Specimen Management

July 2024 QQ: Specimen Storage

Coag specimen mismanagement is the source of most errors in hemostasis testing. As mentioned in our June 28, 2024 entry, Adjusting AC Volume in Polycythemia, CLSI released its latest edition of H21: Collection, Transport, and Processing of Blood Specimens for Testing Plasma-Based Coagulation Assays, 6th ed. Guideline H21, Clinical Laboratory and Standards Institute, 2024. The […]

Specimen Management

Adjusting AC Volume in Polycythemia

University of Alabama at Birmingham clinical pathologist Chad Siniard MD, shared the following streamlined approach to adjusting the sodium citrate volume to accommodate specimens from patients whose hematocrit exceeds 55%. The formula is adapted from CLSI Collection, Transport, and Processing of Blood Specimens for Testing Plasma-Based Coagulation Assays, 6th ed. Guideline H21, Clinical Laboratory and […]

Specimen Management

Clot Detection by Wooden Sticks

Fritsma Factor participants, a colleague brought up the problem of clotted hemostasis specimens within the context of remote specimen collection. Many facilities recommend checking whole blood specimens with wooden sticks, a policy that has been in place since before 1990 but raises concern for contamination, clot activation, and operator safety. The broad availability of automation […]

Specimen Management

Platelet Satellitism

Here’s a March 11, 2024 message from Erika Knuckles, Hematology Supervisor, Phelps Health. “Good Morning George, I was consulting ‘Mr. Google’ to see if I could find any information on what would cause patients to form platelet clumps in both EDTA and sodium citrate. We excluded the collection process. diseases, and medication. I thought you […]

Specimen Management

Heparin and Mixing Studies

From colleague Brenda Goforth, Senior CLS Hematology, Coagulation, and Urinalysis | Clinical Laboratory, Antelope Valley Medical Center Hi George, When using Hepzyme on patients who are on heparin and a mixing study is ordered, what is the standard for when neutralization is complete? If the PTT is normal after one neutralization, then proceed to 37ºC incubation, but what […]

Northeast Laboratory Conference, 10/17–18, 2023

the Northeast Laboratory Conference is this week, Tuesday, October 17, and Wednesday, October 18 at the Holiday Inn By the Bay, 88 Spring Street, Portland Main. I [Geo] lead an interactive session, “Trauma-Induced Coagulopathy and Massive Transfusion Protocol,” geared toward Hematology, Hemostasis, and Transfusion Medicine specialists from 10–11:30. Click here for the handout. My second […]

Bleeding Disorders

September 2023 Quick Question: Hemolysis

Our September 2023 Quick Question was a poll that asked, “What unit sends most of your hemolyzed specimens?” The poll received 32 answers: Newborn ICU: 8 [25%] Emergency room: 20 [63%] Other ICU sources: 3 [9%] Remote phlebotomy site: 1 [3%] Thanks to all for your responses. Although visible plasma hemolysis may indicate in vivo […]

Quick Question Archive

September 2023 Quick Question: Source of Hemolyzed Specimens

Our September 2023 Quick Question is a simple poll that we hope to use to describe means to reduce specimen hemolysis. If you don’t see an answer that fits your situation, please add your comment below.

Quick Question Archive

August 2023 Quick Question: Hemolysis

Our August 2023 Quick Question was a poll that attracted 26 responses. The question was “How do you distinguish ex vivo from intravascular plasma hemolysis?” Redraw specimen: 11 [42%] Analyze plasma LDH: 0 Analyze plasma potassium: 4 [15%] Analyze plasma hemoglobin: 4 [15%] Analyze plasma haptoglobin: 7 [28%] For decades, we’ve redrawn specimens when plasma […]

Specimen Management

August 2023 Quick Question: Coag Specimen Hemolysis

Our August 2023 Quick Question asks, How do you distinguish ex vivo from intravascular plasma hemolysis? The question arises from our lengthy July 25, 2023 discussion, DIC and hemolysis, and is a poll; there is no wrong answer. Read the comments section featuring hemostasis experts Dave McGlasson, Dr. Emmanuel Favaloro, Dr. Giuseppe Lippi, and Robert […]

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

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