Specimen Management

Platelet Count on Spun Blue-top

From Tiffany Jones, Orlando Health: I was wondering if you could clarify for me why we can’t use a blue citrate tube for a platelet count after it has been spun once. Are there any studies to back up this reason? My facility seems to get a fair amount of patients displaying EDTA-induced platelet clumping […]

Specimen Management

HCT >55% and Citrate Volume Adjustment

George, is there research available now that states a HCT >55% will not interfere with PT or PTT results? We struggle with the CAP requirement. We use a mechanical based method for PT and PTT within our organization. Hello, and thank you for your question. The current CLSI guideline, Adcock DM, Hoefner DM, Kottke-Marchant K, […]

Screening Assays

Effect of HCT on POC INR

George received this question from the ASCLS Consumer Web Forum via Bonnie Jo Taylor, MHS, MT(ASCP)SH. I have hemochromatosis, too much iron in my blood. I’ve also had blood clots in my lungs. I peroidically undergo phlebotomy treatments to lower iron count. Will this alter the results of my INR finger prick test results? Here […]

Anticoagulant Therapy

Collecting Heparin Assay Specimens from a Device

Dear George Fritsma, I work at The Valley Hospital in Ridgewood N.J. and our nursing staff has the following question about drawing an APTT from a central line/picc line when heparin is infusing. Is there a protocol of how long to stop the infusion? Also, should the first syringe be discarded? I am interested in knowing […]

Anticoagulant Therapy

Coagulation Testing on an EDTA Specimen

Hi George: We encountered a case recently where we were asked to perform coagulation testing on specimens collected in EDTA vacutainers. The patient was refusing to give more blood than already collected for further coagulation tests and the attending doctor requested us to perform the tests in the blood collected in EDTA vials. We refused […]

Specimen Management

Correction for HCT >55%

Joan Chapman sent this question. Our institution corrects for HCT greater than 55% for routine and special coagulation assays. It has been our observation, however, that occasionally a patient sample will have a normal PT and PTT in spite of a high crit. We have had a policy that states if the PT and PTT […]

Screening Assays

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 […]

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George Fritsma is a medical laboratory scientist, educator, and author. George is a member of the International Society on Thrombosis and Hemostasis, the International Society for Laboratory Hematology, and the American Society for Clinical Laboratory Science.

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