TEG- Exam 3

Question 1

What three processes are involved in hemostasis?

Answer 1

Activation
Clot formation
Clot lysis

Question 2

Clot: Platelet-fibrin network

Answer 2

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

Question 3

What is a clot composed of?

Answer 3

Platelets 80-90%

Fibrin 10-20%

Question 4

What tests are available for component measurements?

Answer 4

PT/INR
PTT
Fibinogen concentration
Platelet Count

Question 5

PT/INR Test

Answer 5

Measures extrinsic clotting (VIIa, Xa, IIa)

Question 6

PTT

Answer 6

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

Question 7

Measurement of component interactions

Answer 7

TEG (shows the net effect “whole picture” of hemostasis

Question 8

What is TEG?

Answer 8

A whole blood hemostasis analyzer

Point of care test

Question 9

What is TEG?

Answer 9

A whole blood hemostasis analyzer

Point of care test

Question 10

How does TEG work?

Answer 10

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

Question 11

How does TEG work?

Answer 11

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

Question 12

R

Answer 12

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

Question 13

Alpha

Answer 13

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

Question 14

K

Answer 14

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

Question 15

MA

Answer 15

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

Question 16

GI

Answer 16

coagulation index is linear combination of the above parameters

Question 17

LY30

Answer 17

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

Question 18

R

Answer 18

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)

Question 19

Alpha

Answer 19

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

Question 20

K

Answer 20

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

Question 21

MA

Answer 21

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

Question 22

CI

Answer 22

coagulation index is linear combination of the above parameters

Question 23

LY30

Answer 23

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

Question 24

LY30

Answer 24

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

Question 25

R Likely Variable

Answer 25

Coagulation Factors

Question 26

Alpha Likely Variable

Answer 26

Fibrinogen

Question 27

K LIkely Variable

Answer 27

Fibrinogen

Question 28

MA Likely Variable

Answer 28

Platelets

Question 29

Ly30 likely variable

Answer 29

Fibrinolysis

Question 30

Ly30 likely variable

Answer 30

Fibrinolysis

Question 31

TEG Assays

Answer 31

Standard (Kaolin) Rapid TEG Heparinase Platelet Mapping

Question 32

Standard (Kaolin)

Answer 32

Uses parameters listed above

Question 33

Rapid TEG

Answer 33

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

Question 34

Heparinase

Answer 34

Use on bypass or post bypass alongside a standard TEG

Question 35

Platetlet Mapping

Answer 35

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

Question 36

Platelet Mapping

Answer 36

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

Question 37

Platelet Mapping

Answer 37

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

Question 38

What does platelet mapping measure?

Answer 38

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

Question 39

What does platelet mapping measure?

Answer 39

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

Question 40

Platelet Mapping: What drugs are monitored?

Answer 40

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

Question 41

ADP receptor inhibitors

Answer 41

clopidogrel, ticlopidine

Question 42

Arachidonic acid pathway inihibitors

Answer 42

aspirin

Question 43

GPIIb/IIIa inhibitors

Answer 43

abciximab, tirofiban, eptifibatide

Question 44

Rotational Elastometry (ROTEM)

Answer 44

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