6. Thromboelastography Flashcards
TF function
converts F7 to F7a
F7a function
converts F10 to F 10a
F10a function
generates thrombin
thrombin function
activates more plts and more factors to amplify clotting
incr plt SA =
incr binding
incr clotting
thrombin activates
plts
Factor 5
Factor 9
thrombin convert
fibrinogen to fibrin to reinforce the clot
tPA function
converts plasminogen to plasmin
plasmin function
breaks clot apart
thromboelastography
“recording the ability of a thrombus to change”
thrombus
ability to change
record
what blood is used for TEG
whole blood
what tube is needed for TEG
blue top
how long TEG results
15-45 mins
R time
time to beginning of start of clot formation
normal R time
5-10 mins
prolonged R time indicates
clotting factor deficiency
prolonged R time treatment
FFP
kinetics time
- end of R to where clot reaches 20 mm
- time to clot forming a fixed strength
kinetics time normal
1-3 mins
prolonged kinetics time
fibrinogen deficiency
prolonged kinetics time treatment
cryo
alpha angle
speed of fibrin acculumlation
thrombin burst
alpha angle normal
53-72 deg
low alpha angle
fibrinogen deficiency
low alpha angle treatment
cryo
MA
measure of strength of fully formed clot
normal MA
50-70 mm
decr MA
plt deficiency
decr MA treatment
plts
DDAVP
LY30
% of fibrinolysis of clot after 30 mins
normal LY30
0-8%
high LY30
hyperfibrinolytic pt
high LY30 treatment
TXA
TEG pros
whole blood
real-time results
show prothrombosis
TEG does not indicate
uremia
vW disease
apsirin
TEG does not test
pt adhesion to tissue
what does TEG test
self-adhesion only
DIC
abnormal systemic blood clotting leading to organ failure
concomitant consumtpion to plts and factors which lead to hemorrhagic complication
DIC S+S
excessive bleeding
excessive clotting
excessive clotting features (3)
ARDS
renal impairement
CNS derangements
thresholds to treat PLTs
< 50,000
low PLT treat
1-2 units of PLTs
firbinogen threshold
< 1.5-2 g/L
low fibrinogen treatment
5-10 units cryo
or
2 g fibrinogen concentrate
PT/PTT threshold
1.5x normal
high PT/PTT treatment
15-30 mL/kg FFP
should you treat bleeding in DIC
yes
what labs for possible DIC
clotting panel (blue top)
TEG (blue top)
DIC labs
CBC
clotting screen
serum fibrinogen
D-Dimer
DIC lab frequency
6-8 hrs
DIC treatment for lab evident DIC
LMWH
blood support order DIC
plt
cryo/fibrinogen
FFP