The Utility of Thromboelastography to Guide Blood Product Transfusion

An ACLPS Critical Review

Amy E. Schmidt, MD, PhD; Anna Karolina Israel, MD; Majed A. Refaai, MD


Am J Clin Pathol. 2019;152(4):407-422. 

In This Article

Abstract and Introduction


Objectives: To provide an overview of the clot viscoelastic testing technology and to describe its utility in guiding blood product transfusions.

Methods: A case scenario will be discussed as well as interpretation of thromboelastography (TEG) tracings. In addition, literature examining the utility of viscoelastic testing in guiding patient management and blood product transfusions will be reviewed.

Results: TEG/rotational thromboelastometry (ROTEM) is useful in evaluating clot kinetics in trauma and acutely bleeding patients. TEG/ROTEM parameters are reflective of values measured using standard coagulation assays; however, TEG/ROTEM parameters are more rapidly available and more costly. TEG and ROTEM are used in three main settings: cardiac surgery, liver transplantation, and trauma to assess global hemostasis and administration of blood products.

Conclusions: TEG/ROTEM can be helpful in guiding resuscitation and blood product transfusion. Several studies have demonstrated a reduction in transfusion of blood components with TEG/ROTEM; however, other studies have suggested that TEG/ROTEM is not clinically effective in guiding transfusion.