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October 2024 QQ Summary: When Do You Order a Bethesda Titer?

This is a follow-up to our 9-30-24 post introducing our October Quick Question, “At what FVIII activity level do you order a Bethesda inhibitor assay (Nijmegen-Bethesda Assay, NBA)?” It occurred to me (Geo) that the demand for NBAs may have diminished with the 2017 release of HemLibra® (emicizumab), the FVIII bypassing therapy, to be followed […]

Bleeding Disorders

Coag Conversation: ITP and Platelet Functional Disorders

Introducing “A Coag Conversation: ITP and Inherited Platelet Function Disorders-Part One.” a three-part series featuring Michele Lambert, MD, MSTR, interviewed by George Fritsma and sponsored by BioMedica Diagnostics, Inc. Dr. Lambert is Associate Professor of Pediatrics at the Pearlman School of Medicine, University of Pennsylvania and Pediatric Hematologist at the Children’s Hospital of Philadelphia. In […]

Platelet Function Testing

Northeast Lab Conference: “Have We Cured Hemophilia?” Handout

George presents “Have We Cured Hemophilia” at the Northeast Laboratory Conference on Wednesday, October 16, 10–11:30. Click here for your 6-slide-per-page full-color handout.

Bleeding Disorders

Lupus Anticoagulant Testing

Anfal Helu asked: I have a question regarding the screening and confirmatory testing for the lupus anticoagulant (LA). Recently, a young female pt was clotting everywhere after a hospital visit for a status epilepticus attack during which she was intubated and placed on mechanical ventilation. She had 2 pulmonary emboli, 2 MI, ischemic colitis, renal […]

More on Nijmegen-Bethesda Test Volumes

From Ali Sadeghi-Khomami PhD, Precision BioLogic scientist. Access to national and global testing databases is needed to answer the NBA test order volumes question. I am unsure if such a database exists, but relevant data could also be retrieved from insurance companies to estimate the annual rate of NBA inhibitor assays. Yearly marketing report documents […]

Bleeding Disorders

Nijmegen-Bethesda Test Volumes

This is a follow-up to our 9-30-24 post introducing our October Quick Question, “At what FVIII activity level do you order a Nijmegen-Bethesda inhibitor assay (NBA)?” It occurred to me (Geo) that the demand for NBAs may have diminished with the advent of the FVIII bypassing therapies, HemLibra® (emicizumab), soon to be followed by MIM8 […]

Bleeding Disorders

October 2024 Cheat Sheet

Click here for your October 2024 Cheat Sheet. You will receive your email copy of the Cheat Sheet in a few days. Thank you for your continued Fritsma Factor interest.

October 2024 Quick Question: Inhibitors

A 9/5/24 question from Chad Siniard, MD, director of the University of Alabama at Birmingham Hospital coagulation service, generated a discussion on the FVIII level that a facility chooses to generate an order for a Nijmegen-Bethesda FVIII inhibitor assay. Our October 2024 Quick Question (on the right) is a poll that asks, “At what FVIII […]

Bleeding Disorders

September 2024 Quick Question Response: PTT and FVIII Level

Our September 2024 Quick Question drew 59 responses and asked: “At what FVIII activity level should the PTT become prolonged?” Our answers were: 60 U/dL: 6 (10%) 40 U/dL: 37 (63%) 10 U/dL: 12 (20%) 1 U/dL: 4 (7%) Most of us chose the correct answer. The PTT “partial thromboplastin” manufacturers develop their reagent to […]

Bleeding Disorders

Reptilase Time

I received this question on 9/14/24: Hello George, Is there any condition where reptilase time is prolonged while thrombin time is normal? My answer is, in a word, no. The thrombin time (TT, or TCT) typically uses 50–100 mg topical human or bovine thrombin, mixed 1:1 with plasma. A normal plasma/thrombin mix clots within ~20 […]

Bleeding Disorders

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George Fritsma is a medical laboratory scientist, educator, and author. George holds faculty appointments with Rutgers University and Michigan State University, and is a member of the International Society on Thrombosis and Hemostasis, American Association of Clinical Chemists, and American Society for Clinical Laboratory Science.

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Quick Question