Which R and MA TEG values do you consider as cut-off values to initiate plasma and platelets transfusion during liver transplantation?
I would not do anything if there simultaneuosly would not be clinic. I would also like a hepteg and fibrinogen levels. Clinic alwas no 1
It depends the time when we do the TEG. In the pre an hepatic phase even if the TEG is abnormal and there is not much of bleeding clinically we do not correct TEG as giving more products will increase bleeding by increasing the volume. Platelet count as low as 50 to 60 k are usually tolerated. In the Anhepatic phase if R is 9 to 12, 2FFP and more than 12, 4 FFP may be necessary. Again platelet count of 50 to 60 even with reduced MA is sufficient. In the Neohepatic phase TEG will be abnormal initially. It is better to wait 10 min following Hep art and reperfusion to repeat TEG and the management is as above.
We also should consider the fact that TEG does not take account of the contribution of endothelium in clotting
Again, we would use The TEG to monitor changes, try to explain abnormal blessings or effects of heparin (extrinsic and intrinsic) - not as a pre-emptic tool before clinical signs appear.
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