A trauma patient receives a massive transfusion (>10 units of packed red cells in 24 h). Viscoelastic testing (TEG) shows clot formation time (K time) prolonged and maximum amplitude (MA) severely reduced. Which product addresses the primary abnormality indicated?

• A Fresh frozen plasma to replace clotting factors
• B Cryoprecipitate to replace fibrinogen
• C Platelet concentrate, as MA reflects platelet-fibrin interaction and reduced platelet function ✓
• D Protamine to reverse heparin-like effect from stored blood

Explanation

On TEG/ROTEM, maximum amplitude (MA) reflects the absolute strength of the clot and is determined primarily by platelet count/function and secondarily by fibrinogen. A severely reduced MA in the context of massive transfusion indicates dilutional thrombocytopenia and platelet dysfunction. K time (clot formation time) prolongation reflects kinetics of fibrin polymerisation influenced by fibrinogen and thrombin generation, but the primary target when MA is the dominant abnormality is platelet transfusion. Cryoprecipitate is indicated when fibrinogen <1.5 g/L or FLEVEL (fibrin contribution) is the isolated abnormality.

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

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