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This article discusses the use of rotational thromboelastometry (ROTEM) in the perioperative management of a patient with severe hemophilia A undergoing ankle surgery. Hemophilia A is an inherited bleeding disorder caused by a deficiency of clotting factor VIII (FVIII). Standard laboratory tests are limited in predicting bleeding and guiding hemostasis management in patients with clotting factor disorders. ROTEM analysis allows for real-time evaluation of clotting function and monitoring of hemostatic treatment during the perioperative period. The article suggests that systematic monitoring using ROTEM could be a promising strategy for the use of FVIII concentrates in hemophilia A patients during surgery. However, further research is needed to validate this approach. [Extracted from the article]

Rotational thromboelastometry (ROTEM) is a viscoelastic method, which provides a graphical and numerical representation of induced hemostasis in whole blood samples. Its ability to quickly assess the state of hemostasis is used in the management of bleeding from a variety of causes. The separate activation of particular parts of hemocoagulation in INTEM, EXTEM, and FIBTEM tests allows for a more comprehensive and faster evaluation of the missing component of hemostasis followed by targeted therapy. One of the most common cause of coagulopathy is trauma-induced coagulopathy. Fibrinogen replacement therapy by ROTEM allows for the use of a standard dosage of fibrinogen, which has been shown to be successful in preventing dilutional coagulopathy following colloid and crystalloid replacement and excessive amount of allogeneic blood transfusions. The best reflection of fibrinogen activity is observed in the FIBTEM assay, where fibrinogen replacement therapy is recommended at an MCF (maximum clot firmness) of FIBTEM < 10 mm and FIBTEM A10 < 7 mm. ROTEM also plays an important role in the diagnostic and management of inherited fibrinogen disorders. These can be manifested by bleeding complications, where changes in the MCF parameter are the most useful tool for assessing the effectiveness of fibrinogen replacement therapy. ROTEM-guided bleeding management algorithms effectively reduce the number of transfusions, healthcare costs, and complications, leading to the improvement of patient safety and overall health. [ABSTRACT FROM AUTHOR]