In response to a question from Kim Kinney we posted the following "Quick Question" last week, "What is your critical INR call-out number?" The answers were relatively predictable...

Here is some follow-up to the question posted last week by Julie Schartiger MLT (ASCP) from Holzer Medical Center, Gallipolis, OH. Julie wrote: "I was wondering if there was a list of the specific disease states and the correction factors involved.  For example, if a specimen was corrected by the addition of normal pooled plasma, but the Russell viper venom test was abnormal, what disease state would this indicate?  It would be nice to have a chart for quick reference."

It occurred to me that we need a summary of presumed acquired and congenital coagulation deficiencies related to prothrombin time (PT) and partial thromboplastin time (PTT) results in bleeding patients. Here is a table that may be useful...

Good afternoon,  I have been referred to you to ask about Factor V.  After my sisters tested positive for this blood disorder I took the test for Factor V and was told that my count was 2.49.  My family physician is not familiar with this disorder.  I would like to know if this number means that I tested positive  for this condition, or am I negative?  What should my next step be?  Should I make an appointment with a hemotologist?  I would really appreciate your opinion, as I am told you are quite familiar with Factor V. Thank you so much for your time.  Sincerely, Jan Scott

George: I was looking at different coagulation methods, possibly doing factor testing and mixing studies.  We are looking at various instruments, one being the ACL TOP.  I was wondering if there was a list of the specific disease states and the correction factors involved.  For example, if a specimen was corrected by the addition of normal pooled plasma, but the Russell viper venom test was abnormal, what disease state would this indicate?  It would be nice to have a chart for quick reference.  Thanks for your time.

Julie Schartiger MLT (ASCP)
Holzer Medical Center
100 Jackson Pike
Gallipolis, OH  45631

For as long as I can remember, the transfusion service has released fresh frozen plasma (FFP) to treat emergent or chronic bleeding secondary to liver disease coagulopathy, vitamin K deficiency, DIC, warfarin overdose rescue, or single factor deficiencies for which no single factor concentrates were available; prothrombin, V, VII, X.

FFP is supernatant plasma expressed from centrifuged whole blood and frozen within eight hours of collection. However, FFP usage is diminishing as we change to FP24. What is FP24?

here is a message from Jennifer at the University of Tennessee at Memphis, who is doing a research study about utilization of the INR. Jennifer would like to document the frequency of PT tests ordered daily, nationwide. Please send a reply giving your laboratory's volume so she can extrapolate to estimate a nationwide volume. Thank you.

Jennifer: thanks to Stephen Duff at Precision Biologic, we've located a CDC report on laboratory testing volumes. Click on http://wwwn.cdc.gov/mlp/coagulation_resources.aspx, it should bring you there.

Kim Kinney at Clarian brings question only when she has a really tough problem, as she can resolve most coagulation issues that come along. She is converting her central lab and a number of satellite labs from MDA to Beckman-Coulter Inc. (BCI, TOP) instrumentation, and most recently is moving her factor V and VII activity levels to the new instrument and reagents. Factors V and VII assays are based on the prothrombin time reagent, and although it is rare to have a single factor V or VII deficiency, they are often assayed to confirm liver disease and to distinguish the coagulation effects of liver disease from vitamin K deficiency.
Anyway, her problem is this...