Abstract: Objective To investigate the effect of thrombelastogram(TEG)in monitoring hemostatic and coagulation function in patients undergoing elective orthopedic surgery during blood transfusion. Methods A total of 300 elective orthopedic surgery patients were divided into two groups by ball touching grouping method. Control group(n=150)received blood transfusion guided by conventional coagulation indicators, while the research group(n=150)received blood transfusion guided by TEG in monitoring of hemostatic and coagulation function. The therapeutic effects of the two groups were compared. Results After surgery, prothrombin time(PT)and activated partial thrombin time in the research group were significantly shorter, and FIB was significantly higher than those in the control group(P<0.05); the amount of intraoperative blood loss, postoperative 24 h blood loss, and the amount of fresh frozen plasma, suspended red blood cells, hemoglobin and platelets in the research group were significantly less than those in the control group(P<0.05); the incidence of adverse reactions was 1.33% in the research group, which was significantly lower than 8.67% in the control group(P<0.05). Conclusion During elective orthopedic surgery, the implementation of TEG in monitoring hemostatic and coagulation function in guiding blood transfusion can maintain stability of coagulation function, control the amount of blood loss and the amount of blood products, and reduce the - occurrence of adverse reactions after blood transfusion.