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Cepheid Factor II and V Mutations

From Dr. Joyce Low, St. Vincent’s Hospital, Sydney. We were wondering if anyone has had experience of the Cepheid combine factor V Leiden mutation and prothrombin G20210A (Xpert factor II and V) assay on the GeneXpert which was FDA-cleared in 2006.

Thank you, Dr. Low, I’ve had no experience, but hope to hear from our participants.

Pediatric INR?

From Patti Richardson, St. Christopher’s Hospital for Children:

Good afternoon, George: For critical values, are pediatric hospitals using the prothrombin time and international normalized ratio (PT & INR)? For pediatric hospitals, what is the INR critical value most often used?

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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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Prolonged PT, Normal Factor Levels

From Joyce Low: We have a patient with a prolonged prothrombin time (PT) and normal partial thromboplastin time (APTT, PTT). He bled, but factor levels were all normal. He’s an 84 year old man here for pacemaker insertion. PT was 19s (Neoplastine; reference interval 11–15s ), PTT 31s (Actin FS RI 25–35s), thrombin time, fibrinogen, and platelets normal. Patient developed a hematoma and infection at pacemaker insertion site. Pacemaker subsequently removed with bleeding that required 3 fresh frozen plasma twice.

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Updated Events Calendar

George just updated our 2014–15 Events Calendar to include next year’s ISLH and ISTH meetings. If you would like your meeting displayed on the Fritsma Factor, please email George.

Hex-phase Only for LA?

From Lorna Bogertman, Valley Health: Hello George, I have a question concerning lupus anticoagulant (LA) testing. We have had several requests from physicians to perform hexagonal phase LA testing only. Is it valid to perform this test without the rest of the LA profile? We have found that if we performed Stago’s LA-sensitive partial thromboplastin time (PTT-LA) and the dilute Russell viper venom time (DRVVT), the LA would have been reported as negative, however in this case the hex phase test was positive. How should this be reported? If the profile is really negative, what are the other causes of a positive hex phase test other than LA?

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World Thrombosis Day October 13

It is time to make your plans for World Thrombosis Day, sponsored by the International Society on Thrombosis and Haemostasis, Inc. Please to WorldThrombosisDay.org or to the WorldThrombosisDay site on Facebook for full information.

Combined IX and XII Deficiency?

From Dr. Jeanine Walenga, Loyola University Medical Center: George, what could be the reason(s) for a 30 yo female patient having multiple
mild factor deficiencies of FIX (64%) and FXII (51%)? The activated partial thromboplastin time (APTT, PTT) was slightly prolonged but corrected with a mixing study. FVIII and FXI were normal. Patient does not have LA or anti-phospholipid antibodies. The best I came up with was that the deficiencies might be due to enhanced excretion from a nephrotic syndrome. Would the double factor deficiencies account for the slightly prolonged APTT? Does the patient have a bleeding risk if going for surgery? Thanks.

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