TEG

Question 1

Transfuse what?

TEG-ACT > 140

Answer 1

FFP

Very delayed clot initiation (coag factors low)

Question 2

Transfuse what?

R time > 10

Answer 2

FFP

Clot is taking too long to start (low coag factors)

Question 3

Transfuse what?

K time > 3

Answer 3

Cryo

Clot is forming too slowly (often low fibrinogen)

Question 4

Transfuse what?

Alpha angle < 53

Answer 4

Cryo +/- plts

Clot build rate is weak (fibrinogen low ± low platelets)

Question 5

Transfuse what?

MA < 50

Answer 5

Plts

Clot strength is weak (low platelets or dysfunction)

Question 6

Transfuse what?

LY30 > 3%

Answer 6

TXA

Clot is breaking down too fast (hyperfibrinolysis)

Question 7

ROTEM

Is CT (clotting time) prolonged, indicating delayed clot formation?
If yes?
If normal?

Answer 7

Yes? Give FFP or PCC
If normal? Is MCF (maximum clot firmness) too low, indicating weak clot?

Question 8

ROTEM

Is MCF (maximum clot firmness) too low, indicating weak clot?
If yes?
If normal?

Answer 8

Yes? Check FIBTEM MCF (test that measures clot formation from fibrin only) and ROTEM (Rotational Thromboelastometry) platelet if available
Normal? Is L130 (the percentage of clot lysis (breakdown) 30 minutes after maximum clot strength is reached) too high indicating too much lysis?

Question 9

ROTEM

After youve checked if FIBTEM MCF and ROTEM platelet is available what do you do? (2)

Answer 9

If FIBTEM MCF is low, give cryo.
If FIBTEM MCF is normal or ROTEM platelet is low, give platelets.

Question 10

If L130 is too high indicating too much lysis, then give what?

Answer 10

TXA