The Dependence of the International Sensitivity Index on the Coagulometer Used to Perform the Prothrombin Time

1990 ◽  
Vol 63 (03) ◽  
pp. 424-429 ◽  
Author(s):  
M J Ray ◽  
I R Smith
Keyword(s):  
Prothrombin Time ◽  
Reference Method ◽  
Calibration Procedure ◽  
World Health ◽  
Sensitivity Index ◽  
Optical Instruments ◽  
Different Types ◽  
Reference Preparation ◽  
Health Organization ◽  
International Sensitivity Index

SummaryThis study was designed to detect any effect that different types of coagulation instrument may have on the International Sensitivity Index (ISI) of a thromboplastin.Manufacturers of commercial thromboplastins now calibrate their reagents against the World Health Organization international reference preparation to assign them an IST. This enables the prothrombin time (PT) estimated with that reagent to be expressed as an International Normalised Ratio (INR).One batch of Thromborel S was calibrated against the Australasian Reference Thromboplastin (ART). The Thromborel S was used on three photo-optical instruments, the Automated Coagulation Laboratory (ACL) (Instrumentation Laboratory), the Cobas Fibro (Roche), and the Coag-a-Pet (General Diagnostics). PTs using ART were performed manually using the reference method.The ISIs calibrated in our laboratory when the ACL and Cobas Fibro were used were not significantly different at the 95% level, being 1.102 ± 0.018 and 1.134 ± 0.022 respectively. The ISI with the Coag-a-Pet of 1.223 ± 0.023 was significantly different to that of the ACL and the Cobas Fibro at the 95% level.The flowcharts for a computer program to perform the necessary calculations are provided. The program allows for the entry and editing of data from the calibration procedure, and provides a mean normal PT and normal range, the ISI and 95% confidence limits of the calibration, and a chart for the conversion of the test PTs to INRs.The authors have made available an IBM compatible program for the calibration of thromboplastins.

The Effect of Some Instruments for Prothrombin Time Testing on the International Sensitivity Index (ISI) of Two Rabbit Tissue Thromboplastin Reagents

1989 ◽  
Vol 62 (03) ◽  
pp. 868-874 ◽  
Author(s):  
Marina Poggio ◽  
Antonius M H P van den Besselaar ◽  
Edo A van der Velde ◽  
Rogier M Bertina
Keyword(s):  
Prothrombin Time ◽  
Oral Anticoagulants ◽  
International Normalized Ratio ◽  
World Health ◽  
Sensitivity Index ◽  
Optical Instruments ◽  
Rabbit Tissue ◽  
Reference Preparation ◽  
Health Organization ◽  
International Sensitivity Index

SummaryTwo commercial rabbit tissue thromboplastins were calibrated against the International Reference Preparation for rabbit thromboplastin (coded RBT/79) by one laboratory using the manual technique, a semi-automatic electro-mechanical coagulometer and three different automatic photo-optical instruments. The calibration of the two reagents was performed in three and two different exercises, respectively, and showed good reproducibility of the procedure. The purpose of calibration is providing a formula for the assessment of the International Normalized Ratio (INR) for patients receiving oral anticoagulants. The World Health Organization (WHO) model for thromboplastin calibration leads to the equation INR = RISI, in which R is the prothrombin time ratio and ISI the International Sensitivity Index of the calibrated thromboplastin/instrument system. This equation was adequate for one reagent, but not for the other when it was used in combination with the four instruments. At therapeutic intensities of anticoagulation, the deviation from the WHO-model observed for the second reagent was clinically insignificant. The WHO model was fully adequate when the second reagent was used with the manual technique. For both thromboplastins, there were statistically significant differences in ISI between the four instruments. The largest difference-amounting to approximately 10%-was observed between two photo-optical instruments. The order of instruments with increasing ISI was the same for the two reagents. It is recommended that thromboplastin manufacturers specify the instruments used for calibration of their reagent.

