Jerry Sapp, Blood Bank Supervisor at Birmingham’s respected Children’s Hospital of Alabama asks whether Thromboelastography would be of any use in monitoring the coagulopathy associated with massive transfusion.
Thromboelastography (TEG) is a global in vitro hemostasis assay that analyzes whole blood clotting patterns for the management of coagulopathies and anthrombotic therapy. Various forms of the Thromboelastograph are the Haemoscope TEG, Pentapharm ROTEM, Sienco Sonoclot, and Hemodyne PAS. TEG produces the thromboelastogram that records the clotting time (R), clot kinetics (K), clot strength (MA), and time to fibrinolysis. The thromboelastogram is affected by platelet function, integrity of the coagulation mechanism, and integrity of fibrinolysis.
Massive transfusion typically means post-trauma transfusion of at least ten units of red blood cells (adults) to prevent hemorrhagic shock, and may include administration of frozen plasma and platelet concentrate to control coagulopathy-induced bleeding. One review of massive transfusion therapy and coagulopathy management is Tien H, Nascimento B, Callum J, Rizoli S. An approach to transfusion and hemorrhage in trauma: current perspectives on restrictive transfusion strategies. J Can Chir 2007;50: 202-9. It references Shore-Lesserson L, Manspeizer HE, DePerio M, et al. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg 1999;88:312-9. The Shore-Lesserson reference is not a study of trauma-triggered massive transfusion but indicates TEG may be used to monitor coagulation efficacy duing blood product administration in cardiac surgery to reduce the usage of red cell, platelet, and plasma units. It is a stretch but the Tien implies we may generalize this conclusion to managing massive transfusion in trauma-induced hemorrhage management. Geo