I’m curious to know how other labs handle routine detection of heparin in samples for lupus anticoagulant testing. We currently run a PT and PTT on all samples right off the bat and then Hepzyme any that have high PTTs before proceeding with testing.
As a quality management project, we are comparing other methods (like running thrombin time before Hepzyming) to see what’s most efficient and cost effective. We do a fairly large volume of lupus profiles here and sometimes end up Hepzyming 10 or 15 samples a run, many of which don’t correct of course. Any feedback is appreciated!
Krista Hostetler, MT (ASCP)
Special Hemostasis Laboratory
Emory Medical Labs
Emory Healthcare, Atlanta, GA
I’ll be interested in seeing responses from our subscribers. In the special coagulation laboratory at UAB the techs use the thrombin time, which is cheap, automated, and speedy; also I know of labs that just use the anti-Xa heparin assay. Geo.
We use the thrombin time to rule out heparin in
We use the thrombin time to rule out heparin in our lupus testing. Our thrombin time is very sensitive to heparin. We invalidate the lupus testing and ask for a redraw when the patient has been off heparin for at least 72 hours. Donna
The reagents we use in our LLI panel (Precision
The reagents we use in our LLI panel (Precision BioLogic’s LA Check and LA Sure plus Stago’s StaClot LA) have heparin neutralizer in them that can handle up to 1.0 IU/mL heparin. We run Stago’s PT/INR and PTT-LA as a screen and if we have a PTT-LA result >150 sec we run a heparin level (anti-Factor Xa). If the heparin is >1.0 IU/mL, we credit the LLI workup as “UNABLE TO INTERPRET LLI. Recommend repeat testing for LLI on sample containing less than 1.0 IU/mL heparin”. We add on the heparin level and bill for it. We came up with our PTT-LA cut-off through trial and error and after looking at data for over a year discovered that we never had over 1.0 IU/ml heparin if the PTT-LA was >150 sec.
We don’t bother with heparin neutralization and haven’t had any complaints from our clients. If they avoid line draws and time the draw for trough levels of LMWH, it’s not that hard to get a sample with less than 1.0 IU/mL heparin.
Thanks for getting some good discussion going!
Kelly Townsend, Tech Specialist at TriCore Reference Laboratories, Albuquerque, New Mexico
I would be happy to share our procedure with you
I would be happy to share our procedure with you.. you can email me at [email protected]
Hi Krista. I am the Tech Specialist at the VA Hospital in Sa
Hi Krista. I am the Tech Specialist at the VA Hospital in San Diego. We are pending to go live with our Anti-Xa assay that will measure both LMW and UF Heparins on our ACL TOP 500s.
I’m interested in reading more about the procedure that the TC from Clarian Health Indianapolis has suggested with utilizing PS from pharmacy. We use PS, if you can believe it or not, on a test that we still offer, called 3P (Plasma Paracoagulation Phenomenon), an indirect method to screening for DIC. So would it be possible to get more info on the use of PS with TCT. =)
Hi Krista. I am the TC for the hemostasis lab at Clarian He
Hi Krista. I am the TC for the hemostasis lab at Clarian Health in Indianapolis, IN. We perform a PT/PTT and a TCT. Any abnormal TCT‘s we then re-test an aliquotof plasma that has protamine sulfate added to it. If heparin is present, the TCT corrects back to normal. Similar to Hepzyme but no cost! We get PS from our pharmacy and make a dilution of the stock that lasts forever. We hae been using this method since I was in MT school and that was a long time ago!!
I perform the Anti-Xa assay for UFH on any PTTs that are abo
I perform the Anti-Xa assay for UFH on any PTTs that are above our therapeutic range. Since PTTs are not the greatest predictor of whether or not a patient is adequately anticoagulated, I tend to not believe them. We have the anti-Xa heparin assay on-board 24/7, versus thrombin time, which we rarely perform.