Multicenter Evaluation of Lyophilized and Deep-frozen Plasmas for Assignment of the International Normalized Ratio

1999 ◽  
Vol 82 (11) ◽  
pp. 1451-1455 ◽  
Author(s):  
L. L. Houbouyan-Reveillard ◽  
M. F. Aillaud ◽  
K. W. E. Denson ◽  
C. Droullé ◽  
M. Johnston ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
External Quality Assessment ◽  
Calibration Procedure ◽  
International Normalized Ratio ◽  
Sensitivity Index ◽  
Local Calibration ◽  
External Quality ◽  
Different Types ◽  
Time Systems ◽  
International Sensitivity Index

SummaryThe interlaboratory variation of the International Normalized Ratio (INR) in various external quality assessment schemes is still relatively high. This is partly caused by inaccuracy of manufacturers’ stated International Sensitivity Index (ISI) and/or local instrumentation effects. The interlaboratory variation and accuracy of INR determinations may be improved by a local calibration procedure based on lyophilized plasmas with assigned INRs. The purpose of the present study was to determine INR values for different types of lyophilized plasmas to be used for local calibration. A total of 13 lyophilized plasmas (one normal, six from coumarin-treated patients, six artificially depleted) were analyzed by 10 laboratories, each using five calibrated prothrombin time (PT) systems. INRs were calculated for each plasma using each laboratory’s specific ISI and mean normal prothrombin time values. In the same way, five deep-frozen pooled plasmas from coumarin-treated patients were analyzed. There were significant INR differences for the lyophilized plasmas between the prothrombin time systems. The differences were relatively small for the deep-frozen coumarin plasmas (CV 2.6-3.3%) and three lyophilized coumarin plasmas from one manufacturer (CV 3.7-4.8%). Important INR differences were observed for three lyophilized coumarin plasmas from another manufacturer (CV 9.5-14.1%) and several artificially depleted plasmas (CV 5.3-12.8%). The citrate concentrations in the artificially depleted plasmas were lower than those in the normal and coumarin plasmas. These differences should be considered in the selection and certification of plasmas as calibrants for local calibration of PT systems. The lyophilized plasmas’ INR values obtained in the present study will be used for a field study of local PT calibration to assess their efficacy.

Calibration of Reference Thromboplastins and Standardisation of the Prothrombin Time Ratio

1983 ◽  
Vol 49 (03) ◽  
pp. 238-244 ◽  
Author(s):  
T B L Kirkwood
Keyword(s):  
Prothrombin Time ◽  
Oral Anticoagulants ◽  
Collaborative Study ◽  
World Health ◽  
Expert Committee ◽  
Calibration Model ◽  
Biological Standardization ◽  
Reference Preparation ◽  
Health Organization ◽  
Practical Implications

SummaryThromboplastins vary in their sensitivity to the haemostatic defect induced by oral anticoagulants. To provide a means of standardising prothrombin time tests, the World Health Organization adopted in 1977 a scheme for calibrating thromboplastins in terms of an International Reference Preparation. Unfortunately, the model on which this scheme was based does not always hold. A revised calibration model has therefore been developed and this has been tested in a recent collaborative study. The revised model, which retains fundamentally the same principle for standardising prothrombin time tests, has proved suitable for calibrating thromboplastins of different species and types and, moreover, has certain statistical advantages over its predecessor. In September 1982, the WHO Expert Committee on Biological Standardization adopted the revised model. This paper explains the nature and rationale of this change and considers its practical implications.

Reliability and Clinical Impact of the Normalization of the Prothrombin Times in Oral Anticoagulant Control

1985 ◽  
Vol 53 (01) ◽  
pp. 148-154 ◽  
Author(s):  
E A Loeliger ◽  
A M H P van den Besselaar ◽  
S M Lewis
Keyword(s):  
Oral Anticoagulant ◽  
International Normalized Ratio ◽  
World Health ◽  
Patient Specific ◽  
Sensitivity Index ◽  
Common Denominator ◽  
Reference Preparation ◽  
The Common ◽  
Health Organization ◽  
Low Sensitivity

