Prolonged Mixing Study in Dialysis

From “Balasubm” at Einstein Healthcare in Philadelphia: Hi George, I have a 74 year old female renal dialysis patient who is asymptomatic with prolonged prothrombin time (PT) of 38 seconds and activated partial thromboplastin time (APTT, PTT) of 116 seconds, with a normal thrombin time. Mixing performed immediately reveals PT of 30.3 seconds (N 9.5-13.5) and […]

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Lupus Anticoagulant

Aug 23 2012

george

Mix Corrects with NP, But not with Deficient Plasmas

From “Japgi,” I have a 6 year old boy, well till a month back, when he had a post-traumatic gum bleed. The bleed was stopped after about half an hour, but a small ooze restarted and stayed for 3 days. His prothrombin time (PT) is 14 seconds (RI 11–16), activated partial thromboplastin time (APTT, PTT) […]

Lupus Anticoagulant

No Need for Prolonged LA Incubation

From Thomas Exner, Owner, HAEMATEX RESEARCH, Sydney, Australia: Hi George, I read your response to a question about lupus anticoagulant (LA) mixing tests in a handout at the SSC meeting in Liverpool recently. I’m a little disappointed that you still recommend prolonged incubation times for these. Most recommendations now are that LA mixes should be tested immediately […]

Lupus Anticoagulant

Normalized DRVVT Ratio?

George has had several conversations with frequent contributor and international expertDave McGlasson (Wilford Hall USAF Medical Center, San Antonio) about normalizing the DRVVT ratio on the laboratory’s DRVVT mean of the reference interval in accordance withZhang L, et al: A simplified algorithm for the laboratory detection of lupus anticoagulants. Am J Clin Pathol 2005;124:894–901. The author […]

Lupus Anticoagulant

PTT Reagent Selection

For those who participated in our summer, 2011 questionnaire (designed by Precision BioLogic’s marketing analyst Mr. Ankush Randhawa) about the choice of PTT reagent relative to its application and sensitivity to lupus anticoagulant, the results now appear in Fritsma GA, Dembitzer FR, Randhawa A, Marques MB, Van Cott EM, Adcock-Funk D, Peerschke EI. Recommendations for appropriate […]

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Anticoagulant Therapy

May 21 2012

george

Error in 2008 IL SCT Procedure

From Laura Paterek: Are you sure the following statement in your article is correct? When a lupus anticoagulant is present, SCT Confirm becomes prolonged beyond the SCT Screen. Normalization renders the SCT insensitive to warfarin. Doesn’t the confirm step decrease when LA is present? Hello, Laura, and thank you for locating this misstatement in my

Lupus Anticoagulant

More on Mixing Studies: Dr. Ortel

We’ve had three posts and several comments regarding lupus anticoagulant (LA) mixing studies since March. These are… March 18, 2012: Test for LA When Mixing Study Corrects? March 22, 2012: Mixing Study Results: Long PT and PTT April 3, 2012: More on LA Mixing Studies In these posts several experts held that it is necessary […]

Lupus Anticoagulant

More on LA Mixing Studies

I received this message from Dr. Rich Cambereri on March 8, and have been holding it pending additional data, but given our March 18, 2012 post from Vanessa Chan in Toronto, and subsequent responses from Herb Crown and Dr. Larry Brace, I’ve decided to use Dr. Cambereri to start a discussion about the use of mixing studies in the lupus anticoagulant (LA) profile: Hi […]

Lupus Anticoagulant

Test for LA When Mixing Study Corrects?

From Vanessa Chan, Sick Kids Hospital, Toronto: Hi George, What is your opinion on the algorithm of tests when testing for lupus anticoagulant? If the mixing tests are normal, should we continue with a confirmatory test? The recent BJH guidelines say, “Mixing tests are a criterion for LA and improve the specificity. However, they introduce a dilution […]

Lupus Anticoagulant

More on Look-Back for Positive APAs

Here is some in depth feedback from “Guest Blogger” Dr. Emmanual Favaloro on the subject of lupus anticoagulant chronicity raised by Pam Owens of TriCore Laboratories, Inc in a Feb 29 post. I sent the highlighted questions to Dr. F on Feb 27: When an LA/APA is defined as “chronic,” does it wax and wane? Not normally according to my understanding, […]

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Lupus Anticoagulant

Lupus Anticoagulant

Prolonged Mixing Study in Dialysis

Mix Corrects with NP, But not with Deficient Plasmas

No Need for Prolonged LA Incubation

Normalized DRVVT Ratio?

PTT Reagent Selection

Error in 2008 IL SCT Procedure

More on Mixing Studies: Dr. Ortel

More on LA Mixing Studies

Test for LA When Mixing Study Corrects?

More on Look-Back for Positive APAs

George Fritsma MS MLS

Cheat Sheets from George

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