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The Significance of Thromboelastogram in Predicting Postpartum Hemorrhage and Guiding Blood Transfusion by Guanglai Fan, Min Yuan, Huiyuan Niu, Yexia Lu, Hongbo Yang, Xueping Liang

Background: The aim of this study was to probe into the significance of the thromboelastogram (TEG) in predicting postpartum hemorrhage and guiding blood transfusion.
Methods: In total, our work selected 200 cases of postpartum hemorrhage patients admitted to the hospital from April 2017 to November 2020 as the research objects, namely the postpartum hemorrhage group. Another 200 cases without postpartum hemorrhage during hospitalized delivery during the same period were chosen as the no postpartum hemorrhage group. The 200 patients complicated with postpartum hemorrhage were allocated into two groups in accordance with whether the blood transfusion was guided by TEG, 100 cases in each group. The changes of blood coagulation as well as TEG indexes in the two groups with/without postpartum hemorrhage were compared, and the diagnostic significance of TEG detection as well as blood coagulation examination for postpartum hemorrhage were analyzed. The TEG index changes before and after infusion of blood products under TEG guidance were counted. The bleeding time and bleeding volume and the blood products infusion with/without TEG guidance were compared. Based on the changes in the coagulation index (CI) of TEG indexes and in D-dimer, correlation analysis between bleeding time and bleeding volume was carried out, predicting the ROC curve and calculating the AUC area through drawing TEG indexes.
Results: In the comparison of coagulation indexes, the APTT, PT as well as TT of the postpartum hemorrhage group were longer than those of the no postpartum hemorrhage group (p < 0.05), and the FIB level was lower than that of the no postpartum hemorrhage group (p < 0.05). The TEG indexes of R, MA, and K in the observation group were greater than those in the control group (p < 0.05); Angle-α and CI were lower than those in the control group (p < 0.05). The sensitivity and specificity of patients receiving TEG detection were higher than those receiving coagulation examination. After injecting blood products, the R, MA, as well as K of TEG indexes were less than before (p < 0.05), and the Angle-α as well as CI were greater than before (p < 0.05). If the patients were guided by TEG, the bleeding time was shorter (p < 0.05) and the bleeding volume was less than those not (p < 0.05). The dosage of blood products, including erythrocytes, fresh frozen plasma, cold precipitation as well as platelets given to those received TEG guidance was less than those who did not (p < 0.05). CI was negatively correlated with the change of D-dimer (p < 0.05), CI was negatively correlated with the change of bleeding time (p < 0.05), and CI was negatively correlated with changes in bleeding volume (p < 0.05). Using R we predicted postpartum hemorrhage AUC area = 0.772. Using MA our team predicted postpartum hemorrhage AUC area = 0.458. Using K we predicted postpartum hemorrhage AUC area = 0.924. Using Angle-α our team predicted postpartum hemorrhage AUC area = 0.728.
Conclusions: For patients with postpartum hemorrhage, applying TEG to guide blood transfusion is available to more promptly guide clinical blood transfusion, reduce the blood transfusion volume, and bleeding volume, thus more effectively promoting the return of blood coagulation to normal and improving the prognosis.

DOI: 10.7754/Clin.Lab.2021.210317