SummaryIn 1983, the World Health Organization (WHO) published recommendations for normalization, in oral anticoagulant control, of the prothrombin time (PT). The common denominator is the International Sensitivity Index (ISI) of a thromboplastin, obtained by means of thromboplastin calibration. The common scale is that of the International Normalized Ratio (INR). The INR is the PT ratio Patient PT/normal PT which would have been found normal PT with the WHO primary international reference preparation (IRP) 67/40. The reliability of the INR depends on the extent of calibration precision, patient-specific influences, as well as interlaboratory variation in the PT determination. Under well-controlled conditions the overall coefficient of variation (CV) of the INR is 11-13.5%, if thromboplastins of ISI ≃ 1 are used. For so-called low-sensitivity thromboplastins (ISI ≃ 2-2.5), the overall variation is larger due to a large between-laboratory variation of the measured PT-ratiosThe user of thromboplastin will be provided with a chart or graph enabling him to convert the conventional terms used for expressing PTs into INRs. For quality assurance, and to prepare his own calibration chart if necessary, he should check normalization by means of control plasmas to which INRs have been assigned.There is sufficient clinical evidence to express optimal therapeutic ranges in terms of INR. Manufacturers should revise and adapt their inserts where necessary in order to conform to these requirements.

The Calibration of the Second Primary International Reference Preparation for Thromboplastin (Thromboplastin, Human, Plain, Coded BCT/253)

1984 ◽  
Vol 52 (03) ◽  
pp. 336-342 ◽  
Author(s):  
Jean M Thomson ◽  
J A Tomenson ◽  
L Poller
Keyword(s):  
Statistical Analysis ◽  
Prothrombin Time ◽  
International System ◽  
Second Primary ◽  
Sensitivity Index ◽  
Calibration Model ◽  
International Reference ◽  
Reference Preparation ◽  
Time Test ◽  
International Sensitivity Index

SummaryAn international collaborative exercise has been undertaken to calibrate a replacement for the first WHO primary international reference preparation (IRP) for thromboplastin. The replacement preparation is a lyophilised batch of British Comparative Thromboplastin (BCT/253, human plain) for use in the Quick prothrombin time test. Seventeen centres participated. The experimental design, calibration model and statistical analysis were based on the recommended WHO procedure. As a result of this calibration exercise an International Sensitivity Index (ISI) of 1.1 has been assigned to the preparation by WHO and it has been officially recognised as the second primary IRP for thromboplastin.The calibration of BCT/253 is an essential link in a new hierarchical structure for the standardisation of the prothrombin time. The aim is to provide a uniform international system of reporting prothrombin time results using International Normalised Ratios (INR) derived from the ISI of individual thromboplastins.

APPLICATIONS OF INTERNATIONAL RECOMMENDATIONS ON THE STANDARDIZATION OF PROTHROMBIN TIME IN ORAL ANTICOAGULANT CONTROL

1987 ◽  
Author(s):  
F Dati ◽  
U Becker ◽  
N Heimburger
Keyword(s):  
Prothrombin Time ◽  
Oral Anticoagulant ◽  
Calibration Procedure ◽  
Sensitivity Index ◽  
Chromogenic Substrate ◽  
Clotting Factors ◽  
Reference Preparation ◽  
Broad Variation ◽  
The Mean

