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Further, temperature is monitored to maintain normothermia. In susceptible patients, blood gas analysis will aid the detection of see more acidosis, anaemia and hypocalcaemia. Routine coagulation parameters like INR, aPTT, PT, platelet count and fibrinogen levels are to be individualised. Activated clotting time (ACT) monitoring is recommended when high dose of heparin is used intraoperatively. Patients with inherited coagulation defects may exsanguinate with trauma or major surgery necessitating second level coagulation tests for specific factor replacement (such as factor VIII, IX and von Willebrand factor concentrate). Thromboelastography and rotational thromboelastometry measurements should be performed at the beginning of surgery as the baseline, when clinically abnormal bleeding occurs and after therapeutic interventions. Point of care coagulation testing[19,36] Point of care (POC) techniques are bed side tests and interpret various aspects of haemostasis more comprehensively and rapidly. They enable economical and effective treatment when compared to SLTs. Their implementation in haemostatic treatment algorithms may reduce both the rate of transfusion of allogeneic blood products and the total cost of treatment for blood loss and coagulopathies. POC techniques can be used to screen coagulopathies and to monitor their treatment, in the preoperative period, resuscitation room, operating room and intensive care unit. Platelet MRIP function The number of platelets does not reflect the quality of platelet function. Bedside aggregometry can be used to study the platelet function. The platelet function analyser (PFA)-100 (Dade Behring) provides a measure of platelet function in citrated whole blood. This method can be used prior to surgery, to rapidly identify aspirin effects and platelet disorders. Intraoperatively, limitations of the PFA-100 include its strong dependence on platelet count (>100 G/l) and Hct (>30%). Optical and impedance click here platelet aggregometry can be used to assess platelet reactivity by measuring changes in luminescence or impedance upon platelet agonist stimulation. PFA-100 and impedance aggregometry (Multiplate) can be performed at bed side with short sample reading times of