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Perf tech 3 > TEG > Flashcards

TEG Flashcards

1
Q

Hemostasis: tightly regulated process by

A
  • Activation

* Clot formation • Clot lysis

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2
Q

Clot: platelet-fibrin network

A

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

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3
Q

platelets percentage of platelet- fibrin network

A

80%-90%

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4
Q

fibrin percentage of platelet fibrin network

A

10%-20%

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5
Q

Component Measurements • PT/INR:

A

measures extrinsic clotting (VIIa, Xa, IIa)

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6
Q

Component Measurements PTT:

A

measures intrinsic clotting (XIIa, Xia, IXa, IIa)

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7
Q

other two component measurement tests

A

• Fibrinogen concentration • Platelet Count

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8
Q

Measurement of component interactions • TEG

A

Shows net effect “whole picture” of hemostasis

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9
Q

what is TEG

A

A whole blood hemostasis analyzer • Point of care test

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10
Q

how does TEG machine work

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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11
Q

coagulation parameters of TEG graph

A

enzymatic(R) Fibrinogen (K, alpha)

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12
Q

enzymatic(R) what it measures

A

clotting time, coag. factors

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13
Q

Fibrinogen (K, alpha) what it measures

A

clot kinetics

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14
Q

fibrinolysis parameters of TEG graph

A

thrombolysins (Ly30, EPL)

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15
Q

thrombolysins (Ly30, EPL) what it measure

A

clot stability and clot breakdown

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16
Q

thrombolysins (Ly30, EPL) what it measure

A

clot stability and clot breakdown

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17
Q

formal definition of TEG parameters (R)

A

latency from time blood was placed in TEG until initial fibrin formation

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18
Q

formal definition of TEG parameters (ALPHA)

A

rapidity (kinetics) of fibrin building and cross linking

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19
Q

formal definition of TEG parameters (K)

A

measure of rapidity to reach a certain clot strength

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20
Q

formal definition of TEG parameters (MA)

A

Max amplitude is a direct function of the max dynamic properties of fibrin and platelet bonding via GPIIB/IIIA and represents ultimate strength of fibrin clot

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21
Q

formal definition of TEG parameters (Cl)

A

coagulation index is a linear combo of above parameters

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22
Q

formal definition of TEG parameters (LY30)

A

measures the rate of amplitude reduction 30 minutes after MA. Gives indication of stability of clot

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23
Q

formal definition of TEG parameters (LY30)

A

measures the rate of amplitude reduction 30 minutes after MA. Gives indication of stability of clot

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24
Q

or more simply (R)

A 
Reaction time (time to clot formation). Likely variable is 
Coagulation Factors
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25
Q

or more simply (α)

A

Speed of fibrin accumulation. likely variable is

Fibrinogen

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26
Q

or more simply (K)

A

Time elapsed until clot reaches a fixed strength

likely variable isFibrinogen

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27
Q

or more simply (MA)

A

Highest vertical amplitude of TEG tracing

likely variable isPlatelets

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28
Q

or more simply (LY30)

A

% of amplitude reduction 30 minutes after its maximum

likely variable is Fibrinolysis

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29
Q

TEG assays Standard (kaolin)

A

uses parameters listed above

30
Q

TEG assays Rapid TEG

A

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

31
Q

TEG assays heparinase

A

Used on bypass or post bypass alongside a standard TEG

32
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

33
Q

AA: Aspirin • ADP: Clopidogrel

A

Run alongside a standard TEG and a TEG with added AA or ADP. • Calculates platelet inhibition as a percentage

34
Q

elongated ( R) thrombin formation abnormalities Possible cause of imbalance:

A

Slow enzymatic

reaction

35
Q

elongated ( R) thrombin formation abnormalities Possible Etiologies

A

Factor deficiency/dysfunction • FFP • Protamine

36
Q

elongated ( R) thrombin formation abnormalities

Common Treatments:

A

• FFP • Protamine

37
Q

LOW (α) angle fibrinogen abnormalities. Possible cause of imbalance

A

• Slow rate of fibrin formation

38
Q

LOW (α) angle fibrinogen abnormalities. Possible etiologies.

