Thrombophilia

Agent Orange and Lupus Anticoagulant?

I (Geo) received an 11-7-24 message from Steve Montag, whose oncologist states that his lupus anticoagulant is “more than likely” caused by Agent Orange exposure. We could only find a single reference associating antiphospholipid antibodies to the Gulf War Syndrome, but nothing linking Agent Orange. Please comment below if you have seen this or can […]

Lupus Anticoagulant Testing

Anfal Helu asked: I have a question regarding the screening and confirmatory testing for the lupus anticoagulant (LA). Recently, a young female pt was clotting everywhere after a hospital visit for a status epilepticus attack during which she was intubated and placed on mechanical ventilation. She had 2 pulmonary emboli, 2 MI, ischemic colitis, renal […]

World Thrombosis Day, October 13

Dear George, As World Thrombosis Day (WTD) approaches on October 13, we’re excited to share new resources to help make this year’s campaign more impactful. Your participation is essential to raising awareness about thrombosis, and we are grateful for your continued support. To help you engage your community, we’ve added new tools and materials. New […]

A Molecular Approach to Assess Platelet Hyperreactivity

Friend Ed Groenendal forwarded this UPI summary of a molecular approach correlating evidence of hyperresponsive platelets to major adverse cardiac or limb events. The investigators started with aggregometry-defined platelet hyperreactivity to apply a transcriptome-based platelet reactivity expression score (PRESS). Click below to see the detailed open-access article describing the development and application of the PRESS. […]

Antiplatelet Therapy

VKA Monitoring in Hepatic Insufficiency

Here is a challenging case from Hrvoje Melinšćak sent 5-30-24: Dear George, In hepatic insufficiency there is often a prolonged basal protime, how to ensure therapeutic values of warfarin when the INR is already elevated? This is of particular concern in those with mechanical cardiac valves. Serum warfarin levels (spectrophotometry) are cumbersome and take days to […]

Is DRVVT Normalization Necessary?

The clot-based dilute Russell viper venom test (DRVVT) reagent activates the coagulation mechanism’s common pathway at the factor X (10) level, relying only on factor V, prothrombin, and fibrinogen for clot formation. The DRVVT test complements the PTT-based assay for lupus anticoagulant (LAC) detection. Because LAC is phospholipid (PL)-dependent, both assays use a minimal-phospholipid (PL) […]

Testing for the Lupus Anticoagulant: The Good, the Bad, and the Ugly

Click here for a “State of the Art Review,” Favaloro EJ, Pasalic L, Selby R. Testing for the lupus anticoagulant: The good, the bad, and the ugly. Research and Practice in Thrombosis and Haemostasis 2024; 8: DOI:https://doi.org/10.1016/j.rpth.2024.102385.

Still More on Chronically Elevated D-dimer

We’ve received an additional comment on our February 3, 2024 entry on the topic of chronically elevated D-dimer.

Lab Assays to Detect Occult Cancer in VTE

Here is a provocative article whose investigators looked for lab assays to detect cancer in patients with unprovoked venous thromboembolism: Sánchez-López V, Marín-Romero S, Ferrer-Galván M, et all. Occult cancer in patients with unprovoked venous thromboembolism: A nested case-control study. Am J Clin Pathol. 2024:aqad178. doi: 10.1093/ajcp/aqad178. Epub ahead of print. PMID: 38340336.

CAP Today: Thrombophilia Testing

Here is a January 2024 CAP Today summary of current thoughts about The Who, When, and Why of Thrombophilia Testing.

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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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