Clot Retraction

I thought the clot retraction test had disappeared when the earth cooled, but I heard from Maggie Schneider MT (ASCP) and Karri Henderson MT (ASCP) at William Beaumont Hospital in Oakland, MI, who occasionally use it. If an institution as “august” as Beaumont is using the clot retraction test, there must be more folks in North America using it. So I went to the books, specifically one Donna Corriveau and I edited and published in 1988. Read more »

Greiner Tubes

Sue Osier from Northside Hospital in Atlanta asks whether anyone is using Greiner specimen collection tubes and whether they seem to be causing any trouble on Stago equipment, specifically, the STA-R and Sapphire. Read more »

Screening for Bleeding Risk

Nancy Kovacs posted this message on the Medlab-L list and has given me permission to post it here.

Hello! I am a member of the MedLab Listserve and have often seen your postings about coagulation issues. Perhaps you can help us with our PFA-100 questions. We have a pain management clinic and wanted to cease doing bleeding times that were requested before invasive procedures such as epidural injections. We are just about ready to bring our PFA-100 analyzer into service - but - we read in the literature that this test is not to be used as an indicator of propensity for surgical bleeding and is not
sensitive to Plavix. Apparently it is to be used to monitor aspirin and DDAVP therapy. So - our question is  - are we back to bleeding times for our pain clinic ? Or should we just advise the doctors of the limitations of the test? If you are doing this test at your institution - what clinical utility does it have for your physicians? Any information, guidance or references you could give us would be greatly appreciated. Nancy

Nancy Kovacs  MT(ASCP)
St. Charles Mercy Lab
Oregon, Ohio 43616 Read more »

ACT Validation

Here is a question from Mary Rozmanc in Sunnybrook:

Hi, George,

I will be evaluating two vendor ACT devices. Is there any information you have or that you can point me to to help me set up a proper evaluation? The reference instrument will be the Medtronic ACT II. I would like to know what type of acceptance criteria I can decide on before I begin the evaluation. Both vendors use ACT cartridges.

Would a cath lab benefit from a high-range ACT test cartridge and when would this be the case?

Thank you, Mary

POCT/Projects Coordinator Read more »

Dr. Dot Adcock in January CAP Today

I’m proud to see the January issue of CAP Today features Dr. Dorothy (Dot) Adcock, Director of Esoterix Laboratory Services, Englewood, CO. Beside highlighting Dot’s career, the article contains valuable tips on mixing studies, von Willebrand disease testing profiles, and global clotting assay. Geo.

Hypothermia and Anticoagulant Monitoring

Here is a question sent to Kim Kinney from a Clarian Pharm D:

I’ve got a great question and I hope you can help.  We are using more and more induced hypothermia for cardiac arrest, and will especially see this increase as our regionalization for MI program gets up to speed.  So if someone is cooled, and they go to cath lab for an intervention and the anesthetist needs to give heparin to get to a certain activated clotting time (ACT, a POC test in surgery), what do we do since the cooling affects the ACT? Further, I was told that for a PTT, we should call the lab and let them know to run it at a certain temp to match the patient. Thanks! Joanna Read more »

Cold Agglutinins

Rita Burns sent me this message on January 8: How do you handle a strong cold agglutinin for coagulation testing?  This particular sample generated dye errors on the Biomerieux (Trinity Biotech, Inc) MDA180.  After warming the sample on the unit, we were able to retrieive results with no error flags, but we are still concerned as to its effect of falsely prolonging results. Read more »

Specimen Hemolysis and D-dimer Elevation

This question arrived January 8 from Twyla Bader MT (ASCP), Heme/Coag Supervisor at St. Joseph Hospital, Bellingham WA:

We use Diagnostica Stago’s  STA Compact analyzers and their LIA D-dimer reagent. Their package insert states there is no interference by hemolysis up to 5.0 g/L HGB. We did find a discrepancy between a hemolyzed sample and a nonhemolyzed recollection from the same patient with little time elapsed. We suspect it was due to a traumatic collection (indicated by hemolysis) that activated the coagulation cascade and resulted in D-dimer produced during the collection process in vitro. What do you  think, is it possible to have a considerable amount of D-dimer result from the collection process alone? Read more »