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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 […]

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 […]

Lupus Anticoagulant

World Thrombosis Day October 13

It is time to make your plans for World Thrombosis Day, sponsored by theInternational 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 […]

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, […]

Specimen Management

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 […]

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! Hi, Ben, great question. At our institution we […]

Lupus Anticoagulant

Whole Blood Platelet Aggregometry

From Rob Hillman: what is the purpose of diluting blood with saline when running impedance aggregometry? Thank you for your question, Rob. I checked with Kathy Jacobs, Director of Sales and Marketing at Chrono-Log Corporation, who replies that diluting the blood with saline brings the sample closer to the ideal hematocrit of 30. The tracing is much smoother than with […]

Platelet Function Testing

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.

Bleeding Disorders

Back to the ELT

In follow-up to Cassandra McGeachy’s August 7 question on the euglobulin lysis time (ELT), I’ve found two references for upgraded ELT methods that may be helpful.They are: Cellai AP. Lami D, Magi A, et al. Assessment of fibrinolytic activity by measuring the lysis time of a tissue factor-induced clot: a feasibility evaluation. Clin Appl Thromb Hemost 2010;16:337–44. […]

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George Fritsma is a medical laboratory scientist, educator, and author. George is a member of the International Society on Thrombosis and Hemostasis, the International Society for Laboratory Hematology, and the American Society for Clinical Laboratory Science.

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