A 
•	Low fibrinogen levels or
function •	Insufficient rate/amount of
thrombin generation •	Platelet deficiency/dysfunction
39
Q

LOW (α) angle fibrinogen abnormalities

Common Treatments

A

FFP • Cryoprecipitate

40
Q

LOW (α) angle fibrinogen abnormalities. Possible etiologies.

A 
•	Low fibrinogen levels or
function •	Insufficient rate/amount of
thrombin generation •	Platelet deficiency/dysfunction
41
Q

LOW (α) angle fibrinogen abnormalities

Common Treatments

A

FFP • Cryoprecipitate

42
Q

Low MA platelet function abnormalities. Possible causes: •

A

Insufficient platelet-clot

formation

43
Q

Low MA platelet function abnormalities, Possible etiologies

A

Poor platelet function • Low platelet count • Low fibrinogen levels or
function

44
Q

Low MA platelet function abnormalities. Common treatments:

A

• Platelets

45
Q

High MA platelet function abnormalities. possible causes:

A

Excessive platelet activity

46
Q

High MA platelet function abnormalities. Possible etiologies

A

• Platelet hypercoagulability

47
Q

High MA platelet function abnormalities. Common Treatments

A

Antiplatelet agents

48
Q

R between 7-10 min

A

slight decrease in clotting factors. give x 1FFP or 4 ml/kg

49
Q

R between 11-14 min

A

moderate decrease in clotting factors. give x 2FFP or 8 ml/kg

50
Q

R between >14 min

A

significant decrease in clotting factors. give x 4FFP or 16 ml/kg

51
Q

MA between 49-54 mm

A

slight decrease in platelet function. .3 mcg/kg DDAVP

52
Q

MA between 41-48 mm

A

moderate decrease in platelet function. x5 platelet units

53
Q

MA

A

significant decrease in platelet function. x 10 platelet units

54
Q

(α) angle less than 45 degress

A

moderate decrease in fibrinogen levels. .06 u/kg cryoprecipitate

55
Q

(α) angle less than 45 degress

A

moderate decrease in fibrinogen levels. .06 u/kg cryoprecipitate

56
Q

LY30 AT 7.5% or greater with C.I. less than 3

A

primary fibrinolysis. antifibrinolytic of choice

57
Q

LY30 AT 7.5% or greater with C.I. greater than 3

A

secondary fibrinolysis. anticoagulant of choice

58
Q

LY30 LESS THAN 7.5% or greater with C.I. greater than 3

A

prothrombotic state. anticoagulant of choice

59
Q

platelet mapping measures

A

Measures the effect of antiplatelet agents on platelet function • Measures the patient’s maximum platelet function as a
reference point
• Measures the percentage of inhibition relative to the patient’s reference point

60
Q

platelet mapping antiplatelet drugs, ADP receptor inhibitors

A

Examples: clopidogrel, ticlopidine

61
Q

platelet mapping antiplatelet drugs, Arachidonic acid pathway inhibitors

A

• Example: aspirin

62
Q

platelet mapping antiplatelet drugs, GPIIb/IIIa inhibitors

A

Examples: abciximab, tirofiban, eptifibatide

63
Q

why platelet mapping

A
  • Individual response to antiplatelet drugs determines clinical outcome
  • Knowing percent of platelet inhibition is insufficient to determine therapeutic efficacy
  • Knowledge of maximum platelet function is also required as a reference point
64
Q

why platelet mapping

A
  • Individual response to antiplatelet drugs determines clinical outcome
  • Knowing percent of platelet inhibition is insufficient to determine therapeutic efficacy
  • Knowledge of maximum platelet function is also required as a reference point
65
Q

rotational elastometry ROTEM

A

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

66
Q

INTEM

A

contains phospholipid and ellagic acid as activators amd provides info. similar to that of the APTT

67
Q

EXTEM

A

contains tissue factor as an activator and provides info. similar to that of the PT

68
Q

HEPTEM

A

contains lyophilised heparinase for neutralizing heparin

69
Q

APTEM

A

contains aprotinin for inhibiting fibrinolysis

70
Q

FIBTEM

A

utilises cytochalasin D, a platelet inhibitor which blocks platelet contribution to clot formation. this allows qualitative analysis of the functional fibrinogen component

71
Q

ECATEM

A

contains ecarin so it is similar to ecarin clotting time. this makes it sensitive to presence of direct thrombin inhiitors

Perf tech 3 (14 decks)

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