Thrombelastography

Thromboelastogram (TEG) is an index that reflects the dynamic changes of blood coagulation (including the formation rate of fibrin, the solid state of dissolution and the firmness of condensate, and the strength of the blast). Therefore, the factors affecting the thromboelastogram are mainly red blood cells. Aggregation state, rigidity of red blood cells, speed of blood coagulation, level of activity of fibrinolytic system, and the like. The main indicator of the thromboelastogram is 1 reaction time (γ) indicating that fibrin formation is not present in the sample to be tested. 2 The solidification time (κ) indicates that fibrin is formed in the test sample and has a certain firmness. The widest distance (ma) of the curves on both sides of the graph indicates the maximum amplitude of thrombosis. 4 thromboelastogram (ε), indicating the size of the elasticity of the thrombus. 5 Maximum solidification time (m), which represents the time from the solidification time to the maximum amplitude. At present, thromboelastograms are detected by a thromboelastograph. Basic Information Specialist classification: cardiovascular examination classification: blood examination Applicable gender: whether men and women apply fasting: fasting Tips: Avoid the influence of human factors on graphics. Normal value Dynamic changes in blood coagulation (including the formation rate of fibrin, the solvency of the dissolved state and condensate, and the strength of the blast) are normal. Clinical significance (1) Thrombotic diseases: nephrotic syndrome, uremia, coronary heart disease, angina pectoris, myocardial infarction, cerebral infarction, arteriovenous thrombosis, etc., r value and K value are significantly reduced, while ma value and mε value increase. (2) Platelet abnormalities: primary and secondary thrombocytopenia, r and K values ​​increase, while ma and mε values ​​decrease. The platelet dysfunction disease has a significant decrease in the ma value and the mε value. (3) Coagulation factor-deficient diseases: Hemorrhagic diseases of hemophilia, the r value and the K value are significantly increased, while the ma value and the mε value are decreased. (4) hyperfibrinolysis disease: primary fibrinolysis, secondary fibrinolysis of disseminated intravascular coagulation, in the case of sudden fibrinolysis, TEG can show the intensity and speed of fibrinolysis. Precautions Avoid the effects of human factors on graphics. Common human factors are as follows: (1) Inadvertent operation: 1 The blood cup was not placed at the bottom of the reaction cell, causing confusion in the graphic head. Remedy: Put the Sheng Cup into the reaction tank and press down. 2 The adjustment screw was not released at the beginning, resulting in a graphic without head. Correction method: Remember the switch direction of the screw, and loosen the screw immediately after the blood and paraffin oil are placed. 3 When the camera is turned off, the brush stop point is far away from the center line. When the machine is turned on, the brush shakes sharply and the r value is not described. Correction method: The brush is close to the center line and then shut down. 4 The brush is lifted due to excessive drawing of the drawing, causing the middle of the figure to break. Correction method: The amount of paper to be placed should be moderate, and the paperboard can be freely moved when the drawing is rotated. (2) Because the blood cup is not clean: there is unwashed paraffin oil inside, which causes the side of the figure to be straight. Correction method: Shengxue cup and small cylinder should be thoroughly washed and dried with barium sulfate. (3) due to vibration: 1 When the machine is working, it suddenly vibrates so that the r value is not straight (or has small burrs). 2 vibration makes the figure concave. 3 A certain frequency of vibration (drilling holes upstairs) causes the edges of the graphics to be jagged. Remedy: Avoid vibration of any factor, the machine should be placed on a stable, fixed table. (4) Due to insufficient amount of paraffin oil 1 No paraffin oil was added, and the figure appeared shark fin. 2 paraffin oil is small, causing graphic malformation Correction method: Paraffin oil should be covered with a bloody cup. (5) due to machine failure One end of the tracing pen is in good contact with the drawing, and the other end is in poor contact, causing a graphic burr. Corrective method: Please inspect the instrument. Inspection process (1) Natural whole blood method: Immediately after the venous blood is taken out, it is placed in a blood cup. (2) Whole blood recalcification method: 38g/L sodium citrate anticoagulant (blood: anticoagulant = 9:1) 0.6ml in plastic test tube or silicon coated test tube, then add 12.9g / L CaCl2 solution Mix 0.4 ml, immediately start the stopwatch, and take 0.36 ml of the mixture in a blood cup. (3) Plasma recalcification method: 38g/L sodium citrate anticoagulation was centrifuged at 1000r/min for 5min, and the upper layer of plasma 0.4ml and the equivalent amount of 12.9g/LCaCl2 solution were mixed and the stopwatch was started immediately. 0.36ml of the mixture was taken. Determined in the blood cup. Not suitable for the crowd 1. Patients who have taken contraceptives, thyroid hormones, steroid hormones, etc., may affect the results of the examination and prohibit patients who have recently taken the drug history. 2, special diseases: patients with hematopoietic function to reduce disease, such as leukemia, various anemia, myelodysplastic syndrome, etc., unless the examination is essential, try to draw less blood. Adverse reactions and risks 1, subcutaneous hemorrhage: due to pressing time less than 5 minutes or blood draw technology is not enough, etc. can cause subcutaneous bleeding. 2, discomfort: the puncture site may appear pain, swelling, tenderness, subcutaneous ecchymosis visible to the naked eye. 3, dizzy or fainting: in the blood draw, due to emotional overstress, fear, reflex caused by vagus nerve excitement, blood pressure decreased, etc. caused by insufficient blood supply to the brain caused by fainting or dizziness. 4. Risk of infection: If you use an unclean needle, you may be at risk of infection.

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