»Point-of-care Testing« Vollblutmethoden in der Hämostasediagnostik

2000 ◽  
Vol 20 (01) ◽  
pp. 13-16
Author(s):  
W. A. Wuillemin
Keyword(s):  
Point Of Care ◽  
Point Of Care Testing ◽  
Point Of Care Tests ◽  
Von Willebrand ◽  
D Dimer

ZusammenfassungPoint-of-care-Tests (POCT) mit Vollblut gibt es für verschiedene Analysen im Bereich der Hämostase. Am häufigsten wird die Thromboplastinzeit mit Kapillarblut durchgeführt. Diese POCT-Analyse ist zuverlässig und wird u. a. bei der Patientenselbstkontrolle der oralen Antikoagulation eingesetzt. Die aPTT als POCT ist teilweise problematisch, deren Einsatz muß kritisch erwogen werden. Der PFA-100-Analyser ist geeignet als Screeningtest für Thrombozytopathien und ausgeprägte Von-Willebrand-Faktor-Mangelzustände. Die D-Dimer-Teste mit Vollblut erfüllen die Anforderungen bezüglich hoher Sensitivität nicht immer.Die Einsatzmöglichkeiten der Hämostase-POCT-Analysen müssen kritisch und wissenschaftlich definiert werden. Diverse Aspekte wie Qualitätskontrolle, Kosten und Gewinnung der Vollblut-Proben müssen weiter bearbeitet werden.

scholarly journals Formulating Design Recommendations for the Acceptance of the Use and Results of Point-of-Care Testing in Low- and Middle-Income Countries: A Literature Review

2019 ◽  
Vol 1 (1) ◽  
pp. 2795-2804
Author(s):  
Yvonne Jolanda Melanie Licher ◽  
Jan Simon Visser ◽  
G-Young Van ◽  
Jan Carel Diehl
Keyword(s):  
Healthcare Workers ◽  
Point Of Care ◽  
Waiting Times ◽  
Point Of Care Testing ◽  
Middle Income ◽  
Future Design ◽  
Middle Income Countries ◽  
Barriers And Opportunities ◽  
Point Of Care Tests ◽  
Low And Middle Income

AbstractIn low- and middle-income countries (LMIC), diagnostics are not always available in remote areas. Hospitals and healthcare centres are often too far from the community, and waiting times are up to a few hours even for relatively simple procedures. Moreover, travelling to the healthcare centre and taking the diagnostic test is frequently unaffordable. Point of Care Tests (POCTs) can improve the availability, accessibility and affordability of the diagnostics by providing the test at the time and place of patient care. Although many POCTs have been developed already, there remain challenges to enable the healthcare workers (HCW) and the patients to use the device in practice. In this paper, we aim to provide a systemic overview of the barriers and opportunities for the adoption of use and acceptance of the results of POCTs based on the literature. The barriers and opportunities were clustered into six themes and used to draw out recommendations for the future design.

Point-of-Care Testing in Liver Disease and Liver Surgery

2017 ◽  
Vol 43 (04) ◽  
pp. 407-415 ◽  
Author(s):  
Lasitha Abeysundara ◽  
Susan Mallett ◽  
Ben Clevenger
Keyword(s):  
Liver Disease ◽  
Blood Product ◽  
Point Of Care ◽  
Massive Bleeding ◽  
Point Of Care Testing ◽  
Hemostatic System ◽  
Coagulation Tests ◽  
Postoperative Thrombosis ◽  
Coagulation Status ◽  
Point Of Care Tests

AbstractThe alterations in coagulation and hemostasis that accompany liver disease are complex, and while patients with this disease have traditionally been perceived as having a bleeding diathesis, it is now understood that in stable patients hemostasis is “re-balanced.” Hepatic surgery, and particularly liver transplantation, can be associated with large fluid shifts, massive bleeding, and coagulopathy, as well as postoperative thrombosis. Point-of-care tests (POCTs) of coagulation facilitate goal-directed treatments and hemostatic monitoring in dynamic environments where the coagulation status can alter rapidly and often unpredictably. POCTs reflect more accurately the re-balanced hemostatic system than do conventional coagulation tests (CCTs). Viscoelastic POCT-guided transfusion algorithms permit a reduction in blood product administration and are a key component of patient blood management programs. Moreover, viscoelastic POCTs are better able to identify patients with hypercoagulability than CCTs. With thrombosis increasingly recognized to be a problem in patients with liver disease, POCTs hold promise for both individualized bleeding and thrombosis management.

scholarly journals Point-of-care testing as the future of pre-hospital emergency medicine: an overview

2021 ◽  
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Cost Effective ◽  
Point Of Care Testing ◽  
Hospital Emergency ◽  
Management Guidelines ◽  
Inspection Errors ◽  
Advantages And Disadvantages ◽  
Point Of Care Tests ◽  
Total Compliance

