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More on Venous Thoracic Outlet Syndrome

George draws your attention to our June 27, 2019 entry describing venous thoracic outlet syndrome afflicting an athletic friend. Our frequent contributor and hemostasis scholar Dr. Vadim Kostousov today, July 24, 2019, provided a seriss of references to VTOS in unusual circumstances.

D-dimer Elevated 6 Months

Dear George, I am a 42 year old African American women in fairly good health. I am obese and I live a partly active life. I went to the emergency room back in January of this year for chest pain and palpitations. While there they did a D-dimer test and a chest CT scan. I […]

Therapeutic Reptilase

Ning Tang writes, Dear George, In China, a categary of hemostatic agents from snake venom named “Haemocoagulase” are widely used, basically they are the generic drugs of Reptilase®, which is produced by a Swiss company. We find that intravenous injection of this drug can cause severe hyperfibrinolysis and hypofibrinogenemia. It seems that Reptilase has been […]

Bleeding Disorders

Vitamin K Kinetics

George received a series of questions about vitamin K kinetics from colleague and friend Catherine N. Otto, MLS, PhD, Rutgers University. Dr. Otto is assisting a Nutrition Science colleague. It seems that vitamin K deficiency (as defined by PT/INR) does not show up until there is serious depletion in the amounts of these activated proteins. Why? […]

Anticoagulant Therapy

FVL and AC Therapy

From friend, colleague, and frequent contributor Dave McGlasson: A friend contacted me about if her should be put on an anticoagulant. He is a 71 year old male who in 2004 suffered a DVT. A subsequent work-up revealed he possessed a heterozygous factor V Leiden mutation. At the time of the clot he had been […]

Anticoagulant Therapy

Case: VWD? Please Answer

A 16-year-old girl experiences chronic menorrhagia. Her PT is 12.2 s, PTT 37.1 s (H), factor VIII activity 51% (L), VWFag 54%, VWFactivity 45% (L), VWFRCo 43% (L), VWF multimers: normal distribution. CBC results are normal except HGB is 11.8 g/dL (L). What is her presumptive diagnosis, what follow-up testing, if any, is necessary, and […]

Bleeding Disorders

Quick Question: TTP Laboratory Assay

Our June, 2019 Quick Question generated a near-unanimous response from 68 voters: What laboratory assay confirms thrombotic thrombocytopenic purpura (TTP)? Shiga toxin test: 3% (2) Complement C3 level: 7% (5) ADAMTS13 activity: 83% (56) VWF multimers: 7% (5) The Shiga toxin test correlates to Shiga toxin-induced hemolytic-uremic syndrome (ST-HUS), the “classic” HUS detected mainly in […]

Arterial Thrombosis

Lot to Lot Validation

From Maureen (Mo) Tacke, St Luke’s Health System: Hi George, our institution is coming to the joyous time of lot roll over in coagulation, and it’s got me wondering… Is our process a little (or a lot) overkill? Current process: Normal ref range studies (20 normals) for PT, PTT, FIB, AT, TT, PC, PS, DRVVT, […]

Venous Thoracic Outlet Syndrome

I (Geo) recently learned of an acquaintance who has developed venous thoracic outlet syndrome (VTOS), also termed “effort thrombosis” or more formally, Paget-Schroetter syndrome. This is thrombosis of the axilosubclavian vein where the vein passes by the junction of the clavicle and first rib. VTOS is rare, and is seen in athletes, for example, baseball […]

Aspirin Presentation June 26, 2019

Thanks to the American Society for Clinical Laboratory Science for providing George with the opportunity to present “Aspirin, the 1899 Wonder Drug Lives Again,” and thanks to the many participants who came to hear the talk. Click or tap here for an updated copy of the presentation handout. George will present an expanded version on […]

Antiplatelet Therapy

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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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