A Study on Blood Component Utilization using Thromboelastograph and Routine Coagulation Test in Liver Transplantation

BACKGROUND: Thromboelastography (TEG) gaining increasing recognition in liver transplantation (LT) with routine coagulation test (RCoT) such as prothrombin time (PT), activated partial thromboplastin time (aPTT),Platelet count (PLT) and fibrinogen. The purpose of our study is to correlate the TEG and RCoT and to assess the blood component utilization in the LT. AIM & OBJECTIVE: To assess the transfusion requirement and utilization of blood components by means of using thromboelastograph along with routine coagulation test and to analyse the correlation between TEG and RCoT in the intraoperative period of liver transplantation. MATERIALS &METHODS: Liver transplant patients had blood drawn before surgical incision till reperfusion phase in the following points: baseline, 120 mins into Preanhepatic phase,30 mins into Anhepatic phase,30 mins and 2 hrs after the initiation of Reperfusion phase assayed with TEG &RCoT seen for correlation. TEG variables and RCoT in the intraoperative period are correlated to fresh frozen plasma, cryoprecipitate, and platelets utilized during the surgery and correlated with spearman correlation coefficient. RESULTS: 13 cases of liver transplant are included in our study over a period of 1 year, out of which 11 cases underwent transfusion. In 10 of the 11 cases, 55 units of FFP and 50 units of Cryoprecipitate components and 15 units of SDP were used in the intraoperative period to correct the altered values in TEG. In 17 occasions in different phases PT and INR values did not match with R values in TEG. In 7 cases with reduced MA value 1 case showed normal platelet count with hyperfibrinolysis represented by increased LY30.2 cases with hyperfibrinolysis showing increased LY30,prolonged aPTT with normal fibrinogen explains dysfibrinogenemia. CONCLUSION: In our study, appropriate use of blood components were determined by TEG values. In several occasions at various phases of liver transplantation, during anhepatic and reperfusion phases, RcoT values did not correlate with TEG values. Since these deviant TEG values were also corrected soon after transfusion of appropriate components, the liver transplantation specialists had to depend on TEG rather than RCoT values. Further, TEG is preferred for the want of short Turn Around Time. Moreover, the overall deranged coagulation process found in the end stage liver disease is well represented by TEG rather than RCoT