Case 144 – update 4

The clinical team looking after the lady are not happy to give tranexamic acid as they feel will be a thrombotic risk.

They do accept advice to give 4FFP and a pool of platelets given the long R time and low MA.

Blood results from arrival in theatre are now available:

Hb 74, plt 54, PT 25 seconds (12 sec to 14.8 sec) , APTT 49 (27sec -41 sec), Fib 1.4g /l (1.9g/l -8g/l)

They have repeated the TEG and call you again.

The Blue line is the CK TEG from arrival in theatre.

The Purple line is the new CK TEG post FFP, Cryoprecipitate and RBC.

R time (min) 5 (5-10)

Angle (degrees) 53 (53-72)

MA (mm) 60 (50-70)

Ly30 (%) 70 (0-8)

What advice would you give the team ?

Are there any other results you could check that can worsen a major haemorrhage situation?

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