Category: Thrombophilia

Inpatient Thrombophilia Testing

Another message from colleague and friend Kelly Townsend, Tricore Reference Laboratories, Albuquerque. Hi George, at one of our large teaching hospitals, we are working with the Internal Medicine department to establish “best practices” for ordering thrombophilia testing on inpatients. Has anyone out there successfully implemented guidelines they are willing to share? Any recent references would also be greatly appreciated. Thanks!
Read more »

CPT Code for SCT?

From Molly Klima, University Hospitals of Cleveland: Hi George, we are in the process of bringing up the Instrumentation Laboratory Silica Clotting Time (SCT) assay and are struggling with the CPT code. Since there is no straightforward CPT for the assay our dilemma is as follows:

  • 85730 Thromboplastin time, partial (PTT); plasma or whole blood
  • 85732 Thromboplastin time, partial (PTT); plasma or whole blood substitution, plasma fractions, each

Read more »

World Thrombosis Day October 13

Thanks to colleague Ali Sadeghi-Khomami PhD for his heads-up announcing the International Society on Thrombosis and Haemostasis‘ World Thrombosis Day launch. World Thrombosis Day will be held annually on October 13, the birthday of Rudolph Virchow, 1821, who coined the terms embolism and thrombosis. See the ISTH World Thrombosis Day page for details.

Validating a Rapid HIT Assay

Charlie Muller, Helen Hayes Hospital TW, posted a question on the Medlab list, paraphrased here with his permission. He is validating the Akers PIFA Heparin/PF4 rapid assay kit for heparin induced thrombocytopenia with thrombosis, and needs a good way to validate it in addition to using Akers’ panels. Charlie’s setting is an acute rehab specialty hospital where a very large majority of patients have been exposed to heparin in various surgical procedures. They consult with a pathologist from Columbia University Medical Center who has had several discussions with the medical staff about HIT being a clinical diagnosis, using Warkentin’s 4T, etc. The staff want a little extra guidance from a rapid lab test.

Protein C and S During PE

From Yvonne Ellis, Hematology Technical Supervisor, IU Health Bedford Laboratory: George, I counseled a physician today about ordering protein C and S on a patient who has a confirmed pulmonary embolism. I told him during a clot was not the time to test for these. He did seem to have a good understanding of the workings of the regulators. He seemed to think though that if someone normally had low levels of these, that the levels would be markedly decreased during a clot process. I told him there is no established evidence of how much prot C and prot S are decreased in a clot formation. It would be different per person and per clot. Was I correct in this? Have there been studies about this subject?
I enjoy the e-mails I receive from the Fritsma Factor. I teach hematology/coag at a 2 year MLT program and use the text you collaborated on with Prof. Rodak. It is a great text. Thank you for any help.
Read more »

Rivaroxaban and Homocysteine

From our frequent contributor Crystal Azevedo, Eastern Maine Health System: Hello George, I am working up more patients taking the new directed oral anticoagulants (NOACs) for therapy. Is there a relationship between rivaroxaban and an elevated plasma homocysteine level? I have seen this more than once and I’m curious. Thanks!

Read more »

PS Antigen Comparison Studies

Dear George, I work in a large midwest reference laboratory. We are looking at bringing in the Prot S free latex test. Have you seen any comparison studies between manufacturers’ kits that I could go out on the internet and read? Thanks, Pamela L. Pool, Section Specialist for Coagulation.

Read more »

More on Shortened PTT

From Anita Elledge, MT (ASCP), blood bank/coagulation supervisor, Sierra Vista Regional Health Center, AZ: Our coagulation testing is done on a Stago Compact instrument. The linear range is 20–200 s for the activated partial thromboplastin time (APTT, PTT). We have a policy that any PTT result <22 s must be redrawn, not just rerun the same sample, because it is said that a low PTT result should not occur and is almost always due to a bad collection. I can’t seem to find any documentation that confirms the < 22 s result being a point for this “recollect.” Can you give me a resource for information or any further help with this?

Read more »

WordPress Themes