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Delta Checks

From Julia Nailling: What delta checks do laboratories commonly use for autoverification of prothrombin time with international normalized ratio (PT/INR), partial thromboplastin time (PTT), fibrinogen, and D-dimer? Hi, Julia, thank you for your question. I’ll let our participants respond to this, as our own laboratory doesn’t use autoverification or delta checks, although we do carefully inspect […]

Reference Range Change Limit

Maria Grana writes, Hello George, what would constitute a “significant change” when performing the yearly reference range study for coagulation? Thanks. Hello, Maria, and thank you for your question. The laboratory director and staff often establish an acceptable reference range (reference interval, normal range) change limit, beyond which it is necessary to publish a new interval. […]

Events

Thanks to Elaine Benoit at Precision BioLogic, our Conference Recommendation calendar is updated and ready for browsing. If you know of any event that is not on the calendar, please send George the name, sponsor, dates, and location for posting. Thank you.

Confusing Coag Test Names

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. […]

Coagulation Factors

Mixing Studies 24/7?

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! […]

Quick Question: Measuring Dabigatran

This question was a reprise of an earlier question and attracted relatively few votes, however it added “In-house dilute thrombin time,” which turns out to be used by several laboratories. What assay do you use to measure dabigatran (Pradaxa)? a. Stago’s ecarin chromogenic assay, 4 (31%) b. Standard thrombin time, 3 (23%) c. In-house dilute […]

Anticoagulant Therapy

Teaching Mixing Studies

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, […]

Warfarin Reversal with 4-Factor PCC

Here is an audio blog by Dr. Samuel Goldhaber describing KCentra, the four-factor prothrombin complex concentrate cleared in March of 2013 for reversal of Coumadin overdose. KCentra has been available for several years in Europe using the trademark Beriplex.

Anticoagulant Therapy

New FDA LMWH Guidelines

Elaine Benoit of Precision BioLogic Inc forwarded a November 6, 2013 message recommending new spinal catheter insertion and removal times for patients receiving low molecular weight heparin (LMWH) such as enoxaparin (Lovenox or generics). To avoid spinal bleeds, the FDA now recommends discontinuing LMWH treatment and delaying procedures by 12 hours when using a prophylactic dose and 24 hours when […]

Anticoagulant Therapy

More on Shortened PTT

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, […]

Screening Assays

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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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