Point-of-care testing (POCT) plays an increasingly important role in pre-emergency medicine by ensuring that patient’s continuum of care is commenced before arrival at health facilities. Given the benefits of POCT during the COVID-19 pandemic, this commentary described the advantages and disadvantages of POCT, and its current practices in pre-hospital emergency medicine. Point-of-care tests are easy to operate, cost-effective, and yield quick and accurate response, but are posed with challenges such as safety errors, poor adherence to quality control standards, and inspection errors. To optimize the benefits of POCT in pre-emergency medicine, it is required that regular trainings are conducted for POCT operators, and total compliance to POCT handling and management guidelines should be considered by each POCT operator.

scholarly journals Evaluation of Serological SARS-CoV-2 Lateral Flow Assays for Rapid Point of Care Testing

2020 ◽  
Author(s):  
Steven E Conklin ◽  
Kathryn Martin ◽  
Yukari C Manabe ◽  
Haley A Schmidt ◽  
Morgan Keruly ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Symptom Onset ◽  
Point Of Care ◽  
Negative Control ◽  
Lateral Flow ◽  
Point Of Care Testing ◽  
Specific Antibodies ◽  
Testing Performance ◽  
Lateral Flow Assays ◽  
Point Of Care Tests

Background. Rapid point-of-care tests (POCTs) for SARS-CoV-2-specific antibodies vary in performance. A critical need exists to perform head-to-head comparison of these assays. Methods. Performance of fifteen different lateral flow POCTs for the detection of SARS-CoV-2-specific antibodies was performed on a well characterized set of 100 samples. Of these, 40 samples from known SARS-CoV-2-infected, convalescent individuals (average of 45 days post symptom onset) were used to assess sensitivity. Sixty samples from the pre-pandemic era (negative control), that were known to have been infected with other respiratory viruses (rhinoviruses A, B, C and/or coronavirus 229E, HKU1, NL63 OC43) were used to assess specificity. The timing of seroconversion was assessed on five POCTs on a panel of 272 longitudinal samples from 47 patients of known time since symptom onset. Results. For the assays that were evaluated, the sensitivity and specificity for any reactive band ranged from 55%-97% and 78%-100%, respectively. When assessing the performance of the IgM and the IgG bands alone, sensitivity and specificity ranged from 0%-88% and 80%-100% for IgM and 25%-95% and 90%-100% for IgG. Longitudinal testing revealed that median time post symptom onset to a positive result was 7 days (IQR 5.4, 9.8) for IgM and 8.2 days (IQR 6.3 to 11.3). Conclusion. The testing performance varied widely among POCTs with most variation related to the sensitivity of the assays. The IgM band was most likely to misclassify pre-pandemic samples. The appearance of IgM and IgG bands occurred almost simultaneously.

scholarly journals Diagnostic Accuracy and User-Friendliness of 5 Point-of-Care D-Dimer Tests for the Exclusion of Deep Vein Thrombosis

2010 ◽  
Vol 56 (11) ◽  
pp. 1758-1766 ◽  
Author(s):  
Geert-Jan Geersing ◽  
Diane B Toll ◽  
Kristel JM Janssen ◽  
Ruud Oudega ◽  
Marloes JC Blikman ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Accuracy ◽  
Point Of Care ◽  
Reference Method ◽  
Roc Curves ◽  
Color Contrast ◽  
User Friendliness ◽  
Predictive Values ◽  
Point Of Care Tests ◽  
D Dimer

BACKGROUND Point-of-care D-dimer tests have recently been introduced to enable rapid exclusion of deep venous thrombosis (DVT) without the need to refer a patient for conventional laboratory-based D-dimer testing. Before implementation in practice, however, the diagnostic accuracy of each test should be validated. METHODS We analyzed data of 577 prospectively identified consecutive primary care patients suspected to have DVT, who underwent 5 point-of-care D-dimer tests—4 quantitative (Vidas®, Pathfast™, Cardiac®, and Triage®) and 1 qualitative (Clearview Simplify®)—and ultrasonography as the reference method. We evaluated the tests for the accuracy of their measurements and submitted a questionnaire to 20 users to assess the user-friendliness of each test. RESULTS All D-dimer tests showed negative predictive values higher than 98%. Sensitivity was high for all point-of-care tests, with a range of 0.91 (Clearview Simplify) to 0.99 (Vidas). Specificity varied between 0.39 (Pathfast) and 0.64 (Clearview Simplify). The quantitative point-of-care tests showed similar and high discriminative power for DVT, according to calculated areas under the ROC curves (range 0.88–0.89). The quantitative Vidas and Pathfast devices showed limited user-friendliness for primary care, owing to a laborious calibration process and long analyzer warm-up time compared to the Cardiac and Triage. For the qualitative Clearview Simplify assay, no analyzer or calibration was needed, but interpretation of a test result was sometimes difficult because of poor color contrast. CONCLUSIONS Point-of-care D-dimer assays show good and similar diagnostic accuracy. The quantitative Cardiac and Triage and the qualitative Clearview Simplify D-dimer seem most user-friendly for excluding DVT in the doctor's office.

