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Perf Tech III (Exam 3) > Topic 13: TEG > Flashcards

Topic 13: TEG Flashcards

1
Q

Clot strength - platelet to fibrin ratio

A
  • Platelets 80%-90%

* Fibrin 10%-20%

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2
Q

Tests that are Component Measurements of clots?

A
  • PT/INR:
  • PTT:
  • Fibrinogen concentration
  • Platelet Count
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3
Q

•PT/INR: measures what?

A

measures extrinsic clotting (VIIa, Xa, IIa)

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4
Q

•PTT:

A

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

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5
Q

Test that Measures component interactions

A
  • TEG

* Shows net effect “whole picture” of hemostasis

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6
Q

TEG is ?

A
  • A whole blood hemostasis analyzer

* Point of care test

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7
Q

How does TEG 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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8
Q

R

A

is the time of latency from the time that the blood was placed in the TEG until the fibrin formation

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9
Q

R

likely variable?

A

Reaction time (time to clot formation)
is the time of latency from the time that the blood was placed in the TEG until the fibrin formation
(coagulation factors)

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10
Q

alpha - α

likely variable?

A

Speed of fibrin accumulation
measure the rapidity of the fibrin build up and cross linking, that is, the speed of clot strengthening
(Fibrinogen)

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11
Q

K

likely variable?

A

Time elapsed until clot reaches a fixed strength
K time is a measure of the rapidity to reach a certain level of clot strength
(Fibrinogen)

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12
Q

MA

likely variable?

A

max amplitude, is a direct function of the max dynamic properties of fibrin and platelet bonding via GPIIb/GPIIIa and represents the ultimate strength of the fibrin clot
Highest vertical amplitude of TEG tracing
(Platelets)

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13
Q

CI

A

coagulation index is a linear combination of MA, K, Alpha, R

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14
Q

LY30

likely variable?

A

measures the rate of amplitude reduction every 30 minutes after MA. gives an indication of stability of the clot
% of amplitude reduction 30 minutes after its maximum
(Fibrinolysis)

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15
Q

LY30

likely variable?

A

measures the rate of amplitude reduction every 30 minutes after MA. gives an indication of stability of the clot
% of amplitude reduction 30 minutes after its maximum
(Fibrinolysis)

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16
Q

Standard (kaolin)

A

•Uses normal parameters

uses CI, MA, LY30, K, R alpha

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17
Q

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
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18
Q

Heparinase

A

•Used on bypass or post bypass alongside a standard TEG

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19
Q

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
  • AA: Aspirin
  • ADP: Clopidogrel
  • Run alongside a standard TEG and a TEG with added AA or ADP.
  • Calculates platelet inhibition as a percentage
20
Q

Elongated R-Thrombin Formation Abnormalities:

Possible cause of imbalance:

A

•Slow enzymatic reaction

21
Q

Elongated R-Thrombin Formation Abnormalities:

Possible Etiologies

A
  • Factor deficiency/dysfunction

* Residual heparin

22
Q

Elongated R-Thrombin Formation Abnormalities:

Common Treatments:

A
  • FFP

* Protamine

23
Q

Low alpha angle - Fibrin formation

Possible cause of imbalance

A

slow rate of fibrin formation

24
Q

Low alpha angle - Fibrin formation

possible etiologies

A

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

25
Q

Low alpha angle - Fibrin formation

Common treatments

A
  • FFP

* Cryoprecipitate

26
Q

Low MA - possible causes?

A

Insufficient platelet-clot formation

27
Q

Low MA - possible etiologies

A

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

28
Q

Low MA - common treatments?

A

Platlets

29
Q

High MA - possible causes?

A

Excessive platelet activity

30
Q

High MA - possible etiologies?

A

Platelet

hypercoagulability

31
Q

High MA - common treatments

A

antiplatelet agents

32
Q

Platelet mapping measures what??

A

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

33
Q

Platelet mapping – what drugs are monitored?

A

Antiplatelet Drugs
•ADP receptor inhibitors
•Examples: clopidogrel, ticlopidine

  • Arachidonic acid pathway inhibitors
  • Example: aspirin
  • GPIIb/IIIa inhibitors
  • Examples: abciximab, tirofiban, eptifibatide
34
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

35
Q

Rotational Elastometry (ROTEM)

A

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

36
Q

R time between 7-10 min
clinical cause?
suggested treatment?

A

decrease clotting factors

1 FFP or 4 ml/kg

37
Q

R time between 11-14 min
clinical cause?
suggested treatment?

A

decrease clotting factors x2

2 FFP or 8 ml/kg

38
Q

R time greater than 14
clinical cause?
suggested treatment?

A

decrease clotting factors x3

4 FFP or 16 ml/kg

39
Q

MA between 49 - 54mm
clinical cause?
suggested treatment?

A

decrease platelet function

.3mcg/kg DDAVP

40
Q

MA between 41-58mm
clinical cause?
suggested treatment?

A

decrease platelet function

x5 platelet units

41
Q

MA 40 mm or less
clinical cause?
suggested treatment?

A

decrease platelet function x2

x10 platelets units

42
Q

LY30 7.5% or greater, CI less than 3.0
clinical cause?
suggested treatment?

A

primary fibrinolysis

antifibrinolytic

43
Q

LY30 7.5% or greater, CI greater than 3.0
clinical cause?
suggested treatment?

A

secondary fibrinolysis

anticoagulant of choice

44
Q

LY30 less than 7.5%, CI greater than 3.0
clinical cause?
suggested treatment?

A

prothrombotic state

anticoagulant of choice

45
Q

Antiplatelet Drugs
•ADP receptor inhibitors
•Examples:

A

Clopidogrel

Ticlopidine

46
Q

Antiplatelet Drugs
•Arachidonic acid pathway inhibitors

•examples

A

Aspirin

47
Q

Antiplatelet Drugs
•GPIIb/IIIa inhibitors

•Examples:

A

abciximab, tirofiban, eptifibatide

Perf Tech III (Exam 3) (4 decks)

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