Thromboelastography (TEG)

Background

Tromboelastogram (TEG or ROTEM) is used to identify acute coagulopathies in both traumatic and nontraumatic patients. This enables focused use of blood products during resuscitation.

Features of a TEG Curve

• Initiation (R)
  • Factor VIIa and Tissue Factor
• Amplification (K)
  • Thrombin and activation of platelets
• Propagation (α-Angle)
  • Thrombin burst
• Clot strength (MA)
  • Strongest point of fibrin clot
• Clot stability (LY 30%)
  • Degree of fibrinolysis

Normal Values

• R: 4-8 min
• K: 1-4 min
• α-Angle: 47-74°
• MA: 55-73mm
• LY 30%: 0-8%

Abnormal Values

• Prolonged R
  • Factor deficiency (ie hemophilia)
  • Treat with FFP or protamine
• Prolonged K/Reduced α-Angle
  • Fibrinogen deficiency (ie DIC)
  • Treat with cryoprecipitate
• Reduced MA
  • Thrombocytopenia, platelet dysfunction (ie patient on clopidogrel)
  • Treat with platelets or DDAVP
• Elevated LY 30%
  • Rapid clot lysis (ie tPA given)
  • Treat with TXA

TEG Diagram

Normal thromboelastogram

See Also

Coagulopathy (Main) Transfusions

External Links

http://marylandccproject.org/core-content/utility-teg-blood-component-therapy/

Sources

Walsh M, Thomas SG, Howard JC, et al. Blood component therapy in trauma guided with the utilization of the perfusionist and thromboelastography. Journal of Extra-Corporeal Technology. 2011 Sep; 43(3):162-7.