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on the use of thromboelastography in the peripartum management of a patient with
platelet storage pool disorder. We would like to bring the authors’ attention to a
possible error in the graphical information displayed on the thromboelastogram (TEG)
following administration of DDAVP (Fig. 1). The split point, seen when the tracing deviates from baseline representing initial
clot formation, may not have been correctly identified. We believe the spilt point
has been identified prematurely as an irregularity in the baseline can be seen at
the point where the three lines drawn by the TEG software originate. As a consequence,
an alpha angle of 25.4° was calculated whereas if the split point had been identified
correctly, we estimate it would be approximately 45°.
Fig. 1TEG after DDAVP, reproduced from Rajpal et al.
We describe the peripartum management of a 26-year-old primigravida with a platelet storage pool disorder who underwent spontaneous vaginal delivery of twins with epidural analgesia. Postpartum hemorrhage from uterine atony, and cervical and vaginal lacerations were treated successfully with 1-desamino-8D-arginine vasopressin and blood products. The use of thromboelastography in the assessment and management of bleeding risk in the setting of platelet storage pool disorder is described.
