A postoperative patient develops oozing from IV sites and surgical drains. Thromboelastography (TEG) shows prolonged clot initiation time (R-time) with normal MA and LY30. This pattern indicates:

• A Primary fibrinolysis — treat with tranexamic acid
• B Platelet dysfunction — treat with platelets
• C Hypercoagulable state — prophylactic anticoagulation is needed
• D Coagulation factor deficiency — treat with fresh frozen plasma ✓

Explanation

On TEG: R-time reflects initiation of clot formation by coagulation factors (analogous to PT/APTT). A prolonged R-time with normal MA (platelet-fibrin clot strength) and normal LY30 (fibrinolysis) indicates an isolated coagulation factor deficiency requiring FFP. Prolonged MA with normal R indicates platelet dysfunction or thrombocytopaenia. Elevated LY30 (>7.5%) indicates primary fibrinolysis treatable with tranexamic acid. TEG-guided transfusion reduces total blood product usage compared to empiric transfusion.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.