Specimen Management

Theranos

The January 1, 2015 online issue of Fortune features a video interview of Elizabeth Holmes in its “Most Powerful Women” section. Holmes founded and is CEO of Theranos, a 2003 Palo Alto laboratory service. Theranos offers a menu of over 200 assays, including PT, PTT, and D-dimer, all performed on less than 500 µL of […]

Specimen Management

Clotted Specimens

I recently received a message from a local colleague who has received complaints from the nursing department when rejecting clotted coagulation specimens. The problem occurs with both citrated blue-closure and EDTA lavender-closure tubes. A few of the nurses are convinced the laboratory is storing the specimens too long before testing them, thus allowing them to […]

Specimen Management

Vascular Access Device Collection

From Nancy Fabbrini: We have a patient on an argatroban bridge to warfarin. He is a very difficult draw so the service has been drawing blood from the central access device. They have been withdrawing 20 mL of blood before drawing the tube for coagulation testing. Is that sufficient, i.e. do the same “rules” for a […]

Specimen Management

QQ Results: Overfilled Coag Tubes

From our summer, 2014 Quick Question, What is your policy for managing overfilled coagulation specimen tubes? a. We reject overfilled tubes; results are likely to be invalid. 116 votes, 69% b. We accept overfilled tubes; overfilling doesn’t affect results. 28 votes, 17% c. We never see overfilled tubes. 24 votes, 14% CLSI Guideline H21-A5 specifies that coagulation tubes […]

Quick Question Archive

Newborns on ECMO

This was posted by a colleague on another forum. We have noticed that newborn babies plasma, after three weeks on extracorporeal membrane oxygenation (ECMO) becomes dark brown. On our instrument, the fibrinogen rises to approximately 800 mg/dL, though a reference lab reports it as critically low. We also notice falsely elevated platelet counts, for instance, […]

Specimen Management

Drawing Above Heparin Line

We avoid collecting blood from an arm that has an intravenous line, however this practice seems to rely on conventional wisdom, not data. Here is a question from Dennis Ernst, Center for Phlebotomy Education about collecting above a heparin line: My CLSI committee is revising the venipuncture standard and is having trouble locating anything new on drawing above […]

Specimen Management

Ebola Precautions

George presented the first part of a three-part AACC webinar series, Quality Assurance in Hemostasis; What Makes Us Different? A question arose about Ebola virus specimen management. Though not specifically related to hemostasis, it seems appropriate to provide a link to the US Centers for Disease Control and Prevention (CDC) specimen precautions. What the CDC document […]

Specimen Management

Blood Specimen Transfer

George is working with Dr. Jeanine Walenga, coagulation editor, on the “Methods” chapter for the fifth edition of Hematology, Clinical Principles and Applications. (The Rodak Hematology textbook published by Elsevier). While most hemostasis specimens are collected in evacuated tube systems, we use syringes for difficult draws or special applications. When transferring syringe blood to an evacuated tube, […]

Specimen Management

Specimen Management

From Joanna Carroll: I was recently told that samples should be double spun prior to long term freezing. Except in the case of heparin testing, I cannot find any evidence to support this. Also can you tell me if there are recommendations on how to handle samples for fibrinogen, D-dimer and unfractionated heparin anti-Xa assays? Our […]

Specimen Management

How Long to Stop Infusion

From Kim Kinney at Indiana University Health: Hi George. We frequently get asked how long to stop an unfractionated heparin infusion before drawing for a partial thromboplastin time (PTT) from a central line or peripheral stick above the infusion site. We have always referred them to pharmacy. is there a standard practice used by nursing at other institutions […]

Anticoagulant Therapy

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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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