Factor Assay Testing for Trauma Patients

[jshafer]

Hi Everyone,

          I need some advice again for trauma. We currently do not do any factor assays in house. We currently provide PT, aPTT, Ddimer, and Fibrinogen. Do you perform any factor assays for trauma patients with hemophilia A, B, or vWF? Do you offer any factor assays for trauma patients? I’m not sure if factor assays are needed or if this is overkill. How do you handle these type of patients?

Thank you

[LIMPER55]

We use the Thromboelastograph and allow surgeon and anesthesia see real time results.

 

[Ward_X]

I have heard of facilities using TEG or ROTEM.

[David Saikin]

We offer the same tests you do.

[Neil Blumberg]

The vast majority of trauma patients only need TEG/ROTEM as these are the only assays shown to improve clinical outcomes when used to drive transfusion therapy.  For patients who don't respond well (keep bleeding), it's important to have the fibrinogen level, platelet count, PT, PTT as well.  The individual factor assays are largely irrelevant and unneeded.  Hemophilia A and B are vanishingly rare diseases, and vWF is usually mild to moderate in most patients so individual factor analyses would be needed very uncommonly.  A test of platelet function such as the closure time (PFA-100) might be a useful thing to have too, but less relevant in trauma patients.

Edited January 13, 2020 by Neil Blumberg