Transfusion and blood products

• TEG/ROTEM = trade names for thromboelastography measurement to measure parameters of clot formation
• Clot strength is 80% platelets, 20% fibrin
• Performed as point of care test (~ 30 min)
• Use to: determine need for transfusion in trauma, liver transplantation, cardiac surgery

Normal
CT/R = clotting time/reaction time (length of time it takes for clot to form) ↑ CT = give FFP	long time to clot formation, and ↓ alpha angle
MCF/MA = mean clot firmness/mean amplitude = firmness of clot Takes some time to result - earlier surrogate is alpha angle (slope of clot firmness increase) ↓ alpha angle = give cryo ↓ MCF = give platelets MCF should plateau during study; if it decreases, then fibrinolysis is occuring (e.g. DIC, or tPA given) Fibrinolysis = give TXA (tranexamic acid) or aminocaproic acid	low amplitude/MCF
	MCF decreasing