Thromboelastometry (TEM®)

Thromboelastometry is a viscoelastometric method for hemostasis testing in whole blood. TEM® measures the interactions of coagulation factors, inhibitors and cellular components during the phases of clotting and subsequent lysis over time. The rheological conditions of this method mimic the sluggish flow of blood in veins. TEM® is performed on the ROTEM® system, an enhancement of the traditional thromboelastography method, developed by Hartert in 1948.

Detection method:

A whole blood sample is placed into a cuvette and a cylindrical pin is immersed. Between the pin and cuvette remains a gap of 1 mm, bridged by the blood. The pin is rotated by a spring to the right and the left. As long as the blood is liquid, the movement is unrestricted. When blood starts clotting, the clot increasingly restricts the rotation of the pin with rising clot firmness. This kinetic change is detected mechanically and calculated by an integrated computer to the typical curves (TEMogram) and numerical parameters.

thromboelastometry overview

With a set of dedicated assays, TEM® detects hypo- and hyperfunctional stages of the clotting process. The rapidly available results enable a differential diagnosis. When used along with patient history and the clinical picture, ROTEM®  results help discriminate between surgical bleeding, a hemostasis disorder, and hyperfibrinolysis.  These results can also help determine the extent of dilutional coagulopathy, requirement for fibrinogen or platelet substitution and allow heparin and protamine dosage monitoring.
The traditional thromboelastograph by Hartert works with a free-pending pin in a rotating cuvette. The clotting process is detected via a torsion wire. Due to the free suspension of the pin, this traditional method, according to Hartert, is extremely sensitive to vibrations and mechanical shocks. This flaw is overcome in the ROTEM® system by using a rotating pin, fixed on a steel axis which is stabilized by a unique ball bearing and the precise optical detection method. This technology enhancement, combined with automated pipette, touch screen operation and intuitive user-friendly software in ROTEM® has optimized the TEM® for use in hospitals across North America.