http://www.fritsmafactor.com/rss.php?w=new New Blogs in . en-us Wed, 10 Mar 2010 09:17:59 -0500 RSS admin@fritsmafactor.com(Ankush) http://www.fritsmafactor.com/blog.php?bid=292 http://www.fritsmafactor.com/blog.php?bid=292 Here is a message sent last week by Prof. Bernadette (Bunny) Rodak, chief editor of Hematology; Clinical Principles and Applications, Elsevier, Inc, and of  Clinical Laboratory Science, the journal of the American Society for Clinical Laboratory Science. This is from her niece, Susan O'Neill, The Baltimore Life Companies, Owings Mills, MD. Hi Bunny,My father-in-law was recently diagnosed with sticky platelet syndrome. He has been taking aspirin for 30 years and Plavix for the past year, and he is now starting on Coumadin. He has a history of two TIAs and one stroke and he has a hole in his heart. All of which, I think, have something to do with the platelets. When I look it up online, I can't understand what the heck it means. Can you put it in laymen's terms for me? Thanks, Susie Tue, 26 May 2009 00:00:00 -0400 http://www.fritsmafactor.com/blog.php?bid=291 http://www.fritsmafactor.com/blog.php?bid=291 My friend Dan Southern, Professor Emeritus, Western Carolina University, alerted me to a May 7 Wall Street Journal article describing how protein pump inhibitors such as Nexium, taken for gastro-esophageal reflux disease (GERD), inhibit absorption of clopidogrel (Plavix). Many cardiologists prescribe Nexium to control the heartburn some Plavix patients suffer. Gordon Ens and Kirk Guyer of AspirinWorks helped me find the article, which indicates antacids, Zantac, and Tagamet, all non-protein pump inhibitors may be used. Plavix irreversibly binds the platelet membrane ADP receptor P2Y12 and is prescribed as a 1-2 year follow-up to prevent a secondary vascular event in patients who have had an acute myocardial infarction. By the way, the Clinical Laboratory Science program at Western Carolina is one of the spate of 2009 USA closings, which include University of South Alabama and Arizona State University, all three large CLS programs. Geo. Tue, 26 May 2009 00:00:00 -0400 http://www.fritsmafactor.com/blog.php?bid=290 http://www.fritsmafactor.com/blog.php?bid=290 Back to the subject, "should all coagulation specimens be PPP?" Dave McGlasson referred me to an interesting poster comparing PT, PTT, and fibrinogen assays from PPP and whole blood. This was presented at the 2001 meeting of the American Society for Clinical Laboratory Science, and I've provided a paraphrase here... Tue, 26 May 2009 00:00:00 -0400 http://www.fritsmafactor.com/blog.php?bid=289 http://www.fritsmafactor.com/blog.php?bid=289 From Kim Kinney. (Clarian gets the most interesting cases.) Hi George.We have a patient with an acquired factor VIII (FVIII) inhibitor.  He started out having <1% VIII, but he is now up to 33%.  He has had a Bethesda titer all along, but it is starting to go down.  One thing I noticed is that when his VIII level got above around 30% we started having issues with his Bethesda titer in that the lower dilutions did not make much sense.  We had a 1:2 dilution with residual FVIII of 50% but then it went down with more dilutions until we hit the 1:16 dilution and it was back up to 51%.  From there, the FVIII went up in order.  I know that acquired antibodies follow second order kinetics and are not always accurate.  What is the VIII level above which you really should not do a Bethesda titer?  I would like to be able to tell docs above  certain VIII we do not do titers. Thanks for the help. Sun, 24 May 2009 00:00:00 -0400 http://www.fritsmafactor.com/blog.php?bid=288 http://www.fritsmafactor.com/blog.php?bid=288 On Thursday, May 21, 2009 at the University of Alabama at Birmingham Department of Pathology  I provided a lecture on the history of hemophilia therapy entitled "Hemophilia Therapy, Rasputin to Recombinants." Here is the lecture as a 6-per page PDF for the lecture participants or any Fritsma Factor members. Geo. Sat, 23 May 2009 00:00:00 -0400 http://www.fritsmafactor.com/blog.php?bid=287 http://www.fritsmafactor.com/blog.php?bid=287 About four times a year Path residents and Heme-Path fellows rotate through Special Coagulation at UAB and I get the opportunity to provide a few lectures. Thursday I lectured on platelet aggregometry, but I didn't prepare quite enough handouts. Here is the handout as a 6-per page PDF for those who need it, and of course, any Fritsma Factor members. Geo. Sat, 23 May 2009 00:00:00 -0400 http://www.fritsmafactor.com/blog.php?bid=286 http://www.fritsmafactor.com/blog.php?bid=286 This week's question was, "How long do you require patients or controls to go without aspirin before platelet aggregometry?"The answers are below... Wed, 20 May 2009 00:00:00 -0400 http://www.fritsmafactor.com/blog.php?bid=285 http://www.fritsmafactor.com/blog.php?bid=285 Kim Kinney at Clarian has this question about the Thromboelastograph:A  pathologist who trained here asked me about the thromboelastograph (TEG).  Do you have any information on who uses this device, how difficult it is to perform, and QC?  We have had several docs asking us to get this device but we have not gone there yet!  Is it more of a POC device?  Thanks. Sat, 16 May 2009 00:00:00 -0400 http://www.fritsmafactor.com/blog.php?bid=284 http://www.fritsmafactor.com/blog.php?bid=284 Here is a message sent on Monday, May 11, 2009 from Emily Oakley:With minimal staffing, I am trying to cut down on the number of phone calls placed to unit staff. In your lab, do you have two PTT critical values, one for heparinized patients, and one for non-heparin patients such as pre-admits or emergency department patients? At what point do the physicians have to take responsibility for looking at the results of the tests they have ordered? Sat, 16 May 2009 00:00:00 -0400 http://www.fritsmafactor.com/blog.php?bid=283 http://www.fritsmafactor.com/blog.php?bid=283 We’ve not quite completed our switch to WordPress, and I have several messages and topics pending, so I’ve decided to post to our old shell for now. I’m currently in Denver attending the Wyoming-Colorado Clinical Laboratory Collaborative Conference (CLCC). CLCC has a well-attended annual program sponsored by ASCLS-Colorado, ASCLS-Wyoming, the Clinical Laboratory Managers’ Association, and the Colorado Association for Continuing Medical Laboratory Education (CACMLE), the organization that provides CE credit for our Fritsma Factor lectures.CACMLE sponsored a delightful program featuring Dr. Kevin Fitzgerald, DVM, who practices in Denver. Dr. Fitzgerald is a comedian and story-teller who appears on Animal Planet.I provided a seminar entitled “Monitoring Antithrombotic Therapy” that introduced the developing oral anticoagulants Rivaroxaban and Dabigitran. I’ve posted the lecture here as a PowerPoint handout. I hope this is helpful to CLCC participants or to anyone who is interested. Geo. Sat, 16 May 2009 00:00:00 -0400