scholarly journals Covid-19: The Rollercoaster of Fibrin(Ogen), D-Dimer, Von Willebrand Factor, P-Selectin and Their Interactions with Endothelial Cells, Platelets and Erythrocytes

2020 ◽  
Vol 21 (14) ◽  
pp. 5168 ◽  
Author(s):  
Corlia Grobler ◽  
Siphosethu C. Maphumulo ◽  
L. Mireille Grobbelaar ◽  
Jhade C. Bredenkamp ◽  
Gert J. Laubscher ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Von Willebrand Factor ◽  
Poor Prognosis ◽  
Point Of Care ◽  
Signalling Pathways ◽  
Platelet Dysfunction ◽  
Multiple Risk Factors ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
D Dimer

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), also known as coronavirus disease 2019 (COVID-19)-induced infection, is strongly associated with various coagulopathies that may result in either bleeding and thrombocytopenia or hypercoagulation and thrombosis. Thrombotic and bleeding or thrombotic pathologies are significant accompaniments to acute respiratory syndrome and lung complications in COVID-19. Thrombotic events and bleeding often occur in subjects with weak constitutions, multiple risk factors and comorbidities. Of particular interest are the various circulating inflammatory coagulation biomarkers involved directly in clotting, with specific focus on fibrin(ogen), D-dimer, P-selectin and von Willebrand Factor (VWF). Central to the activity of these biomarkers are their receptors and signalling pathways on endothelial cells, platelets and erythrocytes. In this review, we discuss vascular implications of COVID-19 and relate this to circulating biomarker, endothelial, erythrocyte and platelet dysfunction. During the progression of the disease, these markers may either be within healthy levels, upregulated or eventually depleted. Most significant is that patients need to be treated early in the disease progression, when high levels of VWF, P-selectin and fibrinogen are present, with normal or slightly increased levels of D-dimer (however, D-dimer levels will rapidly increase as the disease progresses). Progression to VWF and fibrinogen depletion with high D-dimer levels and even higher P-selectin levels, followed by the cytokine storm, will be indicative of a poor prognosis. We conclude by looking at point-of-care devices and methodologies in COVID-19 management and suggest that a personalized medicine approach should be considered in the treatment of patients.

scholarly journals Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing

Pathogens ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 189 ◽  
Author(s):  
Johan H. Melendez ◽  
Yu-Hsiang Hsieh ◽  
Mathilda Barnes ◽  
Justin Hardick ◽  
Elizabeth A. Gilliams ◽  
...  
Keyword(s):  
Point Of Care ◽  
Multivariate Regression Analysis ◽  
Point Of Care Testing ◽  
Gyrase A ◽  
Ciprofloxacin Resistance ◽  
Point Of Care Tests ◽  
Male Subjects ◽  
Sample Set ◽  
Targeted Approach ◽  
Hiv Negative

Background: Given the lack of new antimicrobials to treat Neisseria gonorrhoeae (NG) infections, reusing previously recommended antimicrobials has been proposed as a strategy to control the spread of multi-drug-resistant NG. We assessed ciprofloxacin susceptibility in a large sample set of NG isolates and identified correlates associated with ciprofloxacin-resistant NG infections. Methods: NG isolates collected in Baltimore, Maryland between 2014 and 2016 were evaluated by Gyrase A (gyrA) PCR and E-test for susceptibility to ciprofloxacin. Clinical characteristics and demographics were evaluated by multivariate regression analysis to identify correlates of ciprofloxacin-resistant NG infections. Results: 510 NG isolates from predominately African American (96.5%), heterosexual (85.7%), and HIV-negative (92.5%) male subjects were included in the study. The overall percentage of isolates with mutant gyrA sequences, indicative of ciprofloxacin resistance, was 32.4%, and significantly increased from 24.7% in 2014 to 45.2% in 2016 (p < 0.001). Participants older than 35 years of age were 2.35 times more likely to have a gyrA mutant NG infection than younger participants (p < 0.001). Race, sexual orientation, symptomology, or co-infection the HIV or syphilis were not associated with a particular NG gyrA genotype. Conclusions: Resistance to ciprofloxacin in Baltimore is lower than other regions and indicates that in this environment, use of ciprofloxacin may be appropriate for targeted treatment provided utilization of enhanced surveillance tools. The targeted use of ciprofloxacin may be more beneficial for individuals under 35 years of age. Point-of-care tests for NG diagnosis and susceptibility testing are urgently needed to identify individuals who can be treated with this targeted approach.

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