Frequent FF contributor Dave McGlasson, MS, MLS posted this comment in LinkedIn on 9/7/23. “I have noticed at recent meetings and in some journal articles that coagulation factors are sometimes referred to in Arabic instead of Roman numerals. For example F8 instead of FVIII. Has this been officially proposed as a change by any standardization committee?”
Dr. Emmanuel Favaloro, also a frequent contributor responds, “Hi Dave, yes, this is happening; in our own organization, the hemostasis group is endorsing this change due to a large number of order errors from clinicians, as well as legibility issues for paper form requests. We think that Arabic numerals are less problematic. We hope!”
Karen Moffat, MSc, ART, FCSMLS, McMaster University responds, “Yes, we also have moved to Arabic numerals. This went live with our new HIS/LIS in June 2022 and our move to clinician ordering. We hope it will minimize order errors and support the interpretation of results. I admit it was weird to see the reports say F2 or F8 at the start but now it’s ‘normal.’ Our hematologists and hemophilia clinic supported this move.”
Marcus Furlong, Diagnostica Stago, responded, “With a sophisticated LIS/EMR platform you should be able to configure a test and mnemonic that would utilize both Roman and Arabic numerals. Orders could be generated from searches on either Roman or Arabic numerals and the final report could be configured with tests reported as Roman numerals.
I [Geo] wonder about the origin of our Roman numeral nomenclature. The International Society on Thrombosis and Haemostasis was founded in 1955 as the International Committee on Thrombosis and Haemostasis. They began with the original nomenclature such as “proaccelerin,” now factor V; “proconvertin,” now factor VII; and “anti-hemophilic factor [AHF];” still used occasionally for factor VIII. They assigned Roman numerals to each factor, ending in 1962 with factor XII [Hageman factor]. An “elder” once told me that the ICTH first met in Rome where the group decided, “When in Rome, do as the Romans do,” but I’ve never confirmed this.
I especially enjoyed Rob Bednarik’s brief closing comment, “Casualty of the mobile device age?” I’m fishing for your opinion. Is a move to Arabic numerals a good idea, or should we stick with tradition?
9-8-23 Responses
From Ali Sadeghi-Khomami, PhD, Precision BioLogic Inc.: I agree that the new graduates have less competency or desire in Roman numbers. Even in the Coag field some of us are not used to large Roman numbering like 50 and 100. I think being convenient and compatible with analyzers, Clinical reports, etc is one side of the story, but accuracy, scientific standards, literature, and clarity are another important side of the story too. So, in what application and context switching between Roman to Western/European numbers are OK, need to be discussed.
If people decide to use Factor 8 instead of Factor VIII in their scientific publications, it doesn’t seem right. Since both factor and eight have their own meanings in many applications, I always considered Factor VIII as a protein in coagulation that is involved in Hemophilia A. Not the eight factors in the series of factors in the coagulation cascade. We also need to think about old and new literature and how to retrieve them from scientific databases in the future if this change is adopted in manuscript writing.
By the way, for clarification, what has been referred to as Arabic numbers here, are called Western or European numbers in the East because Arabic numbers are totally different [click]. There are subtle variations between Arabic, Persian, and other numbers too. It would be interesting to see how this change in style would be adopted by different nations in the future. In the past, Roman numbering was always considered as UNbiased numbering in science (such as UN version of numbers). It was a mechanism to prevent confusion and was used in the prescription of drugs and medicines because it easily stood out from the ordinary writing in any language.
From Elaine Keohane, MLS, PhD, Emeritus Professor, Rutgers: In the HUGO Gene Nomenclature Committee (HGNC), the gene names are in Arabic numerals. Example: Approved symbol: F5, Approved name: coagulation factor V; Approved symbol: F8, Approved name: coagulation factor VIII. In preparing materials for teaching, it is easier to make errors when typing the Roman numerals (e. g. VII instead of VIII).
From Bob Gosselin: No real opinion other than saving a few keystrokes using Arabic, and are kids today even taught Roman numerals (or the 24-hour clock)?
From Donna Castellone: Roman numerals all the way! Feel so bad generation doesn’t learn them….tough! The proper name is FVIII. When you start to mix is this FII or F 11? But I also think all coagulation people should know what a tilt tube clot looks like too.
9-9-23
Dave McGlasson writes, “Preach it Sister!” He continues, “I am calling some friends who are school teachers. What would the coagulation cascade look like? That would take getting used to.
Paul Riley, PhD, Diagnostica Stago responds, “I agree with what Elaine Keohane was saying about using Arabic only for discussing the genes coding for the coag factors because that’s a clear convention in the scientific parlance. I just confirmed with my oldest daughter, who is a high school sophomore that they do still get taught and continually exposed to Roman numerals all throughout elementary school, but we’re also in one of the best school districts in NJ.
Dr. Favaloro continues, ” We captured FII vs. F11 as a potential trap in the change for Westmead, but felt this was still less risky than the current problems with other factors; in the electronic ordering system, both numerical types will be visible/orderable.
The difficulty is not with experts getting it wrong, but clinicians (either junior or with bad illegible writing–I know, a doctor with illegible writing –go figure) ordering tests on paper forms. They have all gone to school and then to University and done all the courses.
I’m not sure we’re ready to change the system in scientific publications; I was only noting the potential change for the clinical ordering of coagulation factor tests. I am reminded here of the ‘parental’ administration of ‘parenteral’ agents as another example of mixed context.
9-10-23
I [Geo] solicited responses from the participants in Rutgers’ graduate hemostasis course. See Justin Hanenberg’s comment below.
