Semin Thromb Hemost 2010; 36(7): 757-763
DOI: 10.1055/s-0030-1265292
© Thieme Medical Publishers

Quality Assurance and Quality Control of Thrombelastography and Rotational Thromboelastometry: The UK NEQAS for Blood Coagulation Experience

Dianne P. Kitchen1 , Steve Kitchen1 , Ian Jennings1 , Tim Woods1 , Isobel Walker1
  • 1UK NEQAS Blood Coagulation, Sheffield, United Kingdom
Further Information

Publication History

Publication Date:
26 October 2010 (online)

ABSTRACT

Global hemostasis devices are currently being employed in operating rooms to assess the bleeding risk and outcomes for patients undergoing surgery. Two devices currently available are the TEG (Thromboelastograph; Haemoscope Corp., Niles, IL) and the ROTEM (Rotation Thromboelastometer; Pentapharm GmbH, Munich, Germany). Both measure the speed of clot formation, the strength of the clot when formed, and clot fibrinolysis kinetics. The two devices use different parameters so no cross comparisons of results can be made. The devices are usually operated by a member of the operating team and not a laboratory scientist; thus their testing and performance is generally not laboratory controlled, despite quality control being required to ensure reliable results. The UK National External Quality Assessment Scheme (NEQAS) for Blood Coagulation has undertaken a series of exercises evaluating the provision of External Quality Assessment (EQA) material for these devices. A series of four studies have taken place using lyophilized plasmas as the test material. Up to 18 TEG users and 10 ROTEM users have been involved in testing two samples per study, for a total of eight samples tested. The samples were normal plasmas, factor VIII or XI deficient samples, or normal plasmas spiked with heparin. The precision of the tests varied greatly for both devices, with coefficients of variances ranging from 7.1 to 39.9% for TEG and 7.0 to 83.6% for ROTEM. Some centers returned results that were sufficiently different from those obtained by other participants to predict alterations in patient management decisions. Our data indicate that regular EQA/proficiency testing is needed for these devices.

REFERENCES

  • 1 Sorensen E R, Lorme T B, Heath D. Thromboelastography: a means to transfusion reduction.  Nurs Manage. 2005;  36(5) 27-33 quiz 33-34
  • 2 Ronald A, Dunning J. Can the use of thromboelastography predict and decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery?.  Interact Cardiovasc Thorac Surg. 2005;  4(5) 456-463
  • 3 Ak K, Isbir C S, Tetik S et al.. Thromboelastography-based transfusion algorithm reduces blood product use after elective CABG: a prospective randomized study.  J Card Surg. 2009;  24(4) 404-410
  • 4 Luddington R J. Thrombelastography/thromboelastometry.  Clin Lab Haematol. 2005;  27(2) 81-90
  • 5 Sørensen B, Johansen P, Christiansen K, Woelke M, Ingerslev J. Whole blood coagulation thrombelastographic profiles employing minimal tissue factor activation.  J Thromb Haemost. 2003;  1(3) 551-558
  • 6 Chitlur M, Lusher J. Standardization of thromboelastography: values and challenges.  Semin Thromb Hemost. 2010;  36(7) 707-711
  • 7 Spiess B D. Coagulation monitoring in the perioperative period.  Acta Anaesthesiol Scand Suppl. 1996;  109 77-79

Dianne KitchenF.I.B.M.S. 

Specialist Scientific Lead for Point of Care Programmes, UK NEQAS for Blood Coagulation

Rutledge Mews, 3 Southbourne Road, Sheffield S10 2QN, United Kingdom

Email: dianne.kitchen@coageqa.org.uk