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HelpTest Code ROTEMHEP ROTEM Main Lab: Heparin Panel
Clinical Information
ROTEM provides a rapid, global assessment of clot development from secondary hemostasis to clot lysis by evaluating clot formation, clot firmness, and clot fibrinolysis. ROTEM utilizes a whole blood sample to demonstrate how platelets, coagulation factors, RBCs, and other elements are working together to initiate a clot, determine clot strength, and investigate if there is ongoing fibrinolysis.
Reflex testing with APTEM is performed when maximum lysis in EXTEM is >15%. APTEM should be compared to EXTEM to identify hyperfibrinolysis.
Synonym
- RTMHEP
Profile Information
| Test Code | Reporting Name | Available Separately | Always Reported |
|---|---|---|---|
| INTEM | CT D | No | No |
| CFT D | No | No | |
| Alpha Angle D | No | No | |
| A10 D | No | No | |
| A20 D | No | No | |
| MCF D | No | No | |
| ML D | No | No | |
| LI30 D | No | No | |
| EXTEM | CT D | No | No |
| CFT D | No | No | |
| Alpha Angle D | No | No | |
| A10 D | No | No | |
| A20 D | No | No | |
| MCF D | No | No | |
| ML D | No | No | |
| LI30 D | No | No | |
| HEPTEM | CT D | No | No |
| CFT D | No | No | |
| Alpha Angle D | No | No | |
| A10 D | No | No | |
| A20 D | No | No | |
| MCF D | No | No | |
| ML D | No | No | |
| LI30 D | No | No | |
| FIBTEM | CT D | No | No |
| CFT D | No | No | |
| Alpha Angle D | No | No | |
| A10 D | No | No | |
| A20 D | No | No | |
| MCF D | No | No | |
| ML D | No | No | |
| LI30 D | No | No |
Specimen Required
Preferred Container/Tube: 3.2% Citrate Blue Top - 2.7 mL
Specimen Volume: 2.7 mL
Acceptable Container/Tube: 3.2% Citrate Blue Top - 1.8 mL
Specimen Volume: 1.8 mL
Specimen Collection Information
Blue top tube must be completely filled; mix gently by inversion.
Do not shake or roll tubes containing patient blood.
Specimens should be kept at room temperature and walked directly to the laboratory for testing.
DO NOT transport via pneumatic tube system
Care should be taken to avoid contamination from IV fluids, espeically lines delivering anticoagulants.
Specimen Stability Information
Ambient:
Whole blood: 4 hours
Rejection Due To
- Ambient specimens >4 hours old
- Clotted specimens
- Underfilled or overfilled tube
- Samples delivered by pneumatic tube system
Testing Algorithm
If the Extem ML% >15%, the Aptem will be performed.
Reflex Tests
| Test Code | Reporting Name | Available Separately | Always Reported |
|---|---|---|---|
| APTEM | CT D | No | No |
| CFT D | No | No | |
| Alpha Angle D | No | No | |
| A10 D | No | No | |
| A20 D | No | No | |
| MCF D | No | No | |
| ML D | No | No | |
| LI30 D | No | No |
Reference Values
INTEM CT: 122-208 sec
INTEM CFT: 45-110 sec
INTEM ALPHA: 70-81 degree
INTEM A20: 51-72 mm
INTEM MCF: 51-72 mm
EXTEM CT: 43-82 sec
EXTEM CFT: 48-127 sec
EXTEM ALPHA: 65-80 degree
EXTEM A20: 50-70 mm
EXTEM MCF: 52-70 mm
FIBTEM A20: 7-21 mm
FIBTEM MCF: 7-21 mm
Reference ranges are not available for all ROTEM components unless otherwise noted: Interpretation of ROTEM results must include all available parameters, patient clinical context and current therapy.
Interpretation of the HEPTEM results must include clinical correlation between the INTEM and the HEPTEM data. All results should be interpreted carefully based on patient clinical context and current therapy.
Interpretation of APTEM results (fibrinolytic activity) must include correlation between the EXTEM and APTEM data. All results should be interpreted carefully based on patient clinical context and current therapy.
Interpretation
Cautions
Limitations of ROTEM thromboelastometry Platelet inhibitors:
- No detection of Aspirin®
- No detection of clopidogrel/Plavix®
- No detection of von Willebrand syndrome
- Poor sensitivity to Reopro®
Anticoagulants:
- Poor sensitivity to low molecular weight heparin, Orgaran® and pentasaccharide
- Poor sensitivity to oral anticoagulants (coumarins: Warfarin®, etc.)
Not intended to be used to identify mild platelet deficiencies or platelet coagulation abnormalities.
Method Description
Rotational Viscoelastic Testing- Rotem Delta: The patented ROTEM technology is based on a fixed cylindrical cup and a permanently oscillating vertical axis.
The axis is supported by a high precision ball bearing and oscillates to the left and to the right through an angle of 4.75°.
Performing Lab
Clinical Lab UH
Day(s) Performed
Monday through Sunday
Report Available
Same day/1 day
Reporting Name
Intem D, Extem D, Heptem D, Fibtem D, Aptem D
CPT Code Information
85396
LOINC Code Information
52776-2
52771-3
52781-2
52773-9
52770-5
52783-8