The determination of prothrombin time (PT) in oral anticoagulant control is affected by a broad variation. The responsible factors are: type of thromboplastin incorporated in the PT reagents, procedure for use, clotting factors or heparin inhibitors added to the reagent, method of expression of PT results. Recently, joint recommendations have been issued by International Committees (ICSH/ICTH) taking into account the system of International Thromboplastins and the statistical model for thromboplastin calibration established by WHO. The aim is a standardization of commercial thromboplastins for PT tests in order to allow the use of the international scale of oral anticoagulant intensity (INR: Intern. Normalized Ratio). Following such recommendations we have standardized two new PT tests, based on coagulometric and photometric methods which rely on the same sensitive human placental thromboplastin. The coagulometric PT test (Thromborel®S) is performed with conventional coagulometers. The photometric PT assay (Chromoquick®) uses a new chromogenic substrate specific for thrombin. This method is based on the measurement of the time necessary to reach a fixed increase of absorbance (0.1 A) using a special microprocessor-controlled photometer.The two PT reagents were calibrated either directly against a reference preparation (BCT) or via an intermediate standard thromboplastin in two multicentric studies. The calibration procedure by the WHO method allows to assign the corresponding ISI (Intern. Sensitivity Index) to the PT reagent used and the transformation of the obtained prothrombin ratio (PR) into INR by the equation INR = PRISI. The calculated ISI values were 1.08 for the coagulometric PT reagent (n = 330) and 1.07 for the photometric reagent (n = 365), respectively.The reproducibility of the ISI value for the new human placental thromboplastin for 64 different batches amounts to 3.6 %, the mean ISI value being 1.12.Comparison with the reference thromboplastins in PR values gave a good correlation.A) Coagul. PT assay (x): r = 0.964; y = 1.03x ™ 0.1;B) Photom. PT assay (x): r = 0.940; y = 1.02x ™ 0.1.

A Simple Nomogram for the Derivation of International Normalised Ratios for the Standardisation of Prothrombin Times

1988 ◽  
Vol 60 (01) ◽  
pp. 018-020 ◽  
Author(s):  
L Poller
Keyword(s):  
Prothrombin Time ◽  
Sensitivity Index ◽  
General Application ◽  
International Reference ◽  
International Scale ◽  
Alternative Formula ◽  
Local Ratio ◽  
Reference Preparation ◽  
International Sensitivity Index ◽  
Scientific Calculator

SummaryThe WHO international scale of reporting prothrombin time results is based on the calibration of local and commercial thromboplastin reagents used in the test against an international reference preparation to derive an International Sensitivity Index (ISI) for each batch of local reagent. This quantifies an individual reagent’s responsiveness to the coumarin induced defect.Once the ISI has been assigned, the derivation of International Normalised Ratios (INR) for reporting results depends on the use of a scientific calculator by which the local ratio is raised to the power of the ISI of the local reagent or use of an alternative formula and logarithms.A system for interpretation of INR, without the need for calculations, is presented for the known range of thromboplastins between 1.0 and 3.0 ISI in nomogram form. This chart may facilitate the general application of the INR system.

scholarly journals European Concerted Action on Anticoagulation. Use of Plasma Samples to Derive International Sensitivity Index for Whole-Blood Prothrombin Time Monitors

2002 ◽  
Vol 48 (2) ◽  
pp. 255-260 ◽  
Author(s):  
Leon Poller ◽  
Michelle Keown ◽  
Nikhil Chauhan ◽  
Anton MHP van den Besselaar ◽  
Joyce Meeuwisse-Braun ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Whole Blood ◽  
Point Of Care ◽  
Chloride Concentration ◽  
Calibration Procedure ◽  
Sensitivity Index ◽  
Plasma Samples ◽  
Concerted Action ◽  
The Mean ◽  
International Sensitivity Index

Abstract Background: To simplify International Sensitivity Index (ISI) calibration, the possibility of substituting fresh plasma for fresh whole-blood samples with point-of-care testing (POCT) whole-blood monitors was investigated in a three-center study of three different POCT systems. Methods: A modified full WHO calibration procedure based on 20 healthy controls and 60 coumarin-treated patients was performed on three monitoring systems with whole-blood and plasma samples against plasma tested using the European Concerted Action on Anticoagulation (ECAA) rabbit reference plain thromboplastin and the manual prothrombin time (PT) method. Results: With one of the three systems, the mean ISI was 1.51 for whole blood and 1.49 for plasma; with the second system, the mean ISI was 1.08 for both whole blood and plasma. With the third system, however, the difference between the mean ISI for whole blood and that for plasma was greater (1.15 and 1.01, respectively). Overall, the precision of the calibrations was less than with traditional manual plasma PT testing. Conclusions: Provided that an appropriate calcium chloride concentration is used, the plasma PT results can be used for accurate ISI calibration of two of these three whole-blood POCT systems. Precision criteria need to be modified for POCT monitors.

