case_images: PMC6136510_01
case_images: Sequential thromboelastometry (ROTEM). ((a), (b), and (c)) Thromboelastometry analysis at the hospital admission ((a) EXTEM, (b) FIBTEM, and (c) APTEM). ((d), (e), and (f)) Second thromboelastometry analysis performed after Tranexamic Acid administration ((d) EXTEM, (e) FIBTEM, and (f) APTEM). ((g), (h), and (i)) Third thromboelastometry analysis performed after additional administration of Tranexamic Acid ((g) EXTEM, (h) FIBTEM, and (i) APTEM). ((j), (k), and (l)) Thromboelastometry analysis performed after factor XIII concentrate (Fibrogammin  P, CSL Behring, Marburg, Germany) ((j) EXTEM, (k) FIBTEM, and (l) APTEM).
case_images: CRIGM2018-6360543.001.jpg
case_images: PMC6136510_01_CRIGM2018-6360543.001.jpg
case_images: fig1
case_images: First ROTEM test showed in EXTEM CT 80s, CFT 105s, alfa-angle 70 , MCF 52 mm, and ML 37%; FIBTEM MCF 13 mm and APTEM MCF 53 mm and ML 20% (Table 1/Figures 1(a), 1(b), and 1(c)). Tranexamic Acid was administered with EXTEM CT 64s, CFT 105s, alfa-angle 69 , MCF 51 mm, and ML 24%; FIBTEM MCF 11 mm, APTEM MCF 51 mm, and ML 20% (Table 1/Figures 1(d), 1(e), and 1(f)). The third ROTEM test showed persistence of maximum lysis above 15% with EXTEM CT 83s, CFT 133s, alfa-angle 66 , MCF 50 mm, and ML 21%; FIBTEM MCF 10 mm and APTEM MCF 51 mm and ML 19% (Table 1/Figures 1(g), 1(h), and 1(i)). This time 1500U of factor XIII concentrate was administrated to correct factor XIII deficiency and fourth ROTEM test was normal with EXTEM CT 64s, CFT 122s, alfa-angle 68 , MCF 50 mm, and ML 15%; FIBTEM MCF 12 mm and APTEM MCF 51 mm and ML 15% (Table 1/Figures 1(j), 1(k), and 1(l)). Thromboelastometry was normal despite CCT were still altered.