Here is a comment from course participant Ismael Imam. “Dr. Emmanuel Favaloro, one of the commentators, mentioned that his organization’s hemostasis group supports this notion, citing the recurring frequent errors in ordering and legibility of handwriting on manual requestions. This is something that I can relate to having worked in hospital settings. I do recall accessioners and specimen processors asking me about what factor was ordered because they were unsure of the nomenclature. The specimen processors who receive these specimens are not always familiar with the terminology and can potentially make clerical errors. Writing “F8” or “Factor 8” would be more intuitive for them in my opinion. However, in academic and teaching settings, I believe that the traditional naming designations are more appropriate.”
Here is another response from Stephanie Howell, also a Rutgers graduate course participant. “The original nomenclature system had many of the coagulation factors named for patients in which deficiencies were identified.1 Roman numerals were added in 1954 to make the coagulation cascade nomenclature easier to navigate. Moving to a nomenclature system utilizing Arabic numerals instead of Roman numerals could simplify the nomenclature. While Arabic numerals are much more common in everyday life, Roman numerals still have a place. Appendices of books and plays or screenplays are two examples of both Roman and Arabic numerals being used in conjunction to designate different things. Using Arabic numerals in place of Roman numerals in the coagulation cascade doesn’t change the cascade. Arabic numerals use fewer characters in most cases and do not pose a risk for transposition. For me personally, I’ve always had a difficult time committing the coagulation cascade to memory, but I’ve never tried using Arabic numerals. I would love to see how this would look in practice. On a slightly different topic, I found a useful timeline of coagulation discovery and testing on the Stago website.“
From Larry Brace, Ph.D. OK, I’m old school, Roman numerals all the way! In dialogue, Dr. Favaloro adds, “Well, the problem is not with the old school, but the newbies coming through.” Dr. Brace responds, “Are you saying that the “newbies” can’t handle Roman numerals? They seem OK with the Superbowl (last time I checked they used Roman numerals). Clotting factors are rather simple in comparison. [Comment from Geo, Do we know for sure that NFL fans can interpret Roman numerals?] Dr. Favaloro responds, “Maybe we should mandate education via the Superbowl? Or are you saying that the Superbowl audience is smarter/more educated than Australian clinicians?”
Dave McGlasson, who started this discussion, went on to poll several colleagues, asking, “I am checking local lab systems to see what they have on their LIS order lists. Have you made any changes Dr. Brace?” Dr. Brace responds, “No Dave, and have no plans to do so. Dr. Favaloro, I can’t speak to the intelligence of Australian physicians but I’m sure they can handle it.
Also, Thomas Exner, Ph.D., Director/Owner of Haematex Research, Sydney Australia writes, “Dear All, Well, if this is a voting thing, I’m all for change, especially when it can prevent mix-ups. After all, what have the Roman numerals ever done for us?
9-12-23
More comments from Rutgers CLSC 5124 Advanced Coagulation course participants. By the way, these participants are mid-career professionals, many with coag experience.
From Kristen Brandt: I can appreciate the traditional use of Roman numerals in the naming of coagulation factors but can see advantages of using Arabic numerals as well. When first learning the coagulation cascade, the learning materials and texts used strictly Roman numerals, so this was my first exposure and what “stuck” in my mind in school. However, once I started working in a clinical laboratory that performed these tests, it was rare that I would use the Roman numeral when writing them out manually, even though testing procedures and reagents used the Roman numeral. Writing out Roman numerals took longer and was not as natural. Also, on more than one occasion, I saw techs accidentally freeze a FVIII sample that should be performed immediately simply because a quick glance at the text on the tube looked like it said FVII, which was not run stat on all shifts in my lab. Or, a tech would thaw and run the incorrect factor assay, as dilutions needed to be ordered manually on the analyzer, and only notice the incorrect assay was performed once they were ready to transmit result to the LIS. This issues largely occurred with an older LIS system that used a small Courier New font that made FVIII and FVII difficult to discern, and after switching to the new LIS system, the test name on samples and present on sample lists was changed to FVIII (8) and FVII (7) to help prevent these mishaps. Therefore, my vote is, when possible, to use either both or Arabic numerals alone as a patient safety measure to make sure everyone can easily distinguish which factor is being tested or ordered.
And Wenxiong He: My opinion is for Roman numerals. My concern is that, in our hospital, we use Arabic numerals for the factor genetic test results. Mixing both the factor activity results and the genetic test results can be confusing for physicians. However, if there is consensus among the hemostasis doctors regarding also using Arabic for the factor activity results, then I think it’s okay. Our lab really listens to the doctors and our doctors are quite helpful in giving us directives.
I see the advantage for change in a hospital LIS system to Arabic numerals, but like to stick to Roman numerals in teaching and educational sessions. To differentiate that a F8 ordered is not, for example, like the gene sequence, may be spell out as F8 coagulation factor activity. This was how it was in the LIS in my previous workplace. However, all validation documents signed by the medical director had the factor assays named in Roman numerals. In my experience, my CAP inspector actually appreciated that the validation documents followed the traditional approach.
DCLS student (Rutgers): Personally, I like the aesthetic of the Roman numerals, but that’s not a good basis for naming something for clinical practice. Do what’s most compatible with current systems and avoid possible errors==that’s most important to me. If that means the LIS better handles “F8” than “FVIII,” it doesn’t bother me all that much. I’m interested to read more on the symbology cultural background posted by Dr. Sadeghi-Khomami. Thanks for that!
I have been seeing sporadic use of Arabic numerals for coagulation factors. I understand the change is to reduce errors and confusion with clinical ordering. I prefer the classical Roman numerals, but I do see the advantage of using Arabic numerals. It’s a new age, I guess.