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Eclampsia and Pre-Eclampsia with Severe Features
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
A platelet count and a coagulation profile should be available on the day of delivery, and considering the rapidity of worsening of the condition, these should be monitored during delivery. Amniotomy and oxytocin or prostaglandins should be used for induction of labour (IOL), if it is considered appropriate depending on the clinical situation. As oxytocin is associated with fluid retention, it should be administered as a more concentrated infusion than normal. Continuous electronic fetal monitoring should be instituted during labour. Instrumental vaginal delivery is not routinely needed, but may be necessary to assist labour in case the maternal bearing-down phase is prolonged, as excessive maternal effort may give rise to increased blood pressure. Ergometrine can precipitate a hypertensive crisis, and therefore, oxytocin should be used instead of ergometrine or syntometrine during the active management of the third stage of labour. However, ergometrine can be used if postpartum haemorrhage occurs and the blood pressure drops (discussed in Chapter 14). Coagulopathy, if present, should be corrected before delivery, ideally with the use of rotational thromboelastometry and in consultation with a transfusion specialist. An uncomplicated vaginal delivery is preferable in case of coagulopathy, because it has the potential to cause less maternal trauma than a caesarean delivery.
Emergency medicine and resuscitation
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
In terms of optimal ratios of blood to other blood products, several retrospective studies have now been overtaken by a large prospective trial – the PROPPR study, which randomised civilian trauma patients to receive either 1:1:1 (plasma, platelets and pRBCs) or 1:1:2.18 Although no overall mortality benefit was found, there were significant differences in early deaths due to bleeding in favour of the higher ratio, supporting as close to 1:1:1 ratios as possible as the initial target. However, all trauma patients are different, and near-patient functional coagulation testing is now employed in the deployed (Role 3) setting, which allows bespoke blood product transfusion depending on the patient’s specific requirements.19 Rotational thromboelastometry (ROTEM™) or thromboelastography (TEG) both allow measurement of clot initiation and function as well as more traditional coagulation parameters. Despite the observed benefit in practice, a recent Cochrane review has suggested that there is not yet enough evidence to support its routine use in guiding trauma resuscitation.20
The blood
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Alastair Duncan, Santosh Patel
Thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) provide a continuous measurement of the viscoelastic properties of blood from the start of clot formation to fibrinolysis.
Prospective assessment of platelet function in patients undergoing elective resection of glioblastoma multiforme
Published in Platelets, 2023
Santiago R. Leal-Noval, Manuel Casado, Cancela Palomares, José L. Narros, José L. García-Garmendia, Ginés Escolar, Diego X. Cuenca, Klaus Görlinger
Thromboelastometry assays were performed using a ROTEM delta system (Tem Innovations GmbH, Munich, Germany).10,20–23 In this study, only the clotting time in EXTEM (extrinsic activation, CT-EXTEM in s), maximum clot firmness in EXTEM (MCF-EXTEM in mm), maximum clot firmness in FIBTEM (fibrin contribution to clot firmness, MCF-FIBTEM in mm), residual clot firmness in percentage of MCF 60 min after CT (Lysis index 60: LI60 in %), and reduction of clot firmness in percentage of MCF-EXTEM at 50–60 min during run time (maximum lysis, ML) were assessed. We stratified subjects into 3 fibrinolysis groups according to their EXTEM-ML/LI60 values: hyperfibrinolysis (ML > 15% and/or LI60 < 82%), physiologic (ML: 4–15% and/or LI60 82–98%) and shutdown (ML < 4% and/or LI60 > 98%).24,25
Characterization of the hemorrhagic syndrome in the New Zealand white rabbit model following total body irradiation
Published in International Journal of Radiation Biology, 2021
Isabel L. Jackson, Ganga Gurung, Emmanuel Ayompe, Elena-Rose Fown, Sarah Triesler, Buddha Mali, Andrea Casildo, Allison Gibbs, Yannick Poirier, Eric P. Cohen, Diana Newman, Zeljko Vujaskovic
Whole blood was processed for thromboelastometry as previously described (Jackson et al. 2019). Briefly, blood samples were maintained at room temperature and run within two hours of collection. Prior to analysis, blood samples were warmed to 37° C for 10 minutes and mixed thoroughly. A 300 μL aliquot of citrated whole blood was tested on a Rotational Thromboelastometry whole blood coagulation analyzer (ROTEM®delta Thromboleastometry, TEM Systems, Inc. Research Triangle Park, NC) in NATEM (e.g. non-activated) test mode. A correction formula for the adjustment of the citrate anticoagulant volume was used to compensate for a lower than normal hematocrit values and a calculated volume of citrate was added to the collection tube. In NATEM test mode, the citrated blood sample was re-calcified with the ROTEM system reagent star-TEM. Forty (40) microliters of star-TEM reagent was added by automated electronic pipette to a ROTEM disposable test cup followed by 300 μl of the citrated whole blood. The program requires the test solution to be drawn into the automated electronic pipette tip for mixing. The test solution (sample plus star-TEM) was then placed on the measuring head for a 60-minute analysis. The proper functioning of the ROTEM was confirmed weekly with quality control standards (TEM Systems, Inc. Research Triangle Park, NC).
Determination of fibrin clot growth and spatial thrombin propagation in the presence of different types of phospholipid surfaces
Published in Platelets, 2021
Ekaterina M. Koltsova, Anna D. Kuprash, Natalya M. Dashkevich, David M. Vardanyan, Artem V. Chernyakov, Maria A. Kumskova, Sukesh C. Nair, Alok Srivastava, Fazoil I. Ataullakhanov, Mikhail A. Panteleev, Anna N. Balandina
Among the laboratory tests that have recently entered clinical practice, thromboelastography/thromboelastometry and thrombin generation tests allow an integrated assessment of the coagulation system. However, none of these tests takes into account the spatial heterogeneity of the activation process and clot growth, whereas it is well known that the coagulation process in the body is fundamentally heterogeneous [1]. Thrombodynamics is a global test for diagnosing coagulation disorders, determining bleeding risks and detecting thrombus formation [2–4]. Unlike other methods used in clinical practice, in which coagulation is activated simultaneously in the whole volume of plasma, this method is based on the principle of local coagulation starting on a flat surface containing a thin layer of tissue factor (TF) and lipids. Therefore, the imitation of vessel wall damage is achieved. Currently, two variations of the Thrombodynamics test have been developed, one of which allows for the detection of spatial thrombin generation in addition to detecting fibrin clot growth.