From Meg Harlin, Peninsula Regional Medical Center in Maryland: Our Laboratory will be bringing in new coagulation analyzers from Instrumentation Laboratories, Inc.; TOPS 300, in February, 2014. We currently perform prothrombin time and international normalized ratio (PT/ INR), partial thromboplastin time (APTT, PTT), fibrinogen, and D-dimer. A Few years ago we stopped doing bleeding times, mixing studies and circulating inhibitors when the lab became a lean core. We are a trauma center, and also do a lot of cardiac and orthopedics. We do have the VerifyNow for platelet function for anti-P2Y12 agents and aspirin. Do you think it would be beneficial if we started thrombin times (TT) and anti-Xa’s at this point of starting up new instrumentation? Thank you for your time with my question, I look forward to hearing from you.
From Saravanan Vinayagam: We are trying to set up the factor VIII inhibitor assay on our ACL TOP analysers. Has anyone got an SOP or previous experience in validating inhibitor assay in an automated analysers? Thank you.
Hello, Saravanan Vinayagam, and thank you for your post. I’m hoping that an IL technical representative will see this and offer some assistance. Geo.
A message from Sue Allen at Baptist Hospital: George, a while back you posted a question to the masses about the correlation between the Abbott i-STAT ACT versus the ITC Hemochron 401 and the Hemochron Jr. and I was wondering if you ever received any responses and have any further information on the subject. We are currently doing the same conversion and needless to say, the methods do not directly correlate. They do quite well at the lower ranges but at the 300–350 sec levels they seem to differ by as much as 100 seconds.Thank you in advance for any light you can shed on the subject.
From Kim Kinney at Indiana University Medical Center (IU Health): Hi George. We are being asked to make the thromboelastograph (TEG) available in our special coag lab for clinical use. I am curious to poll others regarding the use of TEG, who is running the test, who is interpreting the results, etc. We have had the TEG available for several research studies here at IU Health but the testing was performed by a research lab. Thanks for the help, Kim
Hi, Kim, it is great to hear from you again, and I hope we get some feedback! I rarely see TEGs in clinical labs, they seem to live mostly in operating suites where they are used to monitor heparin or thrombolytic therapy. Geo.
Back to our April 24 anticoagulation clinic manager’s question about when to validate a prolonged point of care (POC) prothrombin time with international normalized ratio (PT/INR). George spoke with representatives of Roche Diagnostics, distributor of Coag-U-Chek instruments, while attending the May 3–5 Thrombosis and Hemostasis Summit of North America meeting in Chicago. While Roche contends this is a local decision and makes no firm recommendation, their managers assert that most clinic operators choose 4.0 as the INR above which they send the patient for a follow-up venous PT/INR.
From Bob Gosselin: Hey GF, re point of care (POC) international normalized ratios (INRs), assuming that you are collecting a citrated sample for testing, a high hematocrit (HCT) should not matter for a system that employs fingerstick whole blood, since there is no citrate:plasma ratio issue at hand with using whole blood. Viscosity may be an issue with high HCTs and POC testing.
Robert Gosselin, CLS
Coagulation Specialist, University of California, Davis Health System
Department of Pathology and Laboratory Medicine, Specialty Testing Center