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Test Code ROTEMRTN ROTEM Main Lab: Routine Panel

Clinical Information

ROTEM (EXTEM, FIBTEM, INTEM) testing with the addition of HEPTEM. HEPTEM contains heparinase that can neutralize a heparin effect up to 10 U/mi unfractionated heparin spiked in whole blood. HEPTEM should be compared to INTEM to evaluate patient clotting without the effect of heparin.

Reflex testing with APTEM is performed when maximum lysis in EXTEM is >15%. APTEM should be compared to EXTEM to identify hyperfibrinolysis.

Synonym

  • RTMRTN

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
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 
INTEM ML: No reference range available; see comment
INTEM LI30: No reference range available; see comment

 

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 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

Rotem Physician Advice

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, Fibtem D, Aptem D

CPT Code Information

85396

LOINC Code Information

52769-7
52774-7
52779-6
52773-9
52770-5
52783-8