Case report of amniotic fluid embolism coagulopathy following abortion; use of viscoelastic point-of-care analysis

Table 1 Timeline of laboratory results, ROTEM® results, and interventions in order of time when intervention or testing was initiated

Event or Intervention	Time Obtained	Processing Time^a (minutes)	CBC^b	aPTT (seconds)	INR	Fibrinogen (milligrams/deciliter)/FIBTEM A10 (mm)	EXTEM Clotting Time (CT) and A10
Pre-Op			12.1 134
Event	Dilation and evacuation completed at 08:34.
Event	Ongoing vaginal bleeding, episode of hypotension, return to the OR at 10:28.
Lab 1	10:51	88	10.4 84	38.0	1.7
Lab 2	13:08	132	10.6 93	38.5	2.0	Fibrinogen < 25
ROTEM® 1	13:30					Undetectable FIBTEM value	CT = 359 s, A10 = 16 mm
Intervention	At time of ROTEM® 1 result, initiated 3 g concentrated fibrinogen, 1 unit FFP, 1 × 5-pack platelets.
Lab 3	14:21	72	9.5 53	34.4	1.4	Fibrinogen 49
ROTEM® 2	14:21					2 mm FIBTEM (low amplitude)	Improvement in EXTEM. CT = 187 s, A10 = 20 mm
Intervention	At time of ROTEM® 2 result, initiated 1 g concentrated fibrinogen, 2 units of cryoprecipitate, 3 units of FFP, 1 × 5-pack platelets, 2 g TXA.
Lab 4	15:47	57	6.2 81	22.4	1.0	Fibrinogen 255
Intervention	1 unit cryoprecipitate, 2 units red blood cells given between obtaining Lab 4 and receiving the results.
ROTEM® 3	16:44					13 mm FIBTEM (normal amplitude)	Normal EXTEM. CT = 60 s, A10 = 45 mm
Lab 5	17:01	53	8.7 79	26.6	1.0	Fibrinogen 243
Intervention	2 × 5-pack platelets.
	22:21	34	8.8 141	25.3	1.0	Fibrinogen 283

^aProcessing time (minutes) reflects the time from lab collection to the full panel of labs resulting in the electronic medical record system
^b Hgb Platelets
Complete blood count (CBC) with hemoglobin (Hgb) measured in grams/deciliter, platelets in unit × 10³/μl. Activated partial thromboplastin time (aPTT), International Normalized Ratio (INR), clot amplitude at 10 min (A10), clotting time (CT), rotational thromboelastography (ROTEM®), fresh frozen plasma (FFP), tranexamic acid (TXA)

ISSN: 1471-2393