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, […]

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Specimen Management

Aug 11 2014

george

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 […]

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Anticoagulant Therapy

Mar 28 2014

george

Discard Tubes for Heparin?

From Dennis Ernst, Center for Phlebotomy Education, Inc: I am chairing the CLSIDocument Development Committee on the venipuncture standard revision. At today’s web meeting the question came up about the necessity for discard tubes on heparinized patients. It’s been widely reported that discard tubes are not necessary, and haven’t been for some time. However, it came to our […]

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Anticoagulant Therapy

Feb 3 2014

george

Tube System Effect on Platelets?

From Gnaesh Lyer, Florida Hospital: Have you done any correlation studies for Plavix and aspirin if the tubes are sent by tube system from floors rather than hand delivering the tubes? Does the results vary a lot or with in acceptable range? Thanks. Hello, Gnaesh Lyer, and thank you for your question. I know of no studies […]

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Platelet Function Testing

Jan 14 2014

george

In Vivo Hemolysis

Irene Regan writes that despite doing major literature searches there seems to be no consensus regarding what coagulation results should be released when there is a suspicion of in vivo hemolysis such as in disseminated intravascular coagulation (DIC), when the samples are grossly haemolysed. Currently, Irene issues a fibrinogen (Clauss) and in this case she generally […]

Bleeding Disorders

Coag Specimens on Ice

From our frequent contributor, Kim Kinney at Indiana University Health Pathology Laboratory: Merry Christmas all! George, this may be an old topic, but I am getting some push back from our off-site coordinators. Coagulation samples sent on ice: I have always thought that the current literature stated that iced coag tubes could activate factor VII and potentially shorten […]

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Specimen Management

Specimen Management

Newborns on ECMO

Drawing Above Heparin Line

Ebola Precautions

Blood Specimen Transfer

Specimen Management

How Long to Stop Infusion

Discard Tubes for Heparin?

Tube System Effect on Platelets?

In Vivo Hemolysis

Coag Specimens on Ice

George Fritsma MS MLS

Cheat Sheets from George

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