Blood Management Anesthesiology Clinics

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Presentation transcript:

Blood Management Anesthesiology Clinics Ajay Kumar, MD, SFHM, Moises Auron, MD, SFHM, Mark Ereth, MD, MA Anesthesiology Clinics Volume 31, Issue 2, Pages 433-450 (June 2013) DOI: 10.1016/j.anclin.2013.02.001 Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 1 A thrombelastography (TEG) machine. Anesthesiology Clinics 2013 31, 433-450DOI: (10.1016/j.anclin.2013.02.001) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 2 A pin is suspended in the blood by a torsion wire and is monitored for motion. The torque of the rotation cuvette is transmitted to the immersed pin only after fibrin-platelet bonding has linked the cuvette and pin together. Anesthesiology Clinics 2013 31, 433-450DOI: (10.1016/j.anclin.2013.02.001) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 3 The characteristics of TEG tracings include R (activation), angle (α), MA (maximal clot strength), and lysis (fibrinolysis). Image: “TEG Tracing Graphic” is used by permission of Haemonetics Corporation. TEG® and Thrombelastograph® are registered trademarks of Haemonetics in the US, other countries or both. Anesthesiology Clinics 2013 31, 433-450DOI: (10.1016/j.anclin.2013.02.001) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 4 Test principle of rotational TEG (ROTEM). Citrated whole blood, native whole blood, or plasma (300 μL) and test reagents are pipetted semiautomatically into a single-use plastic cup that is set onto a plastic pin on a rotating vertical axis (±4.75°) guided by ball bearings. The increasing firmness of the clot gradually reduces the movement of the pin. Movement is continuously detected by using a light source, a reflecting mirror on the rotating axis, and a detector chip. The reduction in movement is mathematically transformed into clot firmness (amplitude in millimeters) and plotted against time (in seconds), resulting in a thromboelastometric trace. (From Kozek-Langenecker SA. Perioperative coagulation monitoring. Best Pract Res Clin Anaesthesiol 2010;24:27–40; with permission.) Anesthesiology Clinics 2013 31, 433-450DOI: (10.1016/j.anclin.2013.02.001) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 5 ROTEM curve and parameters. (From Armstrong S, Fernando R, Ashpole K, et al. Assessment of coagulation in the obstetric population using ROTEM(R) thromboelastometry. Int J Obstet Anesth 2011;20(4):293–8; with permission.) Anesthesiology Clinics 2013 31, 433-450DOI: (10.1016/j.anclin.2013.02.001) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 6 Operating room transfusion algorithm. ACT, activated clotting time; aPTT, activated partial thromboplastin time; MA, maximum amplitude; PLT, platelet count; PT, prothrombin time. (Adapted from Nuttall GA, Oliver WC, Santrach PJ, et al. Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology 2001;94:780; with permission.) Anesthesiology Clinics 2013 31, 433-450DOI: (10.1016/j.anclin.2013.02.001) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 7 Percentage of patients transfused intraoperatively before traditional clinical practice and laboratory-guided algorithm. FFP, fresh frozen plasma. (Adapted from Nuttall GA, Oliver WC, Santrach PJ, et al. Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology 2001;94:773–81; with permission.) Anesthesiology Clinics 2013 31, 433-450DOI: (10.1016/j.anclin.2013.02.001) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 8 Coagulation tests predict bleeding in the intensive care unit after cardiac surgery. ACT, activated clotting time; aPTT, activated partial thromboplastin time; MA, maximum amplitude; PLT, platelet count; PT, Prothrombin time. (Adapted from Nuttall GA, Oliver WC, Santrach PJ, et al. Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology 2001;94:773–81; with permission.) Anesthesiology Clinics 2013 31, 433-450DOI: (10.1016/j.anclin.2013.02.001) Copyright © 2013 Elsevier Inc. Terms and Conditions