“We would like to share an interesting case from our practice at Leleka,” says Evgen Grizhymalskyi, the Head of the Anesthesiology and Intensive Care Department.
“A patient M., 27 years old, was admitted to Leleka Maternity Hospital in order to conclude a contract to have childbirth at our hospital; gestational age was 38 weeks. In the course of examination, the doctors at Leleka detected gestational thrombocytopenia. The platelet count in the complete blood count made it impossible to perform pain relief during labor with the use of epidural analgesia.
We, as anaesthesiologists, became interested in this patient. So, we decided to further examine her and develop an action plan for pain relief during labor. After all, the results of complete blood count and coagulogram are not enough to make the right decision in this situation. In this case, thromboelastography helped us to make the right decision.
Thromboelastography differs from standard tests of hemostasis in the fact that it simultaneously evaluates 4 main components of the hemostatic system: coagulation cascade, platelets, anticoagulant mechanisms and the fibrinolytic system. Thromboelastography makes it possible to evaluate the state of hemostatic system as a whole, the presence and degree of compensation for disorders in this system, the general dynamics in critical conditions and the response to therapeutic measures. This technique helped us to choose the right choice of pain relief during labor in women with a low platelet count. The labor was painless and safe.
The patient was discharged home with the baby after 3 days. It is important to know that by the time of delivery, the hemostatic system of pregnant women undergoes significant changes both physiologically (increased activity of coagulation factors, decreased activity of physiological anticoagulants, decreased activity of the fibrinolytic system) and pathologically (for example, gestational thrombocytopenia, coagulopathy associated with pre-eclampsia, etc.).
Childbirth and the early postpartum period are characterized by a high risk of haemorrhage or thrombosis with the development of secondary disorders in the hemostatic system. Changes in hemostasis during childbirth and the early postpartum period are characterized by diversity, dynamic manifestations and often associated with the development of critical conditions.
The use of both hemostatic and antithrombotic agents to correct disorders of the hemostatic system requires accurate laboratory monitoring. The optimal method to monitor the state of the hemostasis system under these conditions is thromboelastography.
The term “hemostasis” refers to biological and biochemical processes, which, on the one hand, are involved in maintaining the vascular integrity and liquid state of the blood, and on the other, provide prevention of haemorrhage. Plasma factors, platelets, vascular wall, red and white blood cells, endovascular factors are involved in the process of hemostasis. To study the hemostatic system, 2 types of tests are used — local and integral.
For integral evaluation of the hemostatic system, the thromboelastography method (TEG) is used with the help of a device called thrombelastograph. The main feature of TEG is to take into account the contribution of both plasma and cellular (platelets, red and white blood cells) participants in hemostatic reactions and their direct concentration.
Thromboelastography (TEG) is a functional method to evaluate the hemostatic system by examining the viscoelastic properties of a thrombus.