Mar 30 2021

george

April 2021 Quick Question: Andexanet Alfa

Our April Quick Question arises from discussions with Chad Siniard, MD., University of Alabama at Birmingham Division of Laboratory Medicine and hemostasis author and expert Dave McGlasson. Andexanet Alfa® is the FDA-approved reversal agent for rivaroxaban and apixaban that has become a standard ER treatment for potential anticoagulant overdose. A key consideration is the US […]

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Anticoagulant Therapy

Mar 30 2021

george

March 2021 Quick Question Response

Our March, 2021 Quick Question was a case study that netted 49 votes. A 2 YO experiences frequent joint bleeds. PT: 22s; PTT: 29s; fibrinogen 280 mg/dL. What do you do next? Assay factors VIII, IX, and XI. 10% [5] Assay factors II, V, and X, 14% [7] Assay factor VII, 70% [34, correct] Assay […]

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Bleeding Disorders

Feb 27 2021

george

Quick Question March 2021: 2 YO W/ Anatomic Bleeds

Our March, 2021 Quick Question is a case study involving a 2 YO who experiences frequent anatomic [joint and body cavity] bleeds. The lab results are PT: 22s; PTT: 29s; fibrinogen 280 mg/dL. What do you do next? Please choose your anwer on the right. You will need to endure the “Captch” function, we’ve had […]

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Bleeding Disorders

Feb 27 2021

george

Quick Question Feb 2021: Easy Bruising Case

Our February, 2021 Quick Question was a case study that drew 60 responses. A 25-YO woman who is 1 month post-partum experiences bruising and menorrhagia. She reports that her mother and brother both experience easy bruising and that her own bruising disappeared during her pregnancy. What condition could cause these symptoms? Acquired hemophilia: 12% [7] […]

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Bleeding Disorders

Jan 31 2021

george

Jan, 2021 QQ: CFX Answers

Our January, 2021 Quick Question asked, “How does your facility monitor warfarin in an atrial fibrillation [AFIB] patient with lupus anticoagulant [LAC]? The answers were… PT–INR; it is valid in LAC [33%] Chromogenic factor X [10, CFX] [33%] Chromogenic anti-factor Xa [23%] None: we switch to a DOAC [11%] Our question attracted too small a […]

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Anticoagulant Therapy

Dec 1 2020

george

December 2020 Quick Question: Emicizumab

Our December, 2020 Quick Question addresses the uncommon incidence of breakthrough bleeds in hemophilia A patient who are being treated with emicizumab [HEMLIBRA], the immunotherapeutic that bypasses factor VIII. Treatment may become an issue in severe hemophilia in which patients develop inhibitors. See our November 29 post, Emicizumab Laboratory Assay Review [click] for some hints […]

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Bleeding Disorders

Dec 1 2020

george

November 2020 QQ: VWF Activity Assay Responses

Our November, 2020 Quick Question attracted 37 participants. Here is the stem: “Which VWF activity assay is preferred at your facility [check 10-31-20 post]?” The selections were… VWF:RCo: 58% [21] VWF:GP1bR: 3% [1] VWF:GP1gM: 14% [5] VWF:Ab: 3% [1] VWF:CBA: 22% [8]* The time-honored Ristocetin cofactor assay remains the most prevalent of VWF activity assays. […]

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Bleeding Disorders

Oct 31 2020

george

October 2020 Quick Question: Inflammatory Marker Results

Our October, 2020 Quick Question was, “What inflammation assay does your lab use to assess SARS-CoV-2 progression?” The  question attracted 223 votes, a record turnout, but the answers were phrased in a way that directed us to a single answer! Here are the results: CRP: 7% [16] ESR: 0% Ferritin: 1% [2] IL-6: 3% [7] […]

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Quick Question Archive

Oct 1 2020

george

October 2020 Quick Question: Inflammation

Our October Quick Question is selected from the many open questions we received during our September 15 webinar. “Covid-Associated Coagulopathy: A Conversation about Controversies and Confusion” [click] featuring Andrew Goodwin, MD, CLIA Medical Director, University of Vermont Medical Center and Laboratory Services and Section Medical Director of the Thrombosis and Hemostasis Laboratory. In our Quick […]

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Quick Question Archive

Oct 1 2020

george

Sept, 2020 Quick Question Reponse: Fibrinolysis

Here are our responses to the September, 2020 Quick Question, wich attracted 51 participants. How does your facility measure fibrinolysis? Plasminogen: 3 [5%] Tissue plasminogen activator [TPA]: 1 [2%] Plasminogen activator inhibitor 1 [PAI-1]: 1 [2%] Thromboelastograph [TEG]: 10 [20%] Rotational thromboelastometry [ROTEM]: 36 [71%] As we speculated the first three measures of fibrinolysis are […]

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Fibrinolysis