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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Perioperative Use of Point of Care Viscoelastic Testing using ROTEM

Abstract Number: T1C-2
Abstract Type: Case Report/Case Series

Aymen Alian MD1 ; Anushri Desai MD2; Antonio Gonzalez MD3

The use of Point of Care Viscoelastic testing (PCVT) has been concentrated in the development of algorithms for intra or post-operative management of obstetrical hemorrhage.1,2There is very scarce data on the use of PCVT to monitor, and or treat high-risk obstetrical patients at risk of intra and post-partum hemorrhage (i.e. chronic placental abruption, hemolysis elevated liver enzyme low platelets (HELLP) syndrome).

A 21 y/o G1P0 patient at 34 weeks and 4 days was transferred from an outside institution into our obstetric service. The patient was transferred with a diagnosis of HELLP syndrome, blood work demonstrated a Hemoglobin (HgB) of 9.3 g/dL, Platelets (PLT) 117 K, Alanine Aminotransferase (AST) - 485 and Aspartate Aminotransferase 787 U/L. A few hours after admission (00:34 am), her blood work was remarkable for a quick drop in PLT - 68K and HgB - 8.4 g/dL. Around 6 am, she commenced complaining of right upper quadrant pain. At 6:30 am, case was presented to our anesthesia team. A ROTEM® was processed at the same time blood work was drawn. ROTEM® results demonstrated normal clotting time (CT) with low A10 in the Extem and Fibtem, suggesting the need for PLT's and cryoprecipitate, see figure-1A. The obstetric team was immediately notified and made aware of the possibility of worsening coagulopathy; PLT and cryoprecipitate were ordered. Blood work results were received around 7:00 am. The latter confirmed our suspicion of worsening coagulopathy; PLT- 17 K, HgB - 8.8 g/dL. Decision was made to deliver patient via cesarean delivery, blood products were received at 7:15. 2 units of PLT and 1 unit of Cryoprecipitate were started in the labor and delivery while awaiting transfer to the OR. Patient was transferred to the OR at 10 am, by 12 pm her coagulopathy was corrected despite the intraoperative bleeding. Between the pre- and intraoperative period, patient received a total of 5 units of packed red blood cells, 3 units PLT and 4 units of cryoprecipitate. Patient was transferred to the surgical intensive care unit (SICU) and discharged from the hospital 5 days later.

Our case demonstrates that the use of ROTEM® can be used for monitoring and early detection of worsening coagulopathy in high-risk patients. At our institution, we are routinely using ROTEM® for monitoring of obstetrical complications associated with coagulopathies (i.e. HELLP syndrome), see Figure 1-B.

1 Anaesthesia 2015

2 J Clin Anesth 2018

SOAP 2018