QUANTIFICATION OF THROMBELASTOGRAPHIC CHANGES AFTER BLOOD COMPONENT TRANSFUSION IN PATIENTS WITH LIVER-DISEASE IN THE INTENSIVE-CARE UNIT

Thrombelastography (TEG) can be used to monitor hemostasis and guide t ransfusion therapy during orthotopic liver transplantation. However, d ata are limited regarding the type and quantity of blood components ne cessary for TEG-guided blood component transfusion in coagulopathic cr itically ill patients with liver disease. We evaluated changes in four thrombelastogram variables (reaction time, thrombin constant time, al pha angle, and maximum amplitude) in whole blood samples after 74 sepa rate blood component transfusions in 60 critically ill patients with a coagulopathy and liver disease. Only platelets significantly improved TEG variables in patients who received a single type of blood compone nt. Each unit of platelets decreased the reaction and thrombin constan t time by 0.43 (P < 0.05) and 0.82 (P < 0.005) min, respectively, incr eased the alpha angle by 1.5 degrees (P < 0.005), and the maximum ampl itude by 1.4 mm (P < 0.005). In patients who received multiple blood c omponents, cryoprecipitate decreased the thrombin constant time by 0.5 6 min/U (P < 0.05), and each unit of platelets decreased the thrombin constant time by 0.39 min (P < 0.005), and increased the ct angle and maximum amplitude by 0.63 degrees (P < 0.05) and 0.99 mm (P < 0.005), respectively. We conclude that platelet transfusions, alone or in comb ination with other blood components, are most effective for improving abnormal TEG variables in coagulopathic critically ill patients with l iver disease.