Rapid HIT Assays

Informal discussions with Ginger Weeden and Lucinda Lojka from Bio-Rad, Incmade me curious about rapid assays for the antibody that causes heparin-induced thrombocytopenia with thrombosis (HIT), anti-heparin/PF4. In North America we typically screen with one of three enzyme immunoassay (EIA) methods, from GTI Diagnostics Inc., Waukesha, WI, USA, PF4 Enhanced®: GTI PF4 Enhanced Package Insert; Hyphen Bio-med, Neuville-Sur-Oise, France, Zymutest HIA® Assay; or Diagnostica Stago, […]

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Anticoagulant Therapy

Aug 1 2013

george

LA Protocol

From Michelle Fahs, Mercy Hospital, St. Louis. Hi, we are going to start performing lupus anticoagulant testing and are planning to perform the PTT–LA and dilute Russell viper venom time (DRVVT). We use Stago instrumentation. We are still determining our testing algorithm from that point and I have a few questions for you. 1. Do you recommend […]

Thrombophilia

APCR Assays on Two STARs

From Linda Stang, Alberta Health Services: George–hoping you or one of your participants has some advice for us. We run the American Diagnostica (now Sekisui) kit for activated protein C resistance ratio (APCRE) on two of our Stago STAR Evolutions. The issue we are having is that one of the instruments reads slightly overall higher ratios (more […]

Thrombophilia

Unexpected DRVVT Confirmation Results

I had the pleasure of meeting Norbert Bennattar, Directeur General of Cryopep, Montpellier, France while attending the International Society on Thrombosis and Haemostasis biennial meeting in Amsterdam, July 1–4, 2013. Mr. Bennattar posed a question I couldn’t answer. When performing the dilute Russell viper venom time (DRVVT) assay for lupus anticoagulant (LA), the operator begins with a screening assay. When prolonged […]

Thrombophilia

PNP Test for LA

Here is a challenging technical question about the platelet neutralization procedure (PNP) for identification of lupus anticoagulant (LA) from Charlene Bierl MD, PhD Director of the Clinical Laboratory. Cooper University Hospital, Camden, NJ. Dr. Bieri’s question was originally addressed to Drs. Marisa B. Marques and Jill Adamski and to specialty technologists Laura Taylor and Patti Tichenor at the University of Alabama at Birmingham Hospital Department of Laboratory Medicine. Following is […]

Thrombophilia

Recommended DIC Profile

From Julia Witt: In an effort to standardize our healthcare organizations, we are looking at our current disseminated intravascular coagulation (DIC) panel. All sites have different ideas. George, what are your suggestions? Hi, Julia. Please forgive some self-promotion. Our handbook, Marques MB, Fritsma GA: Quick Guide to Coagulation Testing, 2nd Edition, AACC Press, 2009 provides the following recommendations […]

Bleeding Disorders

Anti Phospholipid Antibody Result Interpretation

From Charles Nakar, Indiana Hemophilia and Thrombosis Center: I would like your opinion on the laboratory results below regarding a patient who recently switched providers with a history of deep venous thrombosis due to May-Thurner syndrome and possible antiphospholipid antibody syndrome. He had positive anticardiolipin antibody (ACL) screens and a positive STA-clot (x1) during the acute event […]

Thrombophilia

Platelet Count in APA

From Kathleen Doig, PhD, Professor, Biomedical Laboratory Diagnostics at Michigan State University. George – a question arose in our senior Medical Laboratory Science class today as students were constructing algorithms to investigate some case problems I gave them. Here’s the question: What is the platelet count for patients with thrombosis due to antiphospholipid syndrome (APA)? George […]

Thrombophilia

Lupus Anticoagulant Panel

From Don Wahl, Sanford Health: What are the recommended tests to include in a lupus anticoagulant/antiphospholipid antibody (LA/APL) panel? Is there an antiphospholipid group that gives recommendations? Thank you, Don. Hello, Don, and thank you for your question. The group you need is provided in the title of this reference, and the reference provides the assays that […]

Mixing Studies

Hillary Clinton’s Thrombosis

Here is an audio summary of Secretary of State Hillary Clinton’s Cerebral Sinus Venous Thrombosis episode by Samuel Goldhaber, MD

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Thrombophilia

Thrombophilia

Rapid HIT Assays

LA Protocol

APCR Assays on Two STARs

Unexpected DRVVT Confirmation Results

PNP Test for LA

Recommended DIC Profile

Anti Phospholipid Antibody Result Interpretation

Platelet Count in APA

Lupus Anticoagulant Panel

Hillary Clinton’s Thrombosis

George Fritsma MS MLS

Cheat Sheets from George

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