Blood clot elastography Rotem - Test to determine the cause of bleeding

Article by Specialist Doctor II Nguyen Trung Thanh - Anesthesiologist - Anesthesiology Department - Vinmec Central Park International Hospital

Thromboelastometry is a method of testing the coagulation of citrated whole blood samples. ROTEM measures the interaction of clotting factors, inhibitors and the role of blood cells in the stages of clot formation and lysis over time.
ROTEM chart has 2 stages: coagulation phase and fibrinolytic phase. The coagulation phase is the period from the start of the blood test to the time when maximal strength of the clot is reached. The fibrinolysis phase is the next phase to the end of the test.
The parameters on the chart include:
Clotting time (CT): is the time from the time of the test until the 2mm amplitude is reached, this is the period from the beginning of the coagulation and thrombin formation to the beginning. firinization. Clot formation time (CFT): is the time from reaching an amplitude of 2 mm to reaching an amplitude of 20 mm, representing the effect of platelets and fibrinogen in stabilizing blood clots. A5 or A10: is the amplitude at 5 minutes or 10 minutes, is the stage of blood clot formation. Angle α: angle between the horizontal line and the coagulation asymptote at the 2 mm amplitude point. Maximal clot firmness (MCF): is the maximum amplitude that can be achieved before fibrinolysis begins. Lysis index (LI30, LI60): is the percentage of amplitude relative to the MCF at the time after 30 minutes or 60 minutes. Maximum lysis (ML) is the maximum lysis achieved during the test

Usually, routine coagulation tests performed in the laboratory give results in as little as 30 minutes. This time is not too long for non-emergencies due to the patient's condition to be expected, but will be considered a delay in life-threatening emergencies due to unresolved bleeding. determine the cause of the bleeding disorder. The rapid assessment of coagulation function will orient the physician to correct treatment and save the patient in time.
Initial values ​​of clot amplitude at 5 min and 10 min can predict clot amplitude in ROTEM kit, thereby providing early guidance for transfusion of blood and blood products instead of empiric management or waiting for routine coagulation test results to be available. Recent studies around the world have demonstrated that there is a strong correlation between ROTEM test and routine coagulation tests. Currently, ROTEM has been applied in cases of liver transplant, heart transplant, and other surgeries with risk of heavy bleeding during surgery such as obstetric surgery or trauma surgery.
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