Clinical application of thromboelastometry in cardiovascular and thoracic surgery.

VET with ROTEM and TEG have become more integrated into the practice guidelines of multiple medical associations with increasing levels of evidence and recommendation for their use to manage perioperative bleeding. VET, in conjunction with SLT, provides a clearer picture of why a patient bleeds and how to best resolve it. In the clinical setting of CVTS, ROTEM has been shown to reduce transfusion rates and reduce costs associated with transfusion products and transfusion-related adverse events while improving patient outcomes. Incorporating VET into a hospital-wide transfusion restrictive strategy has been proven to be cost-effective and clinically beneficial but requires a multi-level commitment for planning, education and implementation.

Galactose-1-phosphate uridyltransferase dried blood spot quality control materials for newborn screening tests.

OBJECTIVES: We aimed to prepare dried-blood-spot (DBS) quality control (QC) materials for galactose-1-phosphate uridyltransferase (GALT), to evaluate their stability during storage and use, and to evaluate their performance in five DBS GALT test methods. DESIGN AND METHODS: We prepared and characterized GALT-normal and GALT-deficient DBS materials and compared GALT activities in DBSs after predetermined storage intervals at controlled temperatures and humidities. External evaluators documented the suitability of the DBS QC materials for use in five GALT test methods. RESULTS: GALT activity losses from DBSs stored in low (<30%) humidity for 14 days at 45°C, 35 days at 37°C, 91 days at room temperature, 182 days at 4°C, and 367 days at -20°C were 54%, 53%, 52% 23%, and 7% respectively. In paired DBSs stored in high humidity (>50%) for identical intervals, losses were: 45°C-68%; 37°C-79%; room temperature-72%, and 4°C-63%. GALT activities in DBSs stored at 4°C were stable throughout 19 excursions to room temperature. Twenty-five of 26 external evaluators, using five different GALT test methods, classified the GALT-deficient DBSs as "outside normal limits". All evaluators classified the GALT-normal DBSs as "within normal limits". CONCLUSIONS: Most of the GALT activity loss from DBSs stored at elevated or room temperature was attributable to the effects of storage temperature. Most of the loss from DBSs stored at 4°C was attributable to the effects of elevated humidity. Loss from DBSs stored at -20°C was insignificant. The DBS materials were suitable for monitoring performance of all five GALT test methods.