To compare Point-Of-Care thromboelastography( TEG ) parameters in the evaluation of coagulation function in post surgical patients with multi system derangement To review the usage of blood products in them using a teg based regimen

Blood samples were simultaneously collected for coagulation studies by POC TEG (activated clotting time (R),kinetics (K),the alpha angle, the maximum amplitude (MA),LY -30,and the clot index(CI)and evaluation from coagulation lab (PT, APTT, INR, Fibrinogen and D-dimer ) on day 1,day 2,and day 3 of the patients icu stay.. TEG parameters were used to decide upon transfusion of blood products

In our study population(n=15) the mean PT on day 1,2 &3 respectively were 19.1±4.5, 20.48±4.5 &19.81±4.6(control = 11.3), APTT were 36.94±7.07, 37.62±8.77 & 37.35±9.56 (control 29.1)INR were 1.95±0.65, 2.08±0.56 & 2.2±1.19; fibrinogen were 304.93±73.26 ,302.4±77.43, 304.71±78.83, haemoglobin of 9.13±1.78,8.95±2.3,8.84±1.82and platelets counts of 120.53±83.11, 117.33±74.5, 123±87.9. 47.8%,52.2 % and 43.5 % patients had positive d-dimers on day 1,2,3 respectively. TEG parameters of R were 7.13±2.49, 9.7±2.8, 8.86±2.45,K were 2.66±1.48, 3.39±1.8, 2.83±1.6,alpha angle were 55.15±16.39, 48.80±17.2 & 52.3±19.5 MA were 58.25±18.98, 58.72±10.13, 57.21±14.10, ly-30 were 0.3±0.68, 0.19±0.45, 1.04±4.25, CI were -1.5±3.89, -4.1±3.84, -2.38±3.35 on day 1,2 and 3 respectively. The mean blood products used were PRBC .36±0.74,. 36±0.740,; FFP0.57±1.28, 0.57±1.45, 0.62±1.5,platelet concentrate 0,.29±1.06,0 on day 1,2 and 3 respectively .Amongst the lab parameters PT(mean control 11.3),INR and APTT(mean control of samples =29.1) were deranged whereas amongst the TEG parameters R was deranged on all 3 days and CI on day 2.

this picture could possibly be due to intraoperative fluid transfusion leading to haemodilution or due to fluid retention as a result of the multi system inflammatory process.Lab parameters allow us only a cursory glance at the coagulation process not allowing us to distinguish such benign conditions from an actual decrement in clotting factors.as mentioned already we used a TEG based transfusion protocol which allowed us to restrict our use of blood products and possibly decrease the mortality and morbidity in our study population.