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Specimens Collected in the Wrong Tube

Here is a note from participant “dsadowski” at Southampton Hospital: What are some guidelines for determining whether a specimen is citrated plasma vs. serum or another anti-coagulated plasma? My fibrinogen testing is PT-derived, so relying on a low fibrinogen value would not be helpful for determining serum vs. citrated plasma. Thank you for your question. […]

Qualitative Vs. Quantitative D-dimer

A message from “Dchrist” at Mercy Hospital in Chicago: What is the clinical rationale, if any, for offering both a qualitative and quantitative D-dimer assay in the main hospital lab? Hello, and thank you for your question. It may be that your director retains the qualitativeassay for a quick turn-around to help diagnose disseminated intravascular coagulation […]

Off-Label NovoSeven

Most transfusion services adopt a policy recommending Novo Nordisk’s recombinant activated factor VIIa (rFVIIa, NovoSeven®) in acute hemorrhage when conventional therapy; RBCs, frozen plasma, platelet concentrate, and cryoprecipitate fail to stop the bleeding. NovoSeven is FDA-cleared for prophylaxis or therapy in hemophilia A or B patients with inhibitors or people with congenital factor VII deficiency. When it is […]

Mixing Studies

I attended the Twelfth Annual Symposium on Bleeding and Thrombosis May 6 and 7 in Indianapolis. The meeting was sponsored by Midwest Coag Hemostasis and Thrombosis Laboratories and Esoterix, Inc. Laboratory Services and administered by Charles C. Miraglia, MD. I learned several interesting things at the meeting, but would like to feature a series of […]

Quick Question: HIT Testing

Our April Quick Question was “How do you test for heparin-induced thrombocytopenia (HIT)?” Here are the compiled answers: a. Platelet count only: 4 (8%) b. Platelet count and immunoassay: 22 (45%) c. Platelet count and heparin-induced platelet aggregation (HIPA): 10 (20%) d. Platelet count and serotonin release assay (SRA): 2 (4%) e. Platelet count, immunoassay, […]

Whole Blood QC for the PFA-100

A question from Jojie Acosta: After a lab inspection we are required to perform normal whole blood controls each day of testing for our PFA-100. Previously we only did the daily self-test on the PFA, though we ran QC on every shipment of cartridges. We currently have difficulty finding normal donors for the required daily […]

Quick Question Summary: Discard Tube

Our April, 2010 Quick Question was “Do you collect a discard tube prior to collecting a tube for coagulation testing?” Answers: a. Never: 14 (34%) b. Always: 14 (34%) c. Only for special coagulation testing: 13 (32%) For those who are collecting a discard tube in all cases, I have good new for you, you […]

Thrombosis in Athletes?

Here’s a message from Michelle Brown, MS, MLS, faculty at the University of Alabama at Birmingham (UAB) School of Health Professions. Michelle teaches Immunohematology and coordinates the clinical rotations in the Clinical Laboratory Science program that I retired from in 2007. She was Margaret Fritsma’s graduate student a few years ago and now occupies Margaret’s […]

Warfarin & Cotrimoxasole: 4X Bleeding Risk

An article in the current Archives of Internal Medicine identifies the sulfonamide antibiotic cotrimoxazole (Bactrim® and several generics) as conferring a 3.84 odds ratio of upper gastrointestinal bleeding when co-prescribed with warfarin in patients >66. Likewise ciprofloxacin (Ciprol®) co-therapy generated an odds ratio of 1.94, also significant. These antibiotics are primarily used for urinary tract infection and […]

Historical Ranges: CV% and RI

Here is a message from subscriber Dkaguni: “Historical ranges are often used to determine the range for coagulation assays. Are there general guidelines as to how large these ranges can be?” Hello, and thank you for your question. I’ll begin by assuming your question addresses internal assay precision, which is typically expressed as coefficient of […]

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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.

Cheat Sheets from George

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