Orthotopic Liver Transplantation · Transfusion Algorithm

One blood sample. Two protocols. Different decisions.

an interactive recreation of Bonnet et al. — both groups read the same blood, but make different calls

Bonnet A, et al. Eur J Anaesthesiol 2019;36:825–833 · Fig. 1

Patient State
Quick Presets
Surgical Context
Phase
Active haemorrhage
Coagulation Physiology
Procoagulant function drives PT & CT
60
Fibrinogen g / L
2.5
Platelets ×10⁹ / L
120
Fibrinolysis
Same Blood Sample · Two Tests
Standard Coagulation Tests
PTprothrombin time 60 %
Fibrinogen 2.5 g/L
Platelets 120
FDP negative
ROTEM Parameters
EXTEM CT 75 s
EXTEM A10 48 mm
EXTEM MCF 58 mm
FIBTEM A10 14 mm
EXTEM lysis normal
APTEM correction no
Procoagulants ↔ PT & EXTEM CT
Fibrinogen ↔ Clauss & FIBTEM A10/MCF
Platelets + Fib ↔ EXTEM MCF (combined clot strength)
Fibrinolysis ↔ FDP & EXTEM lysis & APTEM correction
Standard arm
0UNITS
ROTEM arm
0UNITS
Standard Algorithm
Fresh frozen plasma
2 units
no indication
Platelets
1 unit
no indication
Fibrinogen concentrate
3 g
no indication
Tranexamic acid
1 g + 3 g daily
no indication
ROTEM Algorithm
Fresh frozen plasma
2 units
no indication
Platelets
1 unit
no indication
Fibrinogen concentrate
3 g
no indication
Tranexamic acid
1 g + 3 g daily
no indication