TEG Nonsense

Question 1

What does the TEG-ACT rapid measure, and what is the normal range?

Answer 1

Activated clotting time to initial fibrin formation. 80 - 140 sec

Question 2

What does R-time measure? Range?

Answer 2

Reaction time to initial fibrin formation. 5 - 10 min

Question 3

What does K-time measure? Range?

Answer 3

Kinetic time for fibrin cross linkages to reach 20 mm clot strength (simple version, measures clot strength and fibrinogen/number of platelets). 1 - 3 min

Question 4

What does alpha angle measure? Range?

Answer 4

Angle from baseline to slope of tracing that represent clot formation (gives insight to fibrinogen and number of platelets). 53 to 72 degrees

Question 5

What does MA measure? Range?

Answer 5

Maximum amplitude of tracing which indicates platelet number/function, 50 - 70 mm

Question 6

What does G value measure? Range?

Answer 6

Calculated value of clot strength (gives insight to the entire coagulation cascade) 5.3 - 12.4 dynes/cm2

Question 7

What does LY30 measure? Range?

Answer 7

Clot lysis at 30 minutes following MA (measure of fibrinolysis), 0 - 3%

Question 8

What is the treatment for a high TEG-ACT? Include the lab value

Answer 8

Greater than 140, give FFP

Question 9

What is the treatment for a high R time? Include the lab value

Answer 9

Greater than 10, give FFP (most common choice) or give a PCC (pro-thrombin complex)

Question 10

What is the treatment for a high K time? Include the lab value

Answer 10

Greater than 3, give Cryo

Question 11

What is the treatment for a low alpha angle? Include the lab value

Answer 11

Less than 53 degrees, Cryo and platelets

Question 12

What is the treatment for a low MA? Include the lab value

Answer 12

Less than 50, give platelets

Question 13

Identify the TEG tracing

Answer 13

Normal

Question 14

Identify the TEG tracing

Answer 14

Heparin or warfarin

Question 15

Identify the TEG tracing

Answer 15

Qualitative or quantitative platelet dysfunction (looks similar to DIC with platelet coagulation/factor depletion, take note that the R time is NOT exaggerated here whereas in that stage of DIC it is elongated)

Question 16

Identify the TEG tracing

Answer 16

Hyperfibrinolysis

Question 17

Identify the TEG tracing

Answer 17

Hypercoagulable state

Question 18

Identify the TEG tracing

Answer 18

DIC with intravascular thrombosis with secondary hyperfibrinolysis

Question 19

Identify the TEG tracing

Answer 19

DIC with platelet coagulation and factor depletion

Question 20

What is the dose of DDAVP?

Answer 20

0.3 mcg/kg in 50 mL given over 15-20 minutes. Maximal effect in 30 minutes, lasts 6-8 hours. Tachyphylaxis is a concern.

Question 21

What must be done after administration of DDAVP?

Answer 21

Water restriction; very easy for patient to become hyponatremic and progress to seizure/coma/death

Question 22

What would you give to a vWF deficient patient not responding to DDAVP? What would you give if your hospital is rich?

Answer 22

Cryo with normal hospitals. Factor VIII concentrate if your hospital can also afford gold toilet seats

Question 23

If MA is low, what would you give if FF (functional fibrinogen) is low? FF is normal?

Answer 23

FF low = Cryo
FF normal = give platelets