Week 12 Handout TEG

Question 1

What does TEG provide in anesthesia?

Answer 1

TEG gives a real-time visual representation of the clotting process, including clot initiation, strength, and breakdown.

Question 2

How does TEG differ from traditional labs?

Answer 2

Traditional labs (PT, aPTT) only assess plasma coagulation factors, while TEG evaluates platelets, fibrinogen, and fibrinolysis.

Question 3

What is the benefit of TEG in transfusion therapy?

Answer 3

It enables goal-directed transfusion therapy, reducing unnecessary use of blood products.

Question 4

What type of results does TEG provide?

Answer 4

Provides faster, point-of-care (POC) results for critical decision-making.

Question 5

What are the first steps to obtain a TEG sample?

Answer 5

1. Gather supplies and PPE (gloves, butterfly needle, blue sodium citrate tube, syringes). 2. Perform venipuncture using aseptic technique.

Question 6

What is the procedure for drawing blood for TEG?

Answer 6

Discard the first 3 mL of blood. Draw 4.5 mL of blood into a blue-capped tube with 0.5 mL of 3.2% sodium citrate.

Question 7

How should the TEG sample be handled after collection?

Answer 7

Invert tube 3 times only, do not shake. Deliver sample upright at room temp to lab—must be tested within 2 hours.

Question 8

How does TEG work?

Answer 8

Blood is placed in a rotating chamber with a suspended piston. As the clot forms, the resistance to movement reflects the clot’s strength.

Question 9

What does the TEG result graph represent?

Answer 9

The result is a visual graph representing the full clotting process.

Question 10

What is R Time in TEG and its normal value?

Answer 10

R Time (4–8 min): Time to initial clot formation → prolonged = give FFP.

Question 11

What is K Time in TEG and its normal value?

Answer 11

K Time (1–4 min): Time to reach certain clot strength → prolonged = give fibrinogen.

Question 12

What is the α Angle in TEG and its normal value?

Answer 12

α Angle (53–72°): Rate of clot formation → reduced = fibrinogen deficiency.

Question 13

What is MA in TEG and its normal value?

Answer 13

MA (50–70 mm): Clot strength → low = give platelets or cryoprecipitate.

Question 14

What is LY30 in TEG and its normal value?

Answer 14

LY30 (0–8%): Clot breakdown after 30 minutes → high = give TXA.

Question 15

What mnemonic can help remember TEG normal values?

Answer 15

Mnemonic for Normal Values: ‘Really Kool Angles Make Lysis low’ (R = 4–8, K = 1–4, Angle = 53–72, MA = 50–70, LY30 = 0–8)

Question 16

What is the significance of TEG in trauma?

Answer 16

Trauma-induced coagulopathy is a major cause of mortality up to 2-4x mortality increase.

Question 17

What are the phases of management in trauma using TEG?

Answer 17

Phase 1: Early aggressive transfusion with minimal crystalloid. Phase 2: Targeted coagulation correction using TEG.

Question 18

What are typical findings in trauma using TEG?

Answer 18

Typical Findings: ↑ R time, ↑ K time, ↓ MA, ↑ LY30

Question 19

What is the management strategy for TEG findings in trauma?

Answer 19

Management: FFP for prolonged R, cryo/platelets for low MA, TXA for high LY30.

Question 20

How is TEG used in cardiac surgery?

Answer 20

TEG is used to differentiate between bleeding resulting from surgical causes or CPB induced coagulopathies.

Question 21

What complications can arise from CPB in cardiac surgery?

Answer 21

CPB can lead to platelet dysfunction, heparin effect, or fibrinolysis.

Question 22

What are typical findings in TEG for cardiac surgery?

Answer 22

Typical Findings: Prolonged R time (from heparin), normal other values if surgical bleeding.

Question 23

What is the key takeaway for TEG in cardiac surgery?

Answer 23

TEG distinguishes between surgical bleeding vs. coagulopathy, avoiding blind transfusions.

Question 24

What is the significance of TEG in obstetrics?

Answer 24

Pregnancy = hypercoagulable; postpartum = increased fibrinolysis.

Question 25

How does TEG assist during postpartum hemorrhage?

Answer 25

Helps guide transfusions during postpartum hemorrhage.

Question 26

What are typical findings in TEG for obstetrics?

