Quantification of thrombelastographic changes after blood component transfusion in patients with liver disease in the intensive care unit.
Thrombelastography (TEG) can be used to monitor hemostasis and guide transfusion therapy during orthotopic liver transplantation. However, data are limited regarding the type and quantity of blood components necessary for TEG-guided blood component transfusion in coagulopathic critically ill patients with liver disease. We evaluated changes in four thrombelastogram variables (reaction time, thrombin constant time, alpha angle, and maximum amplitude) in whole blood samples after 74 separate blood component transfusions in 60 critically ill patients with a coagulopathy and liver disease. Only platelets significantly improved TEG variables in patients who received a single type of blood component. Each unit of platelets decreased the reaction and thrombin constant time by 0.43 (P < 0.05) and 0.82 (P < 0.005) min, respectively, increased the alpha angle by 1.5 degrees (P < 0.005), and the maximum amplitude by 1.4 mm (P < 0.005). In patients who received multiple blood components, cryoprecipitate decreased the thrombin constant time by 0.56 min/U (P < 0.05), and each unit of platelets decreased the thrombin constant time by 0.39 min (P < 0.005), and increased the alpha angle and maximum amplitude by 0.63 degrees (P < 0.05) and 0.99 mm (P < 0.005), respectively. We conclude that platelet transfusions, alone or in combination with other blood components, are most effective for improving abnormal TEG variables in coagulopathic critically ill patients with liver disease.
Clayton
D G
DG
Intensive Care Unit Laboratory, Presbyterian University Hospital, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
Miro
A M
AM
Kramer
D J
DJ
Rodman
N
N
Wearden
S
S
D001778:Blood Coagulation Disorders / Q000097:blood / Q000628:therapy; D016913:Blood Component Transfusion; D001809:Blood Viscosity; D003422:Critical Care; D005169:Factor VIII / Q000627:therapeutic use; D005340:Fibrinogen / Q000627:therapeutic use; D005353:Fibronectins / Q000627:therapeutic use; D006488:Hemostasis, Surgical; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000601:surgery*; D016031:Liver Transplantation; D008991:Monitoring, Physiologic; D010949:Plasma; D017713:Platelet Transfusion; D013916:Thrombelastography; D013918:Thrombin Time
D005353:Fibronectins; C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen