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4 results

  • 4.4 - Monitoring Coagulation, Including Thromboelastography

  • from Section 4 - Therapeutic Interventions and Organ Support
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 473-476

  • Summary

    Key Learning Points

    1. 1. Coagulopathy is common in the ICU and abnormal results should be interpreted in the context of the patient’s clinical condition.

    2. 2. Conventional coagulation tests monitor the intrinsic and extrinsic pathways of coagulation and are the mainstay of haemostatic monitoring.

    3. 3. Full blood count and conventional coagulation tests have a turnaround time that renders them unhelpful in acute bleeding scenarios.

    4. 4. Point-of-care viscoelastic tests, such as thromboelastography (TEG®) and rotational thromboelastrometry (ROTEM®), can provide a rapid overview of coagulation from clot formation to lysis, demonstrating both hypo- and pro-coagulant states.

    5. 5. Algorithms based upon viscoelastic tests in bleeding patients have demonstrated a reduction in blood transfusion requirements.

  • 3.10.6 - Haemostasis, Coagulopathies and the Bleeding Patient

  • from Section 3.10 - Haematological and Oncological Disorders
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 353-360

  • Summary

    Key Learning Points

    1. 1. Coagulation is a tightly regulated process controlled by interactions between the vessel, platelets, clotting factor enzymes, co-factors and inhibitors, aimed at stopping bleeding from damaged vessels.

    2. 2. Coagulation involves initiation, activation and propagation of platelet activity to generate a thrombin burst which polymerises fibrinogen to fibrin, plugging the vessel wall.

    3. 3. Coagulopathy is common in critically ill patients and is associated with increased illness severity and mortality.

    4. 4. The underlying cause of coagulopathy must be diagnosed and treated, whilst avoiding the unnecessary correction of laboratory test results, unless there is clinical bleeding or a surgical procedure required.

    5. 5. Disseminated intravascular coagulopathy is most commonly triggered by sepsis, leading to the consumption of clotting factors and platelets, which, in turn, causes bleeding and microthrombotic events. Treatment must be focused upon the underlying condition.

  • Measurement of milk clotting activity by rotational viscometry

  • Mandy Jacob, Martin Schmidt, Doris Jaros, Harald Rohm
  • Journal:
    Journal of Dairy Research / Volume 78 / Issue 2 / May 2011
    Published online by Cambridge University Press:
    17 March 2011, pp. 191-195
    Print publication:
    May 2011

  • Standard method for the determination of the activity of milk coagulants is the rotating bottle method, where clotting time is defined as the time when visually observable flocculation starts. Aim of this study was to verify whether it is possible to determine milk clotting time by rotational viscometry. Using three different coagulants and reconstituted milk of different pH and temperature, flocculation time and viscosity in steady shear was determined, and milk gelation was monitored by small amplitude oscillating shear rheometry. The results show that, independent of pH and temperature, milk clotting time is related to an apparent viscosity of 7·24±0·45 mPa.s, indicating that rotational viscometry can be used for the screening of flocculation time with an accuracy of approximately 6%.

  • Mathematical Model of Fibrin Polymerization

  • A.I. Lobanov, A.V. Nikolaev, T.K. Starozhilova
  • Journal:
    Mathematical Modelling of Natural Phenomena / Volume 6 / Issue 7 / 2011
    Published online by Cambridge University Press:
    15 June 2011, pp. 55-69
    Print publication:
    2011

  • Blood clotting system (BCS) modelling is an important issue with a plenty of applications in medicine and biophysics. The BCS main function is to form a localized clot at the site of injury preventing blood loss. Mutual influence of fibrin clot consisting mainly of fibrin polymer gel and blood flow is an important factor for BCS to function properly. The process of fibrin polymer mesh formation has not adequately been described by current mathematical models. That is why it is not possible to define the borders of growing clot and model its interaction with a blood flow. This paper main goal is to propose physically well-founded mathematical model of fibrin polymerization and gelation. The proposed model defines the total length of fibrin polymer fibers in the unit volume, determines a position of the border between gel and liquid and allows to evaluate the permeability of growing gel. Without significant structural changes the proposed model could be modified to include the blood shear rate influence on the fibrin polymerization and gelation.