Education  |   November 2017
Fulminant Hyperfibrinolysis Diagnosed by Rotational Thromboelastometry
Author Notes
  • From the Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia.
  • Address correspondence to Dr. McNeil: jsm6j@hscmail.mcc.virginia.edu
Article Information
Education / Images in Anesthesiology / Coagulation and Transfusion / Hematologic System
Education   |   November 2017
Fulminant Hyperfibrinolysis Diagnosed by Rotational Thromboelastometry
Anesthesiology 11 2017, Vol.127, 892. doi:10.1097/ALN.0000000000001742
Anesthesiology 11 2017, Vol.127, 892. doi:10.1097/ALN.0000000000001742
ROTATIONAL thromboelastometry (ROTEM; TEM Innovations, Germany) is a viscoelastic point-of-care test that measures changes in elasticity of a small pin oscillating in citrated whole blood. Reaction curves using different reagents and isolating specific coagulation components are created simultaneously. We present ROTEM images diagnosing fulminant hyperfibrinolysis (Panel A) with normal curves (Panel B) for comparison. INTEM and EXTEM measure contact activation and tissue factor activation, correlating with activated partial thromboplastin time and prothrombin time.1  FIBTEM uses cytochalasin D, eliminating platelet contribution and therefore magnifying fibrinogen’s contribution to clot. APTEM uses aprotinin to inhibit fibrinolysis. Parameters recorded reflect time until clot formation (CT), clot firmness at specific time (A), maximum clot firmness (MCF), and maximum lysis (ML).
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