-protamine thromboelastogram (TEG) on the day of surgery was completely normal. At the time bleeding occurred, the patient was found to have a fibrinogen of 104 mg/dL and a platelet count of 43,000. A TEG was performed that showed a markedly prolonged R-time in the kaolin cup (21 minutes) but substantial correction in the heparinase cup (to 8.8 minutes). Alpha, K and MA were low, as expected. Heparin was felt to be present based on the TEG results, but the physician and nurse caring for the patient insisted that no heparin had been administered.
From Kim Kinney at IU Health (formerly Clarian): Hi George. I am trying to collect as much information from Thromboelastograph® (TEG) users as possible. We are in the process of validation to support the Berlin Heart transplant for our pediatric population. I am wondering what other sites use TEG for, who runs the samples, who interprets and what results are entered into the computer system. Any information would be helpful.
Thank you Kim, we don’t hear from you often enough these days. Let’s give Kim all the TEG information we can collect. Geo.
From Kim Kinney at Indiana University Medical Center (IU Health): Hi George. We are being asked to make the thromboelastograph (TEG) available in our special coag lab for clinical use. I am curious to poll others regarding the use of TEG, who is running the test, who is interpreting the results, etc. We have had the TEG available for several research studies here at IU Health but the testing was performed by a research lab. Thanks for the help, Kim
Hi, Kim, it is great to hear from you again, and I hope we get some feedback! I rarely see TEGs in clinical labs, they seem to live mostly in operating suites where they are used to monitor heparin or thrombolytic therapy. Geo.