THE IMPORTANCE OF THROMBOELASTOMETRY IN THE HEMOSTATIC DISORDERS DIAGNOSIS IN INTENCIVE CARE PATIENTS WITH TRAUMAS (CLINICAL CASE)
Keywords:thrombelastometry; coagulogram; hemostasis; trauma; diagnosis
thromboelastometry and coagulogram in patients with polytrauma.
Materials and methods. The results of thromboelastometry (TEM) and standard coagulogram of 12 patients aged 18 to 74 years with a diagnosis of trauma were analyzed. Analysis of thromboelastometry was performed using a ROTEM delta blood analyzer (Tem Innovations GmbH, Germany), which evaluates the physical properties of a clot. Patients' blood stabilized with sodium citrate was placed in special disposable microcuvettes with the addition of various activators of coagulation reactions. The following indicators of thromboelastometry were determined: CT, CFT, angle alpha (α), MCF, A5, A10 in the tests INTEM, EXTEM and FIBTEM. The determination of coagulogram parameters was carried out according to a standard method. The following parameters were identified: APTT, INR, fibrinogen A content, serum fibrin degradation products (SFDP) concentration.
Results. Coagulogram and thromboelastometry data at different stages of treatment were compared. In patients with the development of traumatic shock, coagulogram indices were changed to varying degrees depending on the stage of a shock. At the first stage of shock, the analysis showed only a 2-fold increase in SFDP and a slight increase in fibrinogen in dynamics. In a patient with a third stage of traumatic shock, the coagulogram indices were within normal limits, but according to TEM (EXTEM and FIBTEM tests), hypocoagulation was observed due to platelets. Only a coagulogram was evaluated in dynamics, hypocoagulation was observed in parameters of internal and external hemostasis pathways (prolongation of APTT, decrease in IPT and increase in INR), increase in fibrinogen A and SFDP. In the group of male patients with closed craniocerebral injuries, an increase in SFMC in the coagulogram had always been combined with changes in the FIBTEM test during TEM.
Conclusion. Thus, in most patients, there is no change in classic coagulogram tests immediately after the injury. At the same time, rotational thromboelastometry makes it possible to fill this deficiency at an earlier date, which indicates a high sensitivity of the method.
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