TEG in a Community Hospital

From Annette Gaskill, Estes Park Medical Center: I’m a MT at a small critical care hospital and also am part of our facility’s trauma committee. In our discussions of trauma cases involving patients already anticoagulated, our surgeon has asked me about thromboelastograms. Our coagulation menu is PT, PTT, and D-dimer; anything else is sent out. We only […]

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Bleeding Disorders

May 2 2013

george

Post-partum Hemorrhage and Component Therapy

Originally posted on October 11, 2011. Hi George! As always, I enjoy this educational resource very much! My question is: Why do healthy women who experience post-partum hemorrhage (PPH) seem to “autocorrect” their coagulopathy with very little help from component therapy? I have noted that once the bleeding site has been tended to, the patient […]

Bleeding Disorders

FEIBA Inhibitor?

Hi Mr. Fritsma! It’s Milena Jr. How are you? I hope you and Mrs. Margaret had some nice holidays. I’m on my intern year now, and I’ve come to know a patient with hemophilia who has factor VIII inhibitor. I wanted to ask if patients can also create inhibitors to FEIBA? is that why some patients […]

Bleeding Disorders

Platelet Function Testing and the Bleeding Time

In 2009 Dave McGlasson and I published McGlasson DL, Fritsma GA, Whole blood platelet aggregometry and platelet function testing. Semin Thromb Hemost 2009;35:168–80. This article, the second-most cited in the 2009 Seminars in Thrombosis and Hemostasis, reminded me of our Quick Question about the Ivy bleeding time posted in early November, and subsequently lost when our site crashed […]

Bleeding Disorders

Are Prophylactic Platelets Beneficial?

In a plenary session on Sunday, December 9, 2012, Dr. Simon Stanworth reported on a trial of 600 patients being treated for hematologic malignancies, chemotherapy, or stem cell transplants, Stanworth SJ, Estcourt L, Powter G, et al. The effect of a no-prophylactic versus prophylactic platelet transfusion strategy on bleeding in patients with hematological malignancies and severe thrombocytopenia (TOPPS […]

Bleeding Disorders

ELISA Vs. LIA VWF:Ag

From Jasmina Ahluwalia: Hi George, Is there any advantage of choosing an immunotubidimetric (latex immunoagglutination, LIA) assay over the enzyme-linked immunosorbent assay (ELISA) for von Willebrand factor antigen (VWF:Ag)? Hello, Jasmina, and thank you for waiting for this answer while we updated the Fritsma Factor site. The two methods have similar sensitivity, specificity, linearity, and coefficient […]

Bleeding Disorders

Managing the Bleeding Patient

I had the opportunity to present “Managing the Bleeding Patient” at the Northeast Laboratory Conference at the Holiday Inn By The Bay in Portland, Maine on Wednesday, October 17, 2012. Thanks to Ellen Libby, Program Chair, for inviting me,Dale Harrison, Ed Rojo and Roger Menk of Diagnostica Stago for hosting me, and to Crystal Azavedo for moderating the session. Please feel free to download my two-part handout below. […]

Bleeding Disorders

Quick Question Summary: VWF Activity

Here is a summary of our July, 2012 Quick Question: How do you assay for von Willebrand factor (VWF) activity? a. VWF ristocetin cofactor (VWF:RCo) by aggregometry: 21 (34%) b. Automated VWF ristocetin cofactor (VWFRCo): 21 (34%) c. VWF activity immunoassay (VWF:Act): 15 (25%) d. Collagen binding assay (CBA): 4 (7%) It seems the collagen […]

Bleeding Disorders

An Unexpected VWD by Lab Diagnosis

I learned about an interesting case at the University of Alabama at Birmingham(UAB) Hospital special coagulation lab today from specialty techs Patti Tichenor andLaura Taylor. A specimen arrived with an order for lupus anticoagulant profile and anti-cardiolipin antibody. The PTT was prolonged and corrected on initial mix. The UAB protocol recommends a two-hour incubation and repeat mixing study […]

Bleeding Disorders

3-MO with prolonged PT and PTT

From “Doctor Mukesh“: a 3 month-old with an old intracranial bleed and an sol has a markedly prolonged prothrombin time (PT) and partial thromboplastin time (PTT) and is bleeding from IV sites but looks pretty alright. What are the possibilities? Hello, and thank you for your question. The PT and PTT reference intervals at three […]

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Bleeding Disorders

Bleeding Disorders

TEG in a Community Hospital

Post-partum Hemorrhage and Component Therapy

FEIBA Inhibitor?

Platelet Function Testing and the Bleeding Time

Are Prophylactic Platelets Beneficial?

ELISA Vs. LIA VWF:Ag

Managing the Bleeding Patient

Quick Question Summary: VWF Activity

An Unexpected VWD by Lab Diagnosis

3-MO with prolonged PT and PTT

George Fritsma MS MLS

Cheat Sheets from George

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