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Perf Tech 3 > 14. TEG- Exam 3 > Flashcards

14. TEG- Exam 3 Flashcards

1
Q

Hemostasis is a tightly regulated process. What are the steps?

A
  • Activation
  • Clot formation
  • Clot lysis
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2
Q

Clot is a platelet-fibrin network. What are the steps

A
  • Platelets form plug
  • Clotting factors reinforce platelets
  • Fibrin acts as a glue
  • Clot strength
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3
Q

clot strength for platelets?

A

80-90%

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4
Q

clot strength for fibrin?

A

10-20%

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5
Q

PT/INR measures?

A 
extrinsic clotting (VIIa, Xa, IIa)
--longer: takes 35 min
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6
Q

PTT measures?

A

intrinsic clotting (XIIa, Xia, IXa, IIa)

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7
Q

TEG=

A
  • A whole blood hemostasis analyzer

* Point of care test

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8
Q

how does the TEG work? 5 steps

A
  • Cup oscillates
  • Pin is attached to torsion wire
  • Clot binds pin to cup
  • Degree and magnitude of pin motion are functions of the clot kinetics and mechanical properties
  • System generates a hemostasis profile
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9
Q

R=

A 
reaction time (time of clot formation)
-Likely variable= coagulation factors
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10
Q

alpha=

A

speed of fibrin accumulation

-Likely variable= fibrinogen

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11
Q

K=

A

time elapsed until clot reaches full strength

-Likely variable= fibrinogen

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12
Q

MA=

A

maximum amplitude= highest vertical amplitude of TEG tracing

-Likely variable= platelets

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13
Q

Cl=

A

coagulation index= linear combination of R, alpha, K, and MA

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14
Q

LY30=

A

% of amplitude reduction 30 min after the max

-Likely variable= fibrinolysis

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15
Q

TEG Assays: Standard (kaolin)=

A

30-40 min

Uses parameters listed above???? ASK GASPAR

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16
Q

TEG Assays: Rapid TEG=

A

20 min or less
•Uses tissue factor in place of kaolin to speed up the reaction
•R-value is replaced by TEG-ACT value
•Other parameters the same

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17
Q

TEG Assays: Heparinase=

A

type of cuvette

Used on CPB or post CPB alongside a standard TEG

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18
Q

TEG Assays: Platelet Mapping=

A

Determines to what degree platelet function is inhibited due to pharmacological inhibition of either the arachidonic acid (AA) or adenosine diphosphate (ADP) pathways
•Run alongside a standard TEG and a TEG with added AA or ADP.
•Calculates platelet inhibition as a percentage

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19
Q

arachidonic acid (AA)=

A

aspirin

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20
Q

adenosine diphosphate (ADP)=

A

Clopidogrel

21
Q

elongated R- Thrombin formation abnormalities:

Possible cause of imbalance=

A

Slow enzymatic reaction

22
Q

elongated R- Thrombin formation abnormalities:

Possible Etiologies=

A
  • Factor deficiency/dysfunction

* Residual heparin

23
Q

elongated R- Thrombin formation abnormalities:

Common Treatments:

A
  • FFP

* Protamine

24
Q

low alpha angle - fibrinogen abnormalities:

Possible cause of imbalance=

A

Slow rate of fibrin formation

25
Q

low alpha angle - fibrinogen abnormalities:

Possible etiologies=

A
  • Low fibrinogen levels or function
  • Insufficient rate/amount of thrombin generation
  • Platelet deficiency/dysfunction
26
Q

low alpha angle - fibrinogen abnormalities:

Common Treatments=

A
  • FFP

* Cryoprecipitate

27
Q

low MA - platelet funciton abnormalities:

Possible causes:

A

•Insufficient platelet-clot formation

28
Q

low MA - platelet funciton abnormalities:

Possible etiologies=

A
  • Poor platelet function
  • Low platelet count
  • Low fibrinogen levels or function
29
Q

low MA - platelet funciton abnormalities:

Common treatments=

A

Platelets

30
Q

high MA - platelet funciton abnormalities:

Possible causes:

A

Excessive platelet activity

31
Q

high MA - platelet funciton abnormalities:

Possible etiologies=

A

Platelet hypercoagulability

32
Q

high MA - platelet funciton abnormalities:

Common treatments=

A

Antiplatelet agents

33
Q

R between 7-10min
Clinical cause?
Treatment?

A

Clinical cause: small decrease in clotting factors

Treatment: x1 FFP or 4 ml/kg

34
Q

R between 11-14min
Clinical cause?
Treatment?

A

Clinical cause: medium decrease in clotting factors

Treatment: x2 FFP or 8 ml/kg

35
Q

R greater than 14min
Clinical cause?
Treatment?

A

Clinical cause: large decrease in clotting factors

Treatment: x4 FFP or 16 ml/kg

36
Q

MA between 49-54 mm
Clinical cause?
Treatment?

A

Clinical cause: small decrease in platelet function

Treatment: 0.3 mcg/kg DDAVP

37
Q

MA between 41-48 mm
Clinical cause?
Treatment?

A

Clinical cause: medium decrease in platelet function

Treatment: x5 platelet units

38
Q

MA less than 40mm
Clinical cause?
Treatment?

A

Clinical cause: large decrease in platelet function

Treatment: x10 platelet units

39
Q

CI less than 45 degrees
Clinical cause?
Treatment?

A

Clinical cause: medium decrease in fibrinogen levels

Treatment: .03 u/kg cryo

40
Q

LY30 at 7.5% or greater and a CI less than 3.0
Clinical cause?
Treatment?

A

Clinical cause: primary fibrinolysis

Treatment: anticoagulant of choice

41
Q

LY30 at 7.5% or greater and a CI greater than 3.0
Clinical cause?
Treatment?

A

Clinical cause: secondary fibrinolysis

Treatment: anticoagulant of choice

42
Q

LY30 at 7.5% or less and a CI greater than 3.0
Clinical cause?
Treatment?

A

Clinical cause: prothrombic state

Treatment: anticoagulant of choice

43
Q

LY30 at 7.5% or less and a CI greater than 3.0
Clinical cause?
Treatment?

A

Clinical cause: prothrombic state

Treatment: anticoagulant of choice

44
Q

what 3 things does platelet mapping measure

A
  • Effect of antiplatelet agents on platelet function
  • Patient’s maximum platelet function as a reference point
  • Percentage of inhibition relative to the patient’s reference point
45
Q

ADP receptor inhibitors=

A

clopidogrel, ticlopidine

46
Q

Arachidonic acid pathway inhibitors=

A

aspirin

47
Q

GPIIb/IIIa inhibitors=

A

abciximab, tirofiban, eptifibatide

48
Q

why should we use platelet mapping

A
  1. Individual response to antiplatelet drugs determines clinical outcome
    2, Knowing percent of platelet inhibition is insufficient to determine therapeutic efficacy
  2. Knowledge of maximum platelet function is also required as a reference point
49
Q

Rotational Elastometry (ROTEM)

A
  • Stationary cup, rotating spindle
  • Clot impedes rotation of the pin
  • Additional tests available

Perf Tech 3 (15 decks)

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