Fibrinolysis

TPA for Pleural Effusion

A colleague contact me on August 24 about a relative who is an inpatient and is experiencing a pleural effusion subsequent to a MRSA infection. The MRSA has been treated and is resolved, but the effusion is mucinous and drains slowly. The surgeon was planning to use recombinant tissue plasminogen activator (TPA, Alteplase) to liquify […]

Specimen Management in Fibrinolysis

I had the opportunity to become reacquainted with Jennifer Jacobsen, MLS (ASCP),Allina Health Laboratories, Minneapolis, while attending the Mayo Laboratories Coagulation Testing Quality conference in Rochester, Minnesota August 7–10. Jennifer has this question about specimen management on patients being treated with tissue plasminogen activator (TPA, Activase®, Alteplase®): George, both the prescribing information for Alteplase and Stago’s fibrinogen reagent package […]

D-dimer: Double-spin?

Hi George. Why is it not important to double-spin D-dimer specimens for platelet poor plasma (PPP) when there’s a delay in testing? Is this because D-dimers are not affected by labile factors as other coag testing? Looking forward to your answer. Teresa Lovejoy, MT (ASCP) Senior Medical Technologist, Hematology Children’s of Alabama. Birmingham, AL Hi, […]

Lipemia, Hemolysis, and D-dimer

From “Cristina:” What is the reason why lipemic and hemolyzed coagulation sample should be rejected? Is it only the D-dimer is susceptible? Thanks. Hello, and thank you for your question. Lipemia is likely to cloud the final reaction solution in a photo-optical method, interfering with the results. On all instruments, the quantitative D-dimer is a […]

More on D-dimer in FVL

I’ve received four expert follow-up comments to our July 5 D-dimer Efficacy in Factor V Leiden Mutation post. Here they are, in order of receipt: From Dr Emmanuel J Favaloro, Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, NSW Australia: Hi George, I have no idea about FVL influencing D-dimer development; I would […]

D-dimer Efficacy in Factor V Leiden Mutation

This 6/30/2012 question from a physician arrived through the American Society for Clinical Laboratory Science Consumer Web Forum. “Does delayed fibrinolysis in a known factor V Leiden (FVL) mutation patient reduce the value of a negative D-dimer test?” George’s initial response: Thank you for your question. I was prepared to answer that there is no connection, […]

Who Does D-dimer on Destiny Max?

Crystal Azavedo at EMH asks: Hi, George. I am looking for users of the Destiny Maxwho are using the analyzer to run quantitative D-dimer. I’m seriously considering adding the analyzer to our platform, but I haven’t heard from any local (northeast US) users that have put DD onboard. Thanks for all your help! Hi, Crystal, I invite […]

DIC: Marker Recovery Time in Therapy

From “Siddhartha,” In disseminated intravascular coagulopathy (DIC) patients, what is the minimum time for the coagulation parameters D-dimer, fibrin degradation products (FDP) and fibrinogen to return to normal levels post frozen plasma (FFP) transfusion? Is it really worthwhile to do these tests in a suspected case of DIC who has already received FFP? Thanks, Siddhartha. […]

High D-dimer, low Fibrin Monomer in Amyloidosis

From “rhe25“: Hi, George, glad to find your resourceful website! Question for you: when the D-dimer is very very high, but the soluble fibrin monomer complex (SFMC) is negative, does that mean primary fibrinolysis in a systemic amyloidosis patient who has bleeding? I have seen a case like this, but the fibrinogen level is elevated, […]

VMAX Error Implies Low Fibrinogen

From Julia Witt, SH (ASCP), Hematology Supervisor, Smith-Glynn-Callaway Clinic, Springfield, MO: Monday, December 26: We recently had a patient present with an MI. He is on a standard treatment regiment. Upon his arrival at the hospital, baseline coagulation studies were performed. The fibrinogen result exceeds the linearity of the analyzer. A 1:1 dilution utilizing pooled normal […]

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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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