Thrombelastography Today: Practicability and Analytical Power

Today, rotational thrombelastography as a further development of the classical thrombelastography is increasingly applied to assess haemostasis and to predict complications of coagulation. Due to the improved robustness of the method, RoTEM&rem; analyses are now also performed outside specialised coagulation laboratories and applied in emergency settings. Since coagulation testing, particularly when performed with different activators, is very sensitive to artifacts due to variations in the proportion to anticoagulants, temperature and concentration of activators, meticulous quality control is indispensable. For this reason, the German Federal Chamber of Physicians has issued rigorous validity ranges for the classic coagulation tests, such as the prothrombin time (PT/INR) or the activated partial thromboplastin time (aPTT) for variation coefficient acceptance, which are audited 4 times a year by external quality control circles. At present, no comparable quality assurance setup exists for whole blood coagulation testing. Thus, knowledge of the analytical limits, restrictions and caveats of this method is central for critical interpretation of the results and reliable clinical application. This review gives an outline of the practicability and accuracy of the RoTEM methodology and illustrates some pitfalls for the use in detecting and predicting disturbances of haemostasis in a case report.