Introduction: Thromboelastography is a viscoelastic clot assay that uses whole blood to generate a dynamic realtime tracing of the clot, from formation to degradation and includes more information about the clot than platelet count, factor based assays, and tests for degradation products.This test also identifies hypercoagulable states, a cause of morbidity and mortality in oncology patients.Multi-channel analysis further enables assessment of the effects of heparin and body temperature on coagulopathies.Material and Methods: Citrated blood samples are hand carried to the Core laboratory to avoid platelet activation in the pneumatic tube system.Routinely, both plain and heparinase cups are run in parallel and the assay commences following recalcification and activation with kaolin using Haemascope(R) thromboelastographs.The results are promptly released to the electronic medical record, to facilitate timely intra-operative ordering of FFP and are submitted to pathologist queue for interpretation.Results and Discussion: The TEG has proved useful in assessing underlying coagulopathies in patients heparinized for Extra Corporeal Membrane Oxygenation;demonstrating platelet based hypercoagulability in a patient with Heparin Induced Thrombocytopenia;documenting adequacy of platelet function in thrombocytopenic patients suffering myocardial infarctions;documenting platelet hypofunction in patients with mild thrombocytopenia;and guiding therapeutic interventions in patients requiring massive transfusion.The TEG has proven useful in providing insights into the interactions of the factors and platelets that is lacking in other clot based studies using platelet poor plasma.Finally, research studies using first order derivatives of the TEG tracing, analogous to wave form analysis, give more information about the quality of the clot.