Case 144 – update 3

The lady has been taken to theatre but the team have noted she is becoming more unstable despite ongoing replacement with the Major Haemorrhage packs

She had 4 RBC 4 FFP and you advised 2 cryo following initial lab tests. Her TEG was normal at that time point.

She has been given a further 2 RBC and 2 FFP but is still haemodynamically unstable in theatre.

They decide to send further lab tests which are awaited and repeat the TEG.

They call you to ask for advice with the CK TEG trace below:

Green line : Patients Initial CK TEG

Blue line : Patients CK TEG in theatre (heparinise cup also run no evidence of heparin contamination)

R (min) 9.4 (5-10)

Angle (degrees) 48 (53-72)

MA (mm) 40 (50-70)

Ly30 (%) 45 (0-8)

What does the TEG show?

Would you advise anything further based on TEG results?

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