The Practicality of Viscoelastic Testing in Acute Hemorrhage to Guide Appropriate Transfusion Management

Abstract

Abstract Introduction/Objective Acute hemorrhage often leads to multiple blood product transfusions and warrants efficient and dependable laboratory tests to elucidate the etiology for appropriate transfusion management. Conventional coagulation tests (aPPT, PT, INR, platelet count, fibrinogen) are inexpensive and have minimal labor requirements, but have slow turnaround times and may not accurately represent in vivo coagulopathies leading to inappropriate use of transfusion products, which in turn may lead to increased adverse events and mortality. Viscoelastic testing (VET) overcomes some of the disadvantages of conventional coagulation tests, but is not without its own limitations. This case study will summarize the advantages and disadvantages of VET by presenting two cases to highlight clinical situations in which VET is used and its impact on guiding management and clinical outcomes. Methods/Case Report We present 2 cases of acute hemorrhage to illustrate the importance of correct interpretation of VET in the appropriate clinical setting. Case 1 features a clinical situations in which TEG was misinterpreted due to lack of communication with the laboratory while Case 2 presents an acute hemorrhage situation in which Rapid TEG was used to guide transfusion strategy. While VET has many advantages in acute hemorrhage, clinicians must be aware of the disadvantages and the potential for misinterpretation of data. Results (if a Case Study enter NA) NA Conclusion VET is useful in acute hemorrhage if its functionality is understood and interpretation is correct. Appropriate use of VET may lead to effective transfusion management and improve clinical outcomes. However, it is imperative clinicians are aware of the limitations of VET when making clinical decisions. VET can only improve patient outcomes if it is used in the proper clinical situation and with proper interpretation of the data. Appropriate use of VET has the potential to improve transfusion management and ultimately lead to better patient outcomes.