Whole Blood Assay: Thromboelastometry – Bleeding Management Algorithms

As an essential part of a “patient blood management” program, the concept of thromboelastometry-guided bleeding management aims to stop bleeding as soon as possible and to avoid any unnecessary or inappropriate blood transfusion, which is known to be associated with severe adverse events. Accordingly, the implementation of thromboelastometry-guided bleeding management algorithms (“theranostic approach”) has been shown to reduce transfusion requirements, transfusion-associated adverse events, patient’s morbidity and mortality, as well as hospital costs in several clinical settings. This concept is also gaining acceptance and recommendation in the USA, e.g., in the “practice guidelines for perioperative blood management” published from the “ASA Task Force on Perioperative Blood Management” in 2015. The characteristics of thromboelastometry allows for using the device at the bedside in the emergency department, the operating room, and the intensive care unit in a mobile way and in a multiuser environment, even in military settings. This could further be optimized by developing a fully-automated thromboelastometry device, the ROTEM™ sigma, which is a cartridge-based system with lyophilized reagent beads not requiring pipetting but still using the proven pin-and-cup technology. ROTEM™ sigma is currently used in Europe, but is not approved for use in the USA yet.