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Some Fun With FreeRice.com

Today my daughter, Teri, (Teri Fritsma, PhD, Senior Project Consultant, Minnesota State Colleges and Universities System) introduced Margaret and me to FreeRice.com. Log in and play an addictive analogy game that strengthens your vocabulary and donates 20 grains of rice to the UN food distribution program for every correct answer. Best vocabulary is 50. Follow the link, have some fun, and help feed the hungry.  Geo

Thromboelastography

Jerry Sapp, Blood Bank Supervisor at Birmingham’s respected Children’s Hospital of Alabama asks whether Thromboelastography would be of any use in monitoring the coagulopathy associated with massive transfusion. Read more »

Local ISI (or INR) Calibration

It seems strange North American coagulation laboratories have not adopted local ISI or INR calibration despite articles such as Poller L, Keown M, Ibrahim S, et al. Comparison of local International Sensitivity Index calibration and ‘direct INR’ methods in correction of locally reported International Normalized Ratios: an international study. J Thromb Haemost 2007;5:1002-9 and Adcock DM, Johnston M. Evaluation of frozen plasma calibrants for enhanced standardization of the International Normalized Ratio (INR): A multi-center study. Thromb Haemost 2002; 87:74-9 that demonstrate improved local INR accuracy and lot-to-lot stability. Further… Read more »

More on Arixtra Monitoring

A post from Bryan McGill, PharmD at St. Mary’s Hospital in Madison, WI:

We have a patient with a history of HIT, so we are using Arixtra 2.5 mg q24h for prophylaxis.  Unfortunately the patient also has a CrCl hovering at 30mL/min, so I am worried that the drug may start to build up.  Are you aware of any guidelines for Xa monitoring for fondaparinux? Thanks for your help. Read more »

Checking for Clots

We check all citrate specimens for clots by probing them with applicator sticks before centrifugation. Is this common practice? Are there alternatives?

D-dimer Reporting Discrepancies

Ms. Denise Broadbent, Laboratory Supervisor at Klickitat Valley Hospital in  Goldendale WA posted a question to Medlab-L I will summarize here, followed by a clear discussion from Warren Coffin of Crozer Keystone Health System:

 

Recently we ran a D-dimer, getting a result of >700 ng/mL (negative <230, normal up to 255 ng/ml).  The patient was transferred to another facility whose D-dimer result using a different system was 1.90 mg/L (negative <1.0, normal up to 2.6mg/l).  Understandably our ER doctor was concerned and has asked me to look into the matter.  Specimens were drawn the same day, several hours apart.  I and the hematology supervisor at the other facility have reviewed our QC records and repeated the specimens. Everything is fine except we called the D-dimer positive and the second facility called it suspicious.  I am aware of  the differences among instrumentation, reagents and methods, but, has anyone else seen a discrepancy like this before? Read more »

Linearity

Here is a question from Kim Kinney at Indiana University Medical Center:

I have a question regarding linearity in coagulation. Since most of our special coag assays are based on standard curves, can you not say that an assay is linear from the low to high standard?  If you want to extrapolate beyond the low to high standard, would you then do a linearity study?  I understand linearity in chemistry where most analytes are a direct measurement but when an assay is based on a standard curve do you still need linearity studies? Read more »

ASH Meeting: New Oral Anticoagulants

Two new oral anticoagulants are emerging from phase III trials and receiving attention at this year’s American Society of Hematology annual meeting, in progress in Atlanta, GA. These are… Read more »

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