EMERGENCY · HAEMORRHAGE
ROTEM · Gynaecology
Haemorrhage ROTEM guidance for gynaecology patients. Major haemorrhage policy (Adult) V2.0. Always base treatment upon clinical scenario.
1 ·Initial Steps
Always do this first
Order / Give
4 Units Red Cells
Run
ROTEM (Extem + FibTEM)
2 ·CT Extem > 100 s?
If CT Extem > 100 s AND actively bleeding
Action
Order FFP (give when ready) — run in parallel with waiting for results
Wait for Extem and FibTEM results, then find your branch below.
3 ·Extem A10 < 30 AND FibTEM A5 < 5
Extem A10 < 30 AND FibTEM A5 < 5
Action
Fibrinogen Concentrate 3 g
After infusion completes
Check FibTEM. Give further Fibrinogen Concentrate until FibTEM A5 > 8
3 ·Extem A10 30–45 AND FibTEM A5 5–8
Extem A10 30–45 AND FibTEM A5 5–8
Active / High risk bleeding
Fibrinogen Concentrate 3 g
After infusion completes
Check FibTEM. Give further Fibrinogen Concentrate until FibTEM A5 > 8
Not bleeding
Reassess and ROTEM in 1 hour if still stable
3 ·Extem A10 > 45 AND FibTEM A5 > 8
Extem A10 > 45 AND FibTEM A5 > 8
Result
No products required
Platelets
Give Platelets when
Indication
Low Extem but normal FibTEM, or if ≥ 10 units of blood
Targets
Treatment Goals
Hb 70–90 g/L
Fibrinogen > 1.5 g/L
Platelets > 50 × 10⁹/L
PT Ratio < 1.5
FibTEM A5 goal > 8
Lab Contacts