Recombinant Tissue Factor as Substitute for Conventional Thromboplastin in the Prothrombin Time Test

1992 ◽  
Vol 67 (01) ◽  
pp. 042-045 ◽  
Author(s):  
Armando Tripodi ◽  
Arnaldo Arbini ◽  
Veena Chantarangkul ◽  
Pier Mannuccio Mannucci
Keyword(s):  
Prothrombin Time ◽  
Tissue Factor ◽  
Oral Anticoagulant Therapy ◽  
Clotting Factor ◽  
Rabbit Brain ◽  
Sensitivity Index ◽  
Clotting Factors ◽  
Wide Range ◽  
Reference Preparation ◽  
Time Test

SummaryRelipidated recombinant tissue factor (r-TF) has been assessed in comparison with conventional rabbit brain thromboplastin (Manchester Reagent) for its suitability for measurement of prothrombin time (PT). The International Sensitivity Index (ISI) of r-TF calibrated against the International Reference Preparation BCT/253 (human plain) was found to be 0.96 and 1.12 with instrumental and manual techniques. Our study of plasmas from patients with congenital deficiencies of clotting factors covering a wide range of severity demonstrates that r-TF is able to detect even minor deficiencies of factors involved in the extrinsic and common coagulation pathways. Patients with liver diseases were correctly diagnosed with a prevalence of abnormal results comparable for both reagents. Between-assay reproducibility expressed as coefficient of variation was 2.3 % and 3.9 % at normal and abnormal PT levels.In conclusion, our evaluation shows that relipidated r-TF possesses the necessary requisites of sensitivity, diagnostic accuracy and reproducibility which make it a suitable candidate for PT determination both for monitoring oral anticoagulant therapy and diagnosing congenital and acquired clotting factor deficiencies. Moreover, being a highly defined reagent it may constitute a step forward in the standardization of PT testing.

Effect of Concentration of Trisodium Citrate Anticoagulant on Calculation of the International Normalised Ratio and the International Sensitivity Index of Thromboplastin

1994 ◽  
Vol 72 (01) ◽  
pp. 084-088 ◽  
Author(s):  
E M Duncan ◽  
C R Casey ◽  
B M Duncan ◽  
J V Lloyd
Keyword(s):  
Reference Material ◽  
Oral Anticoagulants ◽  
Reference Method ◽  
Trisodium Citrate ◽  
Sensitivity Index ◽  
Blood Samples ◽  
Orthogonal Regression ◽  
Significant Difference ◽  
International Normalised Ratio ◽  
International Sensitivity Index

SummaryThe aim of this study was to determine whether the concentration of trisodium citrate used to anticoagulate blood has an effect on the INR of the sample and the ISI of the thromboplastin. Five thromboplastins including and Australian reference material were used to measure the prothrombin time of normal and patient samples collected into two concentrations of trisodium citrate - 109 mM and 129 mM. There was no effect of citrate concentration on the INRs determined with the reference material. However for the other four thromboplastins there was a significant difference between INRs for the two citrate groups. The prothrombin times of the samples collected into 129 mM were longer than those collected into 109 mM. This difference was only slight in normal plasma but more marked in patients receiving oral anticoagulants, causing the INRs for patient plasmas collected into 129 mM citrate to be higher then the corresponding samples collected into 109 mM citrate.From orthogonal regression of log prothrombin times by the reference method against each thromboplastin, we found that the ISI for each thromboplastin was approximately 10% lower when determined with samples collected into 129 mM citrate than with samples collected into 109 mM. These results suggest that the concentration of trisodium citrate used for collection of blood samples can affect the calculation of the INR and the calibration of the ISI of thromboplastin. This was found both for commercial thromboplastins prepared by tissue extraction and for a recombinant tissue factor.

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