CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
October 2023—New this month from CAP Publications is Whole Blood Viscoelastic Assays in Clinical Diagnosis: An Illustrated Case-Based Guide. Viscoelastic testing was designed to determine the cause of intraoperative or trauma-related bleeding to guide hemostatic therapy. CAP TODAY asked the book’s editor, Oksana Volod, MD, about the guide. Her answers follow, and a sample chapter is available here.
Dr. Volod is professor of pathology and director of the coagulation consultative service, Cedars-Sinai Medical Center, Los Angeles.
Are whole blood viscoelastic assays in common use today?
The invention of thromboelastography (TEG), the first viscoelastic assay (VEA), predates the description of the activated partial thromboplastin time test in 1953, originating in Germany in 1948. However, widespread adoption of VEA in clinical laboratories occurred only after the introduction of a cell-based model of hemostasis in 1994, which emphasized the crucial roles of platelets and tissue factor in hemostasis. Initially, VEA found limited applications in liver transplantation and cardiac surgeries.
The conventional plasma-based coagulation testing proved challenging for managing patients in various critical clinical scenarios, such as trauma, intraoperative obstetric care, and intensive care. The COVID-19 pandemic dramatically increased the demand for promptly assessing the hemostasis of COVID-19 patients and effectively addressing their coagulation-related complications.
Recent advancements in next-generation VEAs like ROTEM Sigma, TEG 6s, and Quantra have made it possible to perform these tests at the patient’s bedside, leading to a broader range of clinical applications. This development has attracted considerable interest from clinicians, laboratory professionals, and hospitals alike.
What prompted you to put this guide together, who is it written for, and is there any similar book on the market?
The project got its start during my tenure on the CAP Hemostasis and Thrombosis Committee during discussions on the rising interest in VEA and the lack of a textbook. I was entrusted to lead the project by the then committee chair and vice chair, Drs. Dong Chen and Andrew Goodwin.
My fascination with VEA traces back to my residency, where I completed an elective rotation in coagulation at the Royal Free Hospital in London, renowned as one of Europe’s largest hemophilia centers. It was during this period that I was first introduced to VEA, specifically the TEG. Subsequently, I invested a substantial amount of time and effort over the course of 20 years to acquire an in-depth understanding of various VEAs and their applications.
The primary objective of this book is to offer a thorough yet succinct manual to individuals engaged in viscoelastic testing. It covers aspects such as comprehending hemostasis, the practical application, and the interpretation of VEA across diverse clinical settings. This book caters to a broad audience, including pathologists, clinicians, laboratory scientists, perfusionists, nurses, as well as trainees who depend on viscoelastic testing for patient care and decision-making.