Here is a provocative recommendation from colleague and friend, Dan Kaczor:
Hi George, This is the follow-up on the issue of nomenclature posted on 12-1-2025. Although there may be reasons to consider change, as pointed out in the examples given, I believe that we are moving in the wrong direction and are making things difficult for the end users (doctors, pharmacists, nurses). Instead of creating names that are scientific-sounding and only meaningful to those involved in hemostasis, names need to be clearly understandable by the members of the medical community who order them. Here are a few examples:
- Instead of listing the anti-Xa test in our menu, let’s make it easy to order heparin, dabigatran, and rivaroxaban assays by their name.
- Instead of all the new VWF activity names, let’s just offer a VWD profile.
- Instead of FVIII, FIX, and FXI, let’s offer hemophilia A, hemophilia B, or hemophilia C assays for diagnosis and management.
Tests like the PT, APTT, D-dimer, and fibrinogen should be left alone as they are well-known and have withstood the test of time, but they illustrate my point. Our colleagues in chemistry have made my case. If a provider wants to check your glucose, they order a glucose test, not a hexokinase. The same applies to creatinine; they don’t order a Jaffe reaction. If we need a nomenclature change, our primary consideration should be for ease of ordering and relatability to the provider and patient. Further, I doubt that providers or patients give much thought to units–the focus is on the result–is it positive or negative, within the normal range, high (H) or low (L)? Our end users expect the most accurate results available by an understandable name!
Dan later added: Instead of changing the type of numbers used for factors, how about: AF XI (“A” tying it to the APTT), PFVII (“P” tying it to the PT), and CFV (“C” tying it to the common pathway). Imagine how much easier it would be to train the end user–normal APTT/abnormal PT = potential PF issue; abnormal APTT/normal PT = potential AF issue; abnormal APTT/abnormal PT = potential CF issue.
This would help the ordering provider to associate the screening test with a more focused cause after ruling out other possibilities from the patient’s history. One could build on this model for issues like drug interference, LA etc.
I (Geo) responded…
- Agree that everyone knows PT, PT/INR, APTT or PTT, fibrinogen, D-dimer
- I’m not convinced that most providers would know the intrinsic, extrinsic, and common pathways; prefixes could add confusion, though your plan may help educate hemostasis specialists.
- Most order systems are automated, so we could add secondary terms that pop up when the cursor hovers over the primary terms, for instance, Hemophilia A [Bleeding Disorder, FVIII Deficiency], von Willebrand Disease [Bleeding Disorder], Hemophilia B [Christmas Disease, FIX Deficiency], Hemophilia C [Rosenthal Syndrome, FXI Deficiency], warfarin [Coumadin, Coumarin, Acetocoumeral, VKA], heparin [unfractionated heparin].
- Thrombosis
- Antiphospholipid Syndrome [Lupus Anticoagulant, Antiphospholipid Antibodies]
- Control Factor Deficiency [FV Leiden, antithrombin deficiency, protein C deficiency, protein S deficiency]
- Platelet function testing
- And more.
I’m looking forward to some comments.
Everyone has a point. Bob’s comments on the designation of laboratory personnel changing their initials from MT to other titles like MLS, CLS, RMT stemmed partly from the DOD designating their nursing assistants as med techs. Now they are called Certified Nursing Assistants (CNA), which varies by state. Other titles include ward assistant, patient assistant, and transporter.
Dan may be complicating things by expecting physicians and other personnel to know something about the common, extrinsic, and intrinsic pathways. I like what Dr. Favaloro suggests in simplifying the terminology and keeping the Roman numeral requests for the individual factors. I also think that personnel requesting anticoagulant drug levels ask for the individual drug that the patient is receiving rather than a generic test such as the anti-Fxa which made my life difficult in the special coagulation laboratory. I still wish we could change the term lupus anticoagulant. It’s a dinosaur that makes people outside the lab think the patient has an auto-immune disorder such as SLE. It probably won’t be changed in our lifetimes. Let’s keep it as simple as possible and not try to confuse everyone more than already seems to exist.
I’m not sure how name changing really addresses any salient issue…cannot recollect a significant name change that has really altered desire outcome. I still struggle with our identity name changes (MT, CLS, and now MLS) over the years as to what that really accomplished. Lab outsiders have initials that indicate degrees (MD, PhD, MSN, BSN, etc) whereas we still use letters that suggest we went to a trade school.
We need to get out of our sandbox more often that we do and converse with the providers. Pharmacy organizations do not just change orders but deal with providers when orders do not make sense. I’ve always said that the more we engage providers, the more likely they will engage us. A reminder that most providers (physicians, nurses, pharmacists) rarely engage the lab folks, and when/if they do, it is typically with phlebotomists.
Hemostasis is replete with poor names (lupus anticoagulant), or near-duplicate names (factor X, anti-factor Xa), so we are the creators of this universe. Last pontification: Medical school is 4 years, and it was 4 years 50+ years ago, but the amount of information is astronomically more today that it was 50+ years ago…so docs are not the experts for everything, and each division, including laboratory science/medicine, needs to be the champion and baton carrier for expertise.
I tend to align with George, although we still occasionally get paper requests for serum fibrinogen, which I am tempted to just result as zero–but that’s doing a disservice to our patients! Even I forget which pathway is the extrinsic vs intrinsic, as I call them tissue factor and contact pathways. Most requests for FVIII and FIX are not to query hemophilia A or B, but to explain prolonged APTTs or to assess for liver disease or DIC (etc). Certainly agree with docs asking for the drug test (unfractionated heparin, LMWH, rivaroxaban, apixaban, etc) rather than the test (eg anti-Xa) since the same test could be used for different drugs. Don’t agree with the add on comments – AF XI suggests a request for FXI for atrial fibrillation! We have panels for congenital thrombophilia (antithrombin, protein C, protein S), VWD (VWF:Ag, VWF:GPIbR, VWF:CB, FVIII), Antiphospholipid Syndrome (Lupus Anticoagulant, Antiphospholipid Antibodies), etc.