Makindo Medical Notes

📋 About

• 🔍 Point-of-care test that measures viscoelastic properties of blood clotting
• ⚡ Real-time assessment of hemostatic function from clot initiation to fibrinolysis
• 🎯 Provides comprehensive picture of coagulation cascade, platelet function, and clot stability
• 🏥 Increasingly used in surgery, trauma, and critical care settings
• ⏱️ Results available in 5-30 minutes vs hours for traditional coagulation tests

🔬 Methodology

• 🩸 Sample: Fresh whole blood (citrated or native)
• 🔄 Principle: Measures resistance to shear as clot forms and dissolves
• 📈 Output: Real-time graphical trace showing clot development
• 🌡️ Temperature: Performed at 37°C
• ⚙️ Activators: Kaolin, tissue factor, or intrinsic pathway activators

📊 TEG Parameters & Normal Values

⏱️ R-Time (Reaction Time):

• 🎯 Normal range: 5-10 minutes
• 🔍 Measures: Time to initial fibrin formation
• 📈 Prolonged R: Factor deficiency, anticoagulation, hypofibrinogenemia
• 📉 Shortened R: Hypercoagulable state

📐 K-Time & Alpha Angle:

• 🎯 K-Time normal: 1-3 minutes
• 🎯 Alpha angle normal: 53-72 degrees
• 🔍 Measures: Rate of clot strengthening/fibrin polymerization
• 📈 Prolonged K/Low α: Hypofibrinogenemia, thrombocytopenia
• 📉 Shortened K/High α: Hyperfibrinogenemia

💪 MA (Maximum Amplitude):

• 🎯 Normal range: 50-70 mm
• 🔍 Measures: Maximum clot strength (platelets + fibrinogen)
• 📈 High MA: Thrombocytosis, hyperfibrinogenemia
• 📉 Low MA: Thrombocytopenia, platelet dysfunction, hypofibrinogenemia

📉 LY30 (Lysis at 30 minutes):

• 🎯 Normal range: 0-8%
• 🔍 Measures: Fibrinolysis/clot breakdown
• 📈 High LY30 (>8%): Hyperfibrinolysis
• 📉 Low LY30: Impaired fibrinolysis

🩺 Clinical Applications

🏥 Perioperative Management:

• 🔪 Cardiac surgery: Guide blood product transfusion
• 🫀 Liver transplant: Monitor complex coagulopathy
• 🦴 Orthopedic surgery: Assess bleeding risk
• 💉 Anticoagulation reversal: Monitor effectiveness

🚨 Emergency & Trauma:

• 🩸 Massive transfusion: Guide component therapy ratios
• 🚗 Trauma coagulopathy: Early detection and management
• 🧠 Intracranial hemorrhage: Rapid coagulation assessment
• ⚡ DIC diagnosis: Real-time coagulation monitoring

🏥 Critical Care:

• 🦠 Sepsis: Monitor coagulation changes
• 🫁 ECMO patients: Anticoagulation monitoring
• 💊 Drug monitoring: Antiplatelet and anticoagulant effects

🎯 TEG-Guided Transfusion Algorithm

📈 Prolonged R-time (>10 min):

• 💉 Give: Fresh Frozen Plasma (FFP) 10-15 mL/kg
• 🅰️ Alternative: Prothrombin Complex Concentrate (PCC)
• 🎯 Target: R-time 5-10 minutes

📐 Low Alpha angle (<53°) or prolonged K (>3 min):

• 🧪 Give: Cryoprecipitate 1-2 units/10kg
• 🎯 Target: Fibrinogen >1.5-2.0 g/L
• 📊 Alternative: Fibrinogen concentrate

💪 Low MA (<50 mm):

• 🔴 Give: Platelets 1 unit/10kg (or 4-6 units adult)
• 🎯 Target: Platelet count >50 × 10⁹/L
• 💊 Consider: Desmopressin (DDAVP) if platelet dysfunction

📉 High LY30 (>8%):

• 💊 Give: Tranexamic acid 1g IV bolus
• ⚡ Consider: Aminocaproic acid as alternative
• 🎯 Target: LY30 <8%

✅ Advantages of TEG

• ⚡ Rapid results: Real-time monitoring vs hours for lab tests
• 🎯 Targeted therapy: Specific component deficiency identification
• 🩸 Whole blood: Tests entire hemostatic system
• 💰 Cost-effective: Reduced inappropriate transfusions
• 📊 Comprehensive: Covers coagulation, platelets, and fibrinolysis
• 🏥 Point-of-care: Bedside testing available

❌ Limitations

• 👨‍⚕️ User-dependent: Requires training and experience
• 🩸 Sample sensitive: Quality affects results
• 💰 Equipment cost: Initial investment required
• ⚙️ Standardization: Different machines may give varying results
• 🔬 Research needed: More studies needed in some clinical areas
• ❄️ Temperature sensitive: Hypothermia affects results

🔍 Interpretation Examples

🩸 Hemorrhagic Pattern:

• 📈 Prolonged R-time + Low MA = Factor deficiency + Thrombocytopenia
• 📊 Normal R + Low α angle = Hypofibrinogenemia
• 📉 High LY30 = Hyperfibrinolysis

🧬 Hypercoagulable Pattern:

• 📉 Shortened R-time + High MA = Hypercoagulable state
• 📈 High α angle = Hyperfibrinogenemia
• 📊 Low LY30 = Impaired fibrinolysis

🔄 ROTEM vs TEG

• 🔬 ROTEM: Rotational thromboelastometry (European)
• 📊 TEG: Thromboelastography (American)
• ⚙️ Similar principles: Both measure viscoelastic properties
• 📈 Different parameters: ROTEM uses CT, CFT, MCF vs R, K, MA
• 🎯 Clinical utility: Both guide blood product therapy

📚 References

• 📖 Society of Cardiovascular Anesthesiologists Guidelines
• 🏥 European Society of Anaesthesiology Guidelines
• 📕 Hemostasis and Thrombosis: Basic Principles
• 🔬 Journal of Thrombosis and Haemostasis
• 📋 American Society of Anesthesiologists Task Force
• 🩸 Transfusion Medicine Reviews

💡 KEY TAKEAWAY: TEG provides rapid, comprehensive assessment of hemostasis, enabling targeted blood product therapy and improved patient outcomes in bleeding scenarios