Quick Question Archive

November, 2019 Quick Question

Our November, 2019 Quick Question asked, “What may you substitute for the PT when LAC prolongs the PT?” We accumulated 53 votes. A. None, use the PT anyway: 9% (5) B. Chromogenic anti-Xa: 13% (7) C. Chromogenic factor X: 30% (16) D. Activated clotting time: 8% (4) E. Thrombin time: 11% (6) F. There is […]

Anticoagulant Therapy

Quick Question: PT substitute

Our November, 2019 Quick Question asks, “What may you substitute for the PT when LAC prolongs the PT?” This question addresses the unreliability of the PT for monitoring Coumadin therapy when lupus anticoagulant interferes by prolonging the result. It is also relevant to PT prolongation by fibrinogen deficiency or factors II, V, VII, or X […]

Anticoagulant Therapy

Quick Question: Liver Disease or VK Deficiency?

Here are the results to our October, 2019 Quick Question, “What factor assays do you perform to distinguish liver disease from vitamin K deficiency?” a. II and V: 13 (15%) b. V and X: 10 (12%) c. II and X: 8 (9%) d. V and VII: 44 (51%) e. VII and X: 11 (13%) The […]

Bleeding Disorders

September, 2019 QQ Response: Poor Wound Healing

Here is our September, 2019 Quick Question with responses from 100 participants. A 25-YO experienced chronic soft tissue bleeding and poor wound healing. His PT, PTT, and PLT count were normal. What follow-up assay is indicated? a. Platelet aggregometry 24 (24%) b. Factor VIII and IX assay 12 (12%) c. Factor XIII assay 37 (37%) […]

Bleeding Disorders

September, 2019 Quick Question

Please go to our September, 2019 Quick Question on the right, “A 25-YO experienced chronic soft tissue bleeding and poor wound healing. His PT, PTT, and PLT count were normal. What follow-up assay is indicated?” If you don’t see an answer you like, please add a comment. Thank you.

Bleeding Disorders

August, 2019 QQ: DOAC Bridging

Our August, 2019 Quick Question, suggested by frequent contributor, Dave McGlasson, demonstrated the variability in clinical antithrombotic therapy bridging policies when a patient requires a procedure. Here is the question and answers provided by 70 participants: A 60-YO man taking 20 mg/day rivaroxaban for AFIB needs a high bleeding risk surgery. His creatinine is 0.9 […]

Anticoagulant Therapy

July, 2019 QQ: Managing Trauma

Our July, 2019 Quick Question was directed to trauma centers, and attracted 22 responses. The question was… How does your institution manage trauma-induced coagulopathy? Crystalloid plasma expanders 3 (14%) pRBCs 2 (9%) 1:1:1 components 12 (54%) Whole blood 2 (9%) Tranexamic acid 3 (14%) Thank you for your answers. Arising from military experience, a handful […]

Bleeding Disorders

Quick Question: TTP Laboratory Assay

Our June, 2019 Quick Question generated a near-unanimous response from 68 voters: What laboratory assay confirms thrombotic thrombocytopenic purpura (TTP)? Shiga toxin test: 3% (2) Complement C3 level: 7% (5) ADAMTS13 activity: 83% (56) VWF multimers: 7% (5) The Shiga toxin test correlates to Shiga toxin-induced hemolytic-uremic syndrome (ST-HUS), the “classic” HUS detected mainly in […]

Arterial Thrombosis

Quick Question: FVL Order

Our Quick Question for May, 2019 was “A rheumatologist orders a thrombophilia profile that includes a genotypic factor V Leiden mutation assay. You… A. Proceed with the FVL assay: 40% (14) B. First perform the phenotypic APCR: 51% (18) C. Cancel the order: 9% (3) George posted this because the American Society for Clinical Laboratory […]

Quick Question Archive

Quick Question: Pregnant Woman with DVT

Here is our April, 2019 Quick Question, Adapted from Walenga JM. Chapter 35–Normal Hemostasis. In Keohane EM, Otto CN, Walenga JM. Rodak’s Hematology, Clinical Principles and Applications, 6th Edition, 2020. ISBN 978-0-323-53045-3. A 33-year-old pregnant woman developed deep vein thrombosis in her left leg. She reported a family history—her mother had an episode of superficial […]

Quick Question Archive

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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

Quick Question