Thromboelastography (TEG)

Background

Tromboelastogram (TEG or formerly 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

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.