On October 16, 2013 George spoke on the subject, “Clumsy Coagulation Communication, Let’s Blame the Lab” in Seattle, Washington. One issue we discussed was confusing coagulation test names, and we talked about the kinds of erroneous orders that are generated. Here is a follow-up to the presentation, a brief list of confusing names with an explanation for each. This list may be incomplete, please comment with some test ordering and naming problems you have seen. Geo.
From Kim Kinney, IU Health in Indianapolis: We offer mixing studies all shifts, 24/7. If not ordered STAT, we call the floor and ask if it can be set up the next day. Do other institutions run mixes 24/7 regardless of status or just STAT’s? Our PM and night folks are short-handed and have a large workload! Kim, to encourage responses, I’ve arranged to post this as my next Quick Question. Check back by Thursday, the new question should appear. Meanwhile, I invite comments below.
By the way, are your mixing studies ordered from the unit or do you reflex? Geo.
Educators face the issue of limited resources, so Medical Laboratory Science schools are able to illustrate only basic coagulation concepts in the student lab. George monitors the MLS Educators’ list, CLSEDUC, and came across this helpful suggestion from Program Director Michele Harms, MS, MLS. Michele gave me permission to reproduce the message and her laboratory procedure, attached at the end.
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We’ve had lots of activity in August, September, and October. The Cheat Sheet summarizing our August and September posts is now available and will be delivered to your mailbox next week. Geo.
From Anita Elledge, MT (ASCP), blood bank/coagulation supervisor, Sierra Vista Regional Health Center, AZ: Our coagulation testing is done on a Stago Compact instrument. The linear range is 20–200 s for the activated partial thromboplastin time (APTT, PTT). We have a policy that any PTT result <22 s must be redrawn, not just rerun the same sample, because it is said that a low PTT result should not occur and is almost always due to a bad collection. I can’t seem to find any documentation that confirms the < 22 s result being a point for this “recollect.” Can you give me a resource for information or any further help with this?
Prof. Jeanne Isabel, Medical Laboratory Science Program Director, Northern Illinois University, forwarded the following question, posted to the American Society for Clinical Laboratory Science Consumer Forum:
“We run prothrombin time assays with international normalized ratios (PT/INRs) on most all patients pre-procedure regardless of whether they take Coumadin or heparin. I have done some research and this is the general practice but I am wondering if there is a better test. Most of our patients are on Aspirin and/or Plavix or Lovenox rather than Coumadin or heparin. Does the PT/INR reflect the use of these medications or is there a study that would better indicate a risk for bleeding? We do activated clotting times (ACTs) in procedures with the use of heparin. Does that also reflect the anticoagulation affect of Aspirin and Plavix?”