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![Variables measured by the TEG® and ROTEM®
Variable TEG® ROTEM®
Measurement period - Reaction Time [RT]
Time from start to when the
waveform reaches 2mm above
baseline
R Clotting Time [CT]
The time from 2mm above
baseline to 20mm above baseline
K Clot Formation Time [CFT]
Alpha angle [°] α [slope between R and K] α [angle of tangent at 2mm
amplitude]
Maximum angle - CRF
Maximum strength Maximal Amplitude [MA] Maximal Clot Firmness [MCF]
Time to Maximum strength - MCF-t
Amplitude at a specific time A30, A60 A5, A10...
Clot elasticity G MCE
Maximum lysis - CLF
Clot Lysis[CL] at a specific time
[minutes]
CL30, CL60 LY30, LY45, LY60
Time to lysis 2mm from MA CLT [10% difference from MCF]](https://image.slidesharecdn.com/massivetransfusion-150330063048-conversion-gate01/75/Massive-transfusion-16-2048.jpg)
Uploaded byRafiq Ahmad
Massive transfusion
This document defines massive transfusion as replacing one blood volume or more within 24 hours, which corresponds to approximately 10 units of blood for a 70 kg adult. Massive transfusion can cause numerous complications including dilution coagulopathies, hypothermia, acidosis, and tissue hypoxia. The overall mortality for patients requiring massive transfusion is around 40% but increases to over 75% for those who develop hemostatic disorders. Proper use of massive transfusion protocols which rapidly provide blood products can help minimize complications and reduce mortality rates.
In this document
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Introduction by Dr. Rafiq Ahmad on the topic of Massive Transfusion.
Defined as replacing 1 blood volume (70 mL/Kg) within 24 hours, with specifics on levels of blood transfusion.
Conditions indicating massive transfusion: 10+ units in 24 hours, >150mL/min blood loss, and specific definitions for children.
Mortality rates associated with massive transfusions: 40% overall, >75% in patients with hemostatic disorders.
Metabolic disturbances resulting from massive transfusion: dilution coagulopathies and their recognition to minimize morbidity.
Complications include hemodilution and the 'Lethal Triad' of hypothermia, acidosis, and coagulopathy.
Overview of changes in red blood cells during storage.
Comparative data showing parameters like pH and ATP levels pre and post-storage of red blood cells.
Impacts of transfusion on patients, specifically concerning physiological changes.
Further complications associated with massive transfusion, including citrate toxicity and air embolism.
Discussion on the Massive Transfusion Protocol (MTP) and two models for implementing it.
Focus on laboratory-driven massive transfusion involving measurement techniques for coagulation.
Interpretation of Thromboelastography (TEG) data in the context of blood transfusion management.
Introduction to Rotational Thromboelastometry (ROTEM) as an additional TEG technique.
Comparison of key variables measured by TEG and ROTEM, including clot formation and strength metrics.
Current research products include whole blood transfusions, freeze-dried plasma, and stem-cell derived RBCs.
Final remarks and acknowledgments by Dr. Rafiq Ahmad, concluding the presentation.
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Massive transfusion
- 1. Dr. RAFIQ AHMAD MassiveTransfusion
- 2. Definition It ismost commonly defined as replacing 1 blood volume or more within 24 hours One blood volume corresponds to 70 mL/Kg of a typical adults body weight (15 units of blood for a 70 Kg patient; however many facilities estimate 10 units as 1 blood volume). Half of the patient’s blood volume is replaced within 3 hours. More than 4 red cell units transfused within 4 hours with continuous bleeding.
- 3. Other Conditions Morethan 10 units of red cells transfused within 24 hours, or from the time of admission in ER to ICU transfer. More than 20 units of red cells transfused during the entire course of admission Blood loss is more than 150mL/min. In children, it is defined as transfusion of >40 mL/kg (blood volume over 1 month old is approximately 80 mL/kg).
- 4. Morbidity/Mortality The overallmortality of patients requiring massive transfusion is 40%. In patients who develop hemostatic disorders , the mortality rate is > 75%. Other prognostic indicators include underlying conditions such as cirrhosis, cardiopulmonary or cerebrovascular disease, advanced age, and prolonged hypertension Massive transfusion can have numerous deleterious effects on the body
- 5. Morbidity andmortality due to massive transfusion is a direct result of concomitant metabolic disturbances. They include dilution coagulopathies, hypothermia, and tissue hypoxia causing tissue damage and acidosis. The abilities to recognize and treat these adverse conditions associated with massive transfusion can minimize morbidity.
- 6. Complications of MassiveTransfusion Hemodilution from crystaloid fluid resuscitation “Lethal Triad” Hypothermia Acidosis Coagulapathy
- 7. Red cell storageLesions
- 8. Altered Parameters instored RBCs Characteristic Pre-storage Post-storage pH 6.8 6.4 ATP (μmol/g Hb) 4.1 2.9 DPG (μmol /g Hb) 9.0 0.3 Potassium (mEq/L) 2.4 63 Glucose (mg/dl) 608 402 Plasma Hb (mg/dl) 39 372 Hemolysis (%) -- 0.61
- 9. Pre &Post transfusionEffects
- 10. Additional Complications CitrateToxicity Potassium abnormalities Air embolism
- 11. Management of MassiveTransfusion Massive Transfusion Protocol (MTP) 2 Models >Laboratory-driven (Pull) MTP: >Formula-driven (Push) MTP:
- 13. Laboratory-driven (Pull) MTP: MeasuringCoagulation Thromboelastography (TEG)
- 14.
- 15.
- 16. Variables measured bythe TEG® and ROTEM® Variable TEG® ROTEM® Measurement period - Reaction Time [RT] Time from start to when the waveform reaches 2mm above baseline R Clotting Time [CT] The time from 2mm above baseline to 20mm above baseline K Clot Formation Time [CFT] Alpha angle [°] α [slope between R and K] α [angle of tangent at 2mm amplitude] Maximum angle - CRF Maximum strength Maximal Amplitude [MA] Maximal Clot Firmness [MCF] Time to Maximum strength - MCF-t Amplitude at a specific time A30, A60 A5, A10... Clot elasticity G MCE Maximum lysis - CLF Clot Lysis[CL] at a specific time [minutes] CL30, CL60 LY30, LY45, LY60 Time to lysis 2mm from MA CLT [10% difference from MCF]
- 17. New Research Products Whole Blood Transfusion “ Walking blood bank program” Freeze-dried plasma Developed freeze-dried plasma- “HemCon Medical Technologies” Stem-cell derieved red blood cells
- 18.