TEG- Exam 3 Flashcards Preview

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Flashcards in TEG- Exam 3 Deck (44):
1

What three processes are involved in hemostasis?

Activation
Clot formation
Clot lysis

2

Clot: Platelet-fibrin network

Platelets form plug
Clotting factors reinforce platelets
Fibrin acts as a glue
Clot strength

3

What is a clot composed of?

Platelets 80-90%
Fibrin 10-20%

4

What tests are available for component measurements?

PT/INR
PTT
Fibinogen concentration
Platelet Count

5

PT/INR Test

Measures extrinsic clotting (VIIa, Xa, IIa)

6

PTT

measures intrinsic clotting (XIIa, Xia, iXa, IIa)

7

Measurement of component interactions

TEG (shows the net effect "whole picture" of hemostasis

8

What is TEG?

A whole blood hemostasis analyzer
Point of care test

9

What is TEG?

A whole blood hemostasis analyzer
Point of care test

10

How does TEG work?

Cup oscillates
Pin is attached to torsion wire
Clot binds pin to cup
Degree and magnitude of pin motion are functions of the clot kinetics and mechanical properties
System generates a hemostasis profile

11

How does TEG work?

Cup oscillates
Pin is attached to torsion wire
Clot binds pin to cup
Degree and magnitude of pin motion are functions of the clot kinetics and mechanical properties
System generates a hemostasis profile

12

R

time of latency from the time that the blood was placed in the TEG analyzer until the initial fibrin formation

13

Alpha

The alpha value measures the rapidity (kinetics) of fibrin build-up and corss-linking, that is, the speed of clot strengthening

14

K

K time is a measure of the rapidity to reach a certain level of clot strength

15

MA

Max amplitude, direct function of the maximum dynamic properties of firbin and platelet bonding via GPIIb/IIIa and represents the ultimate strength of the fibrin clot

16

GI

coagulation index is linear combination of the above parameters

17

LY30

rate of amplitude reduction 30 minutes after MA. This measurement gives an indication of the stability of the clot

18

R

time of latency from the time that the blood was placed in the TEG analyzer until the initial fibrin formation; reaction time (time to clot formation)

19

Alpha

The alpha value measures the rapidity (kinetics) of fibrin build-up and cross-linking, that is, the speed of clot strengthening; speed of fibrin accumulation

20

K

K time is a measure of the rapidity to reach a certain level of clot strength; time elapsed until clot reaches a fixed strength

21

MA

Max amplitude, direct function of the maximum dynamic properties of firbin and platelet bonding via GPIIb/IIIa and represents the ultimate strength of the fibrin clot; highest vertical amplitude of TEG tracing

22

CI

coagulation index is linear combination of the above parameters

23

LY30

rate of amplitude reduction 30 minutes after MA. This measurement gives an indication of the stability of the clot; % of amplitude reduction 30 min after its max

24

LY30

rate of amplitude reduction 30 minutes after MA. This measurement gives an indication of the stability of the clot; % of amplitude reduction 30 min after its max

25

R Likely Variable

Coagulation Factors

26

Alpha Likely Variable

Fibrinogen

27

K LIkely Variable

Fibrinogen

28

MA Likely Variable

Platelets

29

Ly30 likely variable

Fibrinolysis

30

Ly30 likely variable

Fibrinolysis

31

TEG Assays

Standard (Kaolin)
Rapid TEG
Heparinase
Platelet Mapping

32

Standard (Kaolin)

Uses parameters listed above

33

Rapid TEG

uses tissue factor in place of kaolin to speed up the rxn
R-value is replaced by TEG-ACT value
Other parameters the same

34

Heparinase

Use on bypass or post bypass alongside a standard TEG

35

Platetlet Mapping

Determines to what degree platelet function is inhibited due to pharmacological inhibition of either the arachidonic acid (AA) or ADP pathways
AA: Aspirin
ADP: Clopidrogel
Run alongside a standard TEG and a TEG with added AA or ADP
Calculates platelet inhibition as a percentage

36

Platelet Mapping

Determines to what degree platelet function is inhibited due to pharmacological inhibition of either the arachidonic acid (AA) or ADP pathways
AA: Aspirin
ADP: Clopidrogel
Run alongside a standard TEG and a TEG with added AA or ADP
Calculates platelet inhibition as a percentage

37

Platelet Mapping

Determines to what degree platelet function is inhibited due to pharmacological inhibition of either the arachidonic acid (AA) or ADP pathways
AA: Aspirin
ADP: Clopidrogel
Run alongside a standard TEG and a TEG with added AA or ADP
Calculates platelet inhibition as a percentage

38

What does platelet mapping measure?

Measures the effect of antiplatelet agents on platelet function
Measures the patient's maximum platelet function as a reference point
Measures the percentage of inhibition relative to the patient's reference point

39

What does platelet mapping measure?

Measures the effect of antiplatelet agents on platelet function
Measures the patient's maximum platelet function as a reference point
Measures the percentage of inhibition relative to the patient's reference point

40

Platelet Mapping: What drugs are monitored?

Antiplatelet Drugs
-ADP receptor inhibitors
-Arachidonic acid pathway inhibitiors
-GPIIb/IIIa inihibitors

41

ADP receptor inhibitors

clopidogrel, ticlopidine

42

Arachidonic acid pathway inihibitors

aspirin

43

GPIIb/IIIa inhibitors

abciximab, tirofiban, eptifibatide

44

Rotational Elastometry (ROTEM)

Stationary cup, rotating spindle
Clot impedes rotation of the pin
Additional tests available