Viscoelastic Testing for the Laboratorian: Recent Advances and Practical Advice

Area of Science:

• Clinical pathology
• Hemostasis and thrombosis
• Transfusion medicine

Background:

• Viscoelastic testing is a standard-of-care for goal-directed transfusion management.
• Clinical utility is established in cardiothoracic surgery, trauma, liver transplantation, and obstetric hemorrhage.
• National and international guidelines increasingly endorse viscoelastic testing.

Purpose of the Study:

• Provide an overview of recent advances in viscoelastic testing.
• Offer practical guidance for laboratorians incorporating new viscoelastic technologies.
• Highlight the need for institution-specific validation of transfusion thresholds with next-generation systems.

Main Methods:

• Review of recent advancements in viscoelastic testing technologies.
• Analysis of distinct numerical outputs from next-generation systems compared to established parameters (e.g., TEG 5000, ROTEM delta).
• Discussion of practical considerations for clinical laboratory integration.

Main Results:

• Next-generation viscoelastic systems utilize alternative detection technologies.
• These systems generate distinct numerical outputs for comparable parameters.
• Institution-specific validation of transfusion thresholds is essential for accurate interpretation.

Conclusions:

• Viscoelastic testing is a crucial tool in transfusion management across various high-acuity settings.
• Emerging technologies require careful validation and integration into clinical workflows.
• Laboratorians play a key role in adapting these advancements for optimal patient care.