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AndexXa

On May 4, the FDA approved andexanet alpha (AndexXa, Portola Pharmaceuticsls) as the first and only reversal agent for direct anti-Xa DOACs rivaroxaban (Xarelto), and apixaban (Eliquis) overdose. Tap or click MD Magazine for details. Also see the ANEXXA-A report in Siegal DM, Curnutte JT, Connolly SJ, et al. Andexanet alfa for the reversal of […]

Anticoagulant Therapy

More on Platelet Clumping

From Heather DeVries, Indiana University Health, a follow-up to Dr. King’s April 26 pseudothrombocytopenia entry: Hi George, I recently read an article by Drs. Adcock Funk, Lippi, and Favaloro about quality standards in coagulation testing. The article cited a study indicating that sending PFA samples through a pneumatic tube system would not cause a preanalytical […]

Specimen Management

Critical Fibrinogen Levels

From Heather DeVries, Indiana University Health: Greetings George! One of the facilities in our system is questioning our critical fibrinogen level. Anything <70 mg/dL is considered critical, and they would like to know why we don’t use a cutoff of 100 mg/dL. Our current level was established before I came to IU Health, and our […]

Bleeding Disorders

Cold Agglutinins

From Lissette, UCLA: We requested our hematology specimens to be sent with a warm pack for CBC/DIFF. Is it recommended to keep the sodium citrate tubes for coagulation testing on warm packs as well for patients with cold agglutinin? Is there a recommended method to workup these specimens for coagulation testing? Hello, and thank you […]

Specimen Management

Checking Platelet Poor Plasma

Hemostasis laboratories prepare platelet poor plasma (PPP), plasma with a platelet count below 10,000/uL for clot-based procedures. The CAP doesn’t specify how the laboratory validates their specimens to ensure they are PPP. Please summarize your protocol for our participants. Thank you. Added May 1, 2018: One facility validates all centrifuges, then “pulls” one random specimen […]

Specimen Management

Activated Clotting Time

Please help me (George) learn if the ACT is used for any purpose other than monitoring high dose intravenous heparin during coronary artery bypass graft surgery, percutaneous intervention, ablations, and for monitoring protamine sulfate heparin reversal at the end of the cardiac procedure. Does anyone use the ACT for routine heparin therapy monitoring or for […]

Anticoagulant Therapy

April, 2018 QQ: Dabigatran Assay

Here are the responses to our April, 2018 Quick Question, “How do you measure the oral direct thrombin inhibitor dabigatran?” Standard thrombin time: 7 votes, 8% Activated partial thromboplastin time (APTT, PTT): 5 votes, 5% Chromogenic ecarin clotting time assay: 9 votes, 10% HEMOCLOT thrombin inhibitor assay (plasma-diluted thrombin time): 17 votes, 18% We don’t […]

Anticoagulant Therapy

Pseudothrombocytopenia

From Dr. Bruce King: I had a question about options for analyzing a patient sample that the platelets clump in all anticoagulants tested. We have a 61 y.o. female who was hospitalized for hypertensive issues and noticed some bruising (abdomen) which the patient said had increased over the last several weeks. During the hospitalization it […]

Bleeding Disorders

Welcome to Lab Week 2018

Good day, and welcome to Medical Laboratory Professionals week, April 22–28, 2018. Congratulations and thanks to medical laboratory technicians, scientists, managers, and directors worldwide whose products support at least 70% of medical and surgical decision-making. As promised, I have, with the help of colleagues, prepared a special Lab Week hemostasis case study series. Please review […]

Laboratory Professionals Week April 22–28

Please see the attached Precision BioLogic post card announcing our special case study series developed for Medical Laboratory Professionals’ Week, April 22–28, 2018: /sites/default/files/lab_week_cards_2018_0.pdf

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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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