CICM SAQ 2015.2 Q8

Question

With respect to thromboelastography and haemostasis:

TEG-2

With reference to the parameters labelled in Figure 1:

  1. CT (or R) (CLT in this figure)
  2. CFT (or K)
  3. Alpha angle
  4. MCF (or MA)
  5. LI30 (or LY30 or CL) (A30 in this figure)
  • a) Explain what each parameter represents and what it measures. (60% marks)

Review the following thromboelastograms labelled A – E.

Diagram A represents a normal coagulation profile

  • b) Describe the coagulation status indicated by diagrams B – E. (40% marks)

Answer

Answer and interpretation

a) Explain what each parameter represents and what it measures. (60% marks)

R (reaction time or clotting time) is the time elapsed until first measurable clot forms (amplitude of 2mm) and indicates the initiation of haemostasis and is dependent on presence of clotting factors.

K (kinetics or clot formation time) is the time taken to achieve a certain level of clot firmness (amplitude of 20mm) and indicates amplification of the clotting process. Dependent on fibrinogen.

Alpha angle reflects the speed of fibrin accumulation. Dependent on fibrinogen.

MA/MCF is the maximum amplitude or maximum clot firmness and is the highest vertical amplitude of the TEG tracing. Dependent on platelets and fibrin.

LY30 /CL (clot lysis) is the percentage of amplitude reduction 30 min after maximum amplitude and is a measure of fibrinolysis.

b) Describe the coagulation status indicated by diagrams B – E. (40% marks)

B – Anticoagulant therapy or factor deficiency
C – Platelet dysfunction or thrombocytopaenia or fibrinogen deficiency
D – Fibrinolysis e.g. use of t-PA
E – Hypercoagulable state

  • Pass rate: 69%
  • Highest mark: 9.3
Exams LITFL ACEM 700

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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