More on HemLibra

I follow-up to our October 6, 2018 post describing emicizumab (HemLibra), I have correspondence dated 9/10/18 from Paul Riley, PhD, MBA, Stago Scientific Business Development Manager for North America. Paul writes, “I was wondering if you should put something on FF about emicizumab, like a survey to find out how people are dealing with it […]

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Bleeding Disorders

Oct 8 2018

george

More on Weight-based Aspirin Dosing

Thanks to my friend and colleague Gordon Ens, Inflammatory Markers Laboratory, for the heads-up on this August 31, 2018 Cleveland HeartLab article, Aspirin for the Heart, One Dose Doesn’t Fit All (click or tap) This is in follow-up to our August 13 post, Weight-based Aspirin Dosing, featuring Santosh Kadel at the University of Texas Medical […]

Antiplatelet Therapy

HemLibra

I’ve attached an article from the September, 2018 issue of CAP Today describing the efficacy of emicizumab, Genentech’s synthetic “bispecific” antibody designed to bypass factor VIII inhibitor in hemophilic boys. The article illustrates how emicizumab (HemLibra) is turning hemophilia therapy upside down. Yesterday, October 5, 2018, HemLibra was additionally approved for all hemophilia A sufferers, […]

Bleeding Disorders

Quick Question: DRVVT Results

The International Society on Thrombosis and Haemostasis and the Clinical and Laboratory Standards Institute agree that the lupus anticoagulant (LAC) test profile should employ two testing platforms, and both recommend, among other choices, an assay based upon the dilute Russell viper venom time (DRVVT) and a second assay based on the PTT. Each platform employs […]

Thrombophilia

Quick Question: Extrinsic Pathway

Our September, 2018 Quick Question was a quiz with one correct answer addressing our knowledge of the coagulation cascade: Which coagulation factor is the first activated in the extrinsic pathway? With 144 responding, the answers were: Factor XII: 16 (11%) Factor IX: 9 (6%) Factor VII: 105 (73%) Prothrombin: 14 (10%) Congratulations to the overwhelming […]

Coagulation Factors

Brillinta and Shortness of Breath

I (Geo) just had a chat with a friend who recently had a stent installed and is now on a regular regimen of aspirin, 81 mg/day, and Brillinta, 90 mg/twice a day. He reports no minor bleeds, but he does have shortness of breath episodes. Shortness of breath is recorded as a possible side effect […]

Antiplatelet Therapy

East Texas Bleeding Disorder

Here is a fascinating response to our September 2 solution to the August 10 Minimally Prolonged PT discussion, from Dimitrios Liapis MSc, Vascular Research Private Medical Center, Athens, Greece. From Mr. Liapis: A very interesting case! Did the patient or members of the immediate family report any bleeding history? Other coagulation tests besides PT? It […]

Bleeding Disorders

Platelet Neutralization Procedure

Geoffrey Wool, MD, PhD, Associate Director of Coagulation at the University of Chicago Medical Center Laboratory, provided an excellent Webinar, “Lupus Anticoagulant Testing: Managing Interferences and Optimizing Quality” on the Labroots provider site. Dr. Wool addresses among other issues the time-honored platelet neutralization procedure (PNP), in which concentrated phospholipid extracted from platelets is used to […]

Mixing Studies

R-T Estimation of the INR

Despite the onslaught of direct oral anticoagulants, Coumadin still occupies an important place in anticoagulation. Most facilities employ POC instruments that rapidly generate the PT/INR, and most choose to confirm all INRs that exceed 4.0 by collecting venous blood and performing a plasma-based PT/INR. A 2016 report describes the R-T estimation formula designed to correlate […]

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Anticoagulant Therapy

Sep 2 2018

george

Minimally Prolonged PT: Solution

Referring to our post of August 10, 2018 entitled Minimally Prolonged PT, Dr. Laposata reviewed the patient’s consistently, though slightly prolonged, PT results, and considered a factor VII deficiency. It turns out the patient’s factor VII level was 40%, found also in some first-degree relatives. It may not be that a factor VII level of […]

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Bleeding Disorders

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More on HemLibra

More on Weight-based Aspirin Dosing

HemLibra

Quick Question: DRVVT Results

Quick Question: Extrinsic Pathway

Brillinta and Shortness of Breath

East Texas Bleeding Disorder

Platelet Neutralization Procedure

R-T Estimation of the INR

Minimally Prolonged PT: Solution

George Fritsma MS MLS

Cheat Sheets from George

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Quick Question