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New Test: Rotem Viscoelastic Test
(This test will only be available for UCI Trauma patients)
Background:
Effective Aug. 21, 2019, the UCI Department of Pathology & Laboratory Medicine will offer a new test for whole blood hemostasis testing: Rotem. The Rotem viscoelastic testing system is intended to provide a qualitative and quantitative indication of the coagulation state of a whole blood sample. Rotem records the clot firmness changes in a sample of citrated whole blood as the sample clots, retracts and lyses in real time. The indication for Rotem use is with adult patients where an evaluation of their blood coagulation properties is desired.

This test will only be available for UCI Trauma patients.

Effective date: Aug. 21, 2019

Methodology and reporting:
Thromboelastometry provides global information on the dynamics of clot development, stabilization and dissolution that reflect in vivo hemostasis.

The Rotem system measures Clotting Time (CT) in seconds, Clot Formation Time (CFT) in seconds, Alpha Angle (α) in degrees, Maximum Clot Firmness (CFT) in mm, Amplitude 10 minutes after CT (A10) in mm, Amplitude in 20 minutes after CT (A20) in mm, Lysis Index at 30 minutes (LI30) in percentage, and Maximum Lysis (ML) in percentage.

Rotem assays include:
  • EXTEM: monitors the coagulation process via the extrinsic pathway.
  • FIBTEM: monitors clot firmness after blocking the contribution of platelets. It is always used in conjunction with EXTEM.
  • APTEM: monitors clot firmness after blocking hyperfibrinolysis by aprotinin. It is always used in conjunction with EXTEM.
  • INTEM: monitors the coagulation process via the intrinsic pathway.
  • HEPTEM: same as INTEM, except any heparin in the sample is inactivated by heparinase.
Test limitations:
  • Rotem should not be the sole basis for a patient diagnosis. Rotem results should be considered along with a clinical assessment of the patient’s condition and other coagulation laboratory tests.
  • Rotem is not intended for use on patients under 21 years of age.
  • Patients with Hypofibrinogenemia have not been fully evaluated. Patients with dysfibrinogenemia were not tested.
Test codes:
INTEM, EXTEM, FIBTEM, APTEM, HEPTEM

Specimen required:
2.7 mL blood in two (2) light blue-top (3.2% sodium citrate) plastic tubes, hand delivered to Hematology

Stability:
Ambient: 4 hours
Refrigerated: Unacceptable
Frozen: Unacceptable

Turnaround time (TAT):
Within 2 hours (all tests run STAT)

AVAILABLE ONLY FOR TRAUMA PATIENTS

Rejection criteria:
Specimens submitted in glass tubes, specimens that exceed stated stability, unlabeled/mislabeled/mismatched specimens, specimens submitted in leaking containers, clotted, hemolyzed or under-filled tubes. DO NOT USE TUBE SYSTEM.

A summary of all tests offered by our laboratory services can be found here:
http://www.pathology.uci.edu/services/index.asp

Sincerely,

Jennifer S. Woo, MD
Director
Special Coagulation

Edwin S. Monuki, MD, PhD
Chair
Department of Pathology & Laboratory Medicine
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