Mary Choi, a lab technologist, prepares a blood sample to be run through the ROTEM® test. (Photo by Yuri Markarov)
St. Michael’s blood lab is using an innovative test known as the rotational thromboelastometry or ROTEM® to help clinicians determine the most appropriate clotting product, whether it be plasma, platelets or medications such as tranexamic acid.
St. Michael’s is the first hospital in Canada to use this test in a clinical environment. Other facilities are using it in research settings and are looking to St. Michael’s for insights into how best to implement it clinically.
“ROTEM® has changed the way we care for patients suffering from massive bleeding,” said Dr. Sandro Rizoli, trauma director at St. Michael’s and one of two physicians who championed implementing this test at the hospital. “We no longer have to wait for multiple tests to be run or guess which clotting products may work.”
This technology enables the trauma team to watch a clot form in real-time on a monitor in the trauma room via a computer in the lab. As soon as the team sees how the clot is forming and how strong it is, a member from the team calls the hospital’s blood bank and orders the specific clotting product needed to stop the bleeding. This typically happens within 10 minutes.
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More than 400 blood samples have been processed through the ROTEM® blood test machine since November 2014.
Previously the trauma team would receive a standard delivery of six units of red blood cells and four units of plasma, followed by four units of red blood cells and four units of plasma, every 20 minutes. This was done for every patient suffering from massive blood loss regardless of size, gender or whether he or she actually needed plasma or red blood cells.
“While it is still too early to tell how much blood has been saved since introducing ROTEM®, we are hoping to see a more appropriate usage of blood components that are ordered to treat a patient suffering from massive bleeding and fewer components being wasted,” said Dr. Katerina Pavenski, medical director of the Transfusion Medicine Laboratory at St. Michael’s.
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.