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Category: Fibrinolysis

Age-adjusted D-dimer Limit?

Hi George, I am wondering if anyone is using the age-related D-dimer cutoff for the emergency room based on the ADJUST-PE study? We use Innovance D-dimer reagents from Siemens on the BCS XP analyzer. Our ER physicians are very impatient for us to allow them to use this age-adjusted cut-off, but we have reservations due to CAP and CLIA regulations. Thanks, Sylvia Stacy, Concord Hospital, Concord, NH.

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Wide D-dimer Fluctuations

From Tony Tang, Clinical Laboratory of Tongji Hospital, Wuhan, China:
Hello George, recently we’ve met two or three cases from paediatrics with unexplained massively elevated D-dimer. In these cases, PT and PTT were normal, levels of fibrinogen were decreased (about 1.0-1.5g/L), different D-dimer reagents (STAGO AND IL) got consistent results, levels of rheumatoid factors were normal, clot and hemolysis of specimens could be excluded, however the second specimen from the same patient often got a normal D-dimer result on the next day. Did they got a transient hyperfibrinolysis? or we could attribute these to abnormal sampling for children?  Thanks for your suggestion.

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Back to the ELT

In follow-up to Cassandra McGeachy’s August 7 question on the euglobulin lysis time (ELT), I’ve found two references for upgraded ELT methods that may be helpful.They are:

  • Cellai AP. Lami D, Magi A, et al. Assessment of fibrinolytic activity by measuring the lysis time of a tissue factor-induced clot: a feasibility evaluation. Clin Appl Thromb Hemost 2010;16:337–44.
  • Smith AA, Jacobson LJ, Miller BI, et al. A new euglobulin clot lysis assay for global fibrinolysis. Thrombos Research 2003:112:329–37.

Euglobulin Lysis Time

From friend and colleague Cassandra McGeachy, Louisiana Coagulation Laboratory,

Hi George, I am looking for procedures available for performing the euglobulin lysis time (ELT). I am looking to update my present method if there are any options available.

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Fibrinolytic to Treat Clotted Fluids

George, This is not really a coag question but relates to an issue we see intermittently in our clinical lab. It is the problem of receiving clotted body fluid specimens with the request of a cell count to be performed. While educating the clinician to put the specimen in an anticoagulant tube is ideal to avoid this problem, we do get these requests at times. Since the specimen is not easily recollected, we do not uniformly reject them but do the analysis with a disclaimer. I was wondering if you had any experience or have heard of anyone actually introducing a fibrinolytic agent to break up the clot to be able to perform a more useful evaluation? I remember back in my med tech days that we used to add protamine sulfate to dialysis patient specimens to activate the tubes to clot and wondered if anyone has thought of doing the opposite in these clotted body fluid specimens. I appreciate your thoughts on this question. Thank you in advance. Dr. Bruce King.
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D-dimer in Body Fluids

Here is a note from the American Society for Clinical Laboratory Science Consumer Web Forum: What is the normal value of D-dimer in pleural or peritoneal fluids. I know the normal range of D-dimer in the blood is less than 250 ng/mL D-Dimer Units but what about other body fluids? Thank you.

I have found no reference to D-dimer assays in body fluids except for two primary research publications that record coagulation components in tumor-related exudates. Do any of our participants have any experience with this?

Fibrinogen Assay for Pleural Effusion?

From Pam Owens, Centennial Medical Center, Nashville, TN. Recently a pediatric group approached us asking if we would do a fibrinogen level on pleural fluids before and during administration of tissue plasminogen activator (TPA, Alteplase) for resolution of the effusion. I found the previous reference to this treatment in a post from August 2012, but no mention of a fluid fibrinogen level. So my question is threefold:

1 What is the utilization for this?
2 Does anyone else have experience with this request?
3 Would you put a potentially viscous sample on an instrument or would the test have to be performed some other way?

We are scheduled to meet with the pediatricians when they all return from the holidays, but would like some perspective.

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Prolonged PT, TT, and PTT

From Ning Tang: Hi, George, I come from a clinical laboratory in China. We met a confusing case today and want to get your suggestion: A patient had a prolonged prothrombin time (PT, 20s), partial thromboplastin time (APTT, PTT, 52s) and thrombin time (TT, 127s). Fibrinogen activity is within reference interval (by both Clauss method and TEG), also the patient shows slight bleeding symptoms, is this dysfibrinogenemia? How to confirm it? Thanks for your help!

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