Answer 26

Typical Findings: ↓ R & K, ↑ α angle & MA, ↓ LY30 in pregnancy → ↑ LY30 postpartum.

Question 27

What is the key takeaway for TEG in obstetrics?

Answer 27

Increases safety of neuraxial blocks and reduces unnecessary blood use in OB emergencies.

Question 28

What is the role of TEG in liver disease and transplant?

Answer 28

TEG shows the true coagulation status, as traditional labs overestimate bleeding risk.

Question 29

What are typical findings in TEG for liver disease?

Answer 29

Typical Findings: Preanhepatic: Often stable; Anhepatic: ↑ fibrinolysis; Neohepatic (post-reperfusion): Most severe fibrinolysis.

Question 30

What is the key takeaway for TEG in liver disease?

Answer 30

TEG is the gold standard for guiding transfusion and antifibrinolytic therapy in liver cases.

Question 31

What are the limitations and risks of TEG?

Answer 31

Device variability, cost & availability, lacks specificity, pediatric use limited, risk of delayed treatment.

Question 32

What is the key takeaway regarding TEG's use?

Answer 32

TEG is powerful, but interpretation and availability can limit use. Should complement—not replace—clinical judgment.

Question 33

What is the primary clinical benefit of using Thromboelastography (TEG)? A) It measures individual clotting factors in isolation B) It provides a real-time, functional assessment of coagulation C) It replaces the need for all standard coagulation tests D) It measures only the platelet function

Answer 33

Correct Answer: B) It provides a real-time, functional assessment of coagulation Rationale: TEG provides a real-time evaluation of clot formation, strength, and breakdown, unlike standard tests that only measure plasma components. It assesses the entire coagulation process in whole blood and offers a visual representation of clot dynamics, allowing for a more comprehensive understanding of hemostasis

Question 34

What does an increased R time on a TEG tracing indicate? A) Increased platelet function B) Hypercoagulability C) Impaired clot initiation and formation D) Normal clotting function

Answer 34

Correct Answer: C) Impaired clot initiation and formation Rationale: A prolonged R time suggests a delay in clot formation, which may indicate a deficiency in coagulation factors, the use of inhibitors, or other clotting abnormalities (Groppe

Question 35

Which TEG parameter specifically reflects clot strength? A) R Time B) K Time C) A-Angle D) Maximum Amplitude (MA)

Answer 35

Correct Answer: D) Maximum Amplitude (MA) Rationale: Maximum Amplitude (MA) measures clot strength and is affected by platelet and fibrinogen quality or quantity. A decrease in MA suggests decreased fibrinogen or platelet dysfunction or deficiency (Gropper et al., 2020,

Question 36

Which of the following TEG findings would suggest hyperfibrinolysis? A) Increased LY30 B) Prolonged R time C) Decreased A-Angle D) Increased Maximum Amplitude

Answer 36

Correct Answer: A) Increased LY30 Rationale: LY30 represents the percentage of clot lysis at 30 minutes. An increased LY30 suggests excessive clot breakdown, which is characteristic of hyperfibrinolysis (

Question 37

How does TEG measure clot strength? A) TEG measures the concentration of platelets in the sample B) By analyzing the resistance encountered by the pin as the clot forms C) By measuring electrical conductivity in the blood sample D) By evaluating fibrinogen concentration only

Answer 37

Correct Answer: B) By analyzing the resistance encountered by the pin as the clot forms. Rationale: A blood sample is placed in a rotating cuvette at 37°C, where an activator starts clotting. The sensor gets caught in the forming clot, transferring motion to a recorder. TEG measures clot strength by recording the resistance between the pin and the rotating cup as the clot develops (

Question 38

Why is TEG beneficial in patients with liver disease? A) It evaluates the functional status of coagulation, including clot formation, stability, and breakdown. B) It measures only clotting factor levels like PT and aPTT. C) It focuses only on platelet function without assessing fibrinolysis. D) It replaces the need for any standard coagulation tests.

Answer 38

Correct Answer: A) It evaluates the functional status of coagulation, including clot formation, stability, and breakdown. Rationale: Patients with liver disease have a complex balance of procoagulant and anticoagulant factors that standard lab tests do not fully assess. TEG provides a real-time, functional evaluation of coagulation, platelet interaction, and fibrinolysis, helping guide transfusion therapy more accurately