Coagulation Studies for the Ebola Patient

Pat Doleski suggests that the recommended Ebola patient coagulation test is the PT. What is the hemorrhagic process that occurs in the Ebola patient that the PT is the best screening to direct the use of blood products? We are in the process of setting up a secure ER lab specifically for this type of patient and will be reviewing POC instruments although certain instruments (Coumadin testing only) cannot be used for this purpose.

Pat, thank you for your comment. It took me some hours to relocate a special report from Drs. Duncan’s and Winkler’s group at Emory University that I first read in September and then misplaced. It is Hill CE, Burd EM, Kraft CS et al. Laboratory test support for ebola patients within a high-containment facility. Lab Med. 2014;45:e109-11. Theirs was followed by a fall issue special report by a group at the University of Nebraska, Iwen PC, Garrett JL, Gibbs SG, et al. An integrated approach to laboratory testing for patients with ebola virus disease. Lab Med 2014;45:3246–51. The Emory group lists the PT and a CBC, plus chemistries, urinalysis, malaria test, and a PCR to detect ebola RNA. The Nebraska group adds a PTT. The characteristic advanced ebola infection hemorrhaging is the result of microvascular disruption and extreme vasodilation, causing acute DIC, I agree with Dave McGlasson’s comment below, that a DIC profile, consisting of, in addition to the PT and PTT, a fibrinogen level and D-dimer. The accompanying CBC will help identify the characteristic thrombocytopenia and schistocytes characteristic of DIC. Thank you for raising this very important topic. Geo.