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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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Newborns on ECMO

This was posted by a colleague on another forum.  We have noticed that newborn babies plasma, after three weeks on extracorporeal membrane oxygenation (ECMO) becomes dark brown. On our instrument, the fibrinogen rises to approximately 800 mg/dL, though a reference lab reports it as critically low. We also notice falsely elevated platelet counts, for instance, 150,000 by impedance and 50,000 by optical, but the manual estimate is 15,000. The manufacturer says the fibrinogen could cause a falsely elevated platelet count. Could there be a common denominator causing these interferences?

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CAPS?

As anticipated, Ben Troyer’s August 31, 2014 question about STAT lupus anticoagulant testing drew a number of comments. George also discussed the question with local colleagues who brought up the rare possibility of catastrophic antiphospholipid syndrome (CAPS, Asherson Syndrome), see attached article for description. This may be an additional reason for ordering a STAT LA test, however we agreed it is not a reason for listing LA as a STAT procedure.

CAPS

STAT Lupus Testing?

From Ben Troyer at Med Central Health System:  Should lupus anticoagulant testing be offered on a STAT basis? Our LA test volume is pretty low—we average 3–5 requests per week. We make the test available as a STAT, but I’m not sure that this is necessary or appropriate. I’d appreciate any input. Thanks!

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Whole Blood Platelet Aggregometry

From Rob Hillmanwhat is the purpose of diluting blood with saline when running impedance aggregometry?

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Ristocetin Cofactor Assay

From Kelly Townsend: Is anyone using the BioData PAP-8e for ristocetin cofactor (RICO) testing? We’ve moved from the old PAP-4 to the newer version, but are struggling with the assay. We’d appreciate being able to correspond with anyone who is sucessfully running RICO on the PAP-8e.

Mayo Conference Sept 10–12

You are invited to the Clinical and Laboratory Update in Thrombosis, Anticoagulation and Vascular Medicine: A Board Review Primer, this fall’s Mayo School of Continuous Professional Development at the Mayo Civic Center, Rochester, Minnesota. This is a new location for the meeting, and you will find both The Fritsma Factor and Precision BioLogic represented in the exhibit. This is one of the iconic hemostasis meetings of the year, and we hope to see you there.

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