scholarly journals Unexpected abnormal coagulation test results in a 2-year-old child

2020 ◽  
Vol 30 (1) ◽  
pp. 158-163
Author(s):  
Patricija Banković Radovanović ◽  
Tanja Živković Mikulčić ◽  
Jasmina Simović Medica
Keyword(s):  
Reference Intervals ◽  
Blood Collection ◽  
Coagulation Disorder ◽  
Thrombin Time ◽  
Test Results ◽  
Coagulation Test ◽  
Laboratory Staff ◽  
Blood Withdrawal ◽  
Tympanostomy Tubes ◽  
K Deficiency

Rejection of the sample with repeated blood withdrawal is always an unwanted consequence of sample nonconformity and preanalytical errors, especially in the most vulnerable population – children. Here is presented a case with unexpected abnormal coagulation test results in a 2-yearold child with no previously documented coagulation disorder. Child is planned for tympanostomy tubes removal under the anaesthesia driven procedure, and preoperative coagulation tests revealed prolonged prothrombin time, activated partial thromboplastin time and thrombin time, with fibrinogen and antithrombin within reference intervals. From the anamnestic and clinical data, congenital coagulation disorder was excluded, and with further investigation, sample mismatch, clot presence and accidental ingestion of oral anticoagulant, heparin contamination or vitamin K deficiency were excluded too. Due to suspected EDTA carryover during blood sampling another sample was taken the same day and all tests were performed again. The results for all tests were within reference intervals confirming EDTA effect on falsely prolongation of the coagulation times in the first sample. This case can serve as alert to avoid unnecessary loss in terms of blood withdrawal repetitions and discomfort of the patients and their relatives, tests repeating, prolonging medical procedures, and probably delaying diagnosis or proper medical treatment. It is the responsibility of the laboratory specialists to continuously educate laboratory staff and other phlebotomists on the correct blood collection as well as on its importance for the patient’s safety.

Autovalidation and automation of the postanalytical phase of routine hematology and coagulation analyses in a university hospital laboratory

2018 ◽  
Vol 56 (3) ◽  
pp. 454-462 ◽  
Author(s):  
Ana Mlinaric ◽  
Marija Milos ◽  
Désirée Coen Herak ◽  
Mirjana Fucek ◽  
Vladimira Rimac ◽  
...  
Keyword(s):  
Complete Blood Count ◽  
International Normalized Ratio ◽  
Turnaround Time ◽  
University Hospital ◽  
Thrombin Time ◽  
Test Results ◽  
Coagulation Test ◽  
Specific Patient ◽  
Before And After ◽  
Routine Coagulation

AbstractBackground:The need to satisfy high-throughput demands for laboratory tests continues to be a challenge. Therefore, we aimed to automate postanalytical phase in hematology and coagulation laboratory by autovalidation of complete blood count (CBC) and routine coagulation test results (prothrombin time [PT], international normalized ratio [PT-INR], activated partial thromboplastin time [APTT], fibrinogen, antithrombin activity [AT] and thrombin time [TT]). Work efficacy and turnaround time (TAT) before and after implementation of automated solutions will be compared.Methods:Ordering panels tailored to specific patient populations were implemented. Rerun and reflex testing rules were set in the respective analyzers’ software (Coulter DxH Connectivity 1601, Beckman Coulter, FL, USA; AutoAssistant, Siemens Healthcare Diagnostics, Germany), and sample status information was transferred into the laboratory information system. To evaluate if the automation improved TAT and efficacy, data from manually verified results in September and October of 2015 were compared with the corresponding period in 2016 when autovalidation was implemented.Results:Autovalidation rates of 63% for CBC and 65% for routine coagulation test results were achieved. At the TAT of 120 min, the percentage of reported results increased substantially for all analyzed tests, being above 90% for CBC, PT, PT-INR and fibrinogen and 89% for APTT. This output was achieved with three laboratory technicians less compared with the period when the postanalytical phase was not automated.Conclusions:Automation allowed optimized laboratory workflow for specific patient populations, thereby ensuring standardized results reporting. Autovalidation of test results proved to be an efficient tool for improvement of laboratory work efficacy and TAT.

scholarly journals Croatian Society of Medical Biochemistry and Laboratory Medicine: National recommendations for blood collection, processing, performance and reporting of results for coagulation screening assays prothrombin time, activated partial thromboplastin time

2019 ◽  
Vol 29 (2) ◽  
pp. 262-283 ◽  
Author(s):  
Ana Bronić ◽  
Desiree Coen Herak ◽  
Sandra Margetić ◽  
Marija Milić
Keyword(s):  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Wide Spectrum ◽  
Therapy Monitoring ◽  
Anticoagulation Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Blood Collection ◽  
Thrombin Time ◽  
Test Results ◽  
Diagnostic Laboratory

A modern diagnostic laboratory offers wide spectrum of coagulation assays utilized in the diagnosis and management of patients with haemostatic disorders, preoperative screening and anticoagulation therapy monitoring. The recent survey conducted among Croatian medical biochemistry and transfusion laboratories showed the existence of different practice policies in particular phases of laboratory process during coagulation testing and highlighted areas that need improvement. Lack of assay standardization together with non-harmonized test results between different measurement methods, can potentially lead to incorrect decisions in patient’s treatment. Consequently, patient safety could be compromised. Therefore, recommended procedures related to preanalytical, analytical and postanalytical phases of prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and D-dimer testing are provided in this review, aiming to help laboratories to generate accurate and reliable test results.

scholarly journals Clinical Evaluation of the Torq Zero Delay Centrifuge System for Decentralized Blood Collection and Stabilization

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1019
Author(s):  
Kyungjin Hong ◽  
Gabriella Iacovetti ◽  
Ali Rahimian ◽  
Sean Hong ◽  
Jon Epperson ◽  
...  
Keyword(s):  
Clinical Chemistry ◽  
Blood Collection ◽  
Test Results ◽  
Sample Collection ◽  
Rapid Separation ◽  
Cell Counts ◽  
Collection Device ◽  
Precision Study ◽  
Clinically Significant ◽  
Blood Specimens

Blood sample collection and rapid separation—critical preanalytical steps in clinical chemistry—can be challenging in decentralized collection settings. To address this gap, the Torq™ zero delay centrifuge system includes a lightweight, hand-portable centrifuge (ZDrive™) and a disc-shaped blood collection device (ZDisc™) enabling immediate sample centrifugation at the point of collection. Here, we report results from clinical validation studies comparing performance of the Torq System with a conventional plasma separation tube (PST). Blood specimens from 134 subjects were collected and processed across three independent sites to compare ZDisc and PST performance in the assessment of 14 analytes (K, Na, Cl, Ca, BUN, creatinine, AST, ALT, ALP, total bilirubin, albumin, total protein, cholesterol, and triglycerides). A 31-subject precision study was performed to evaluate reproducibility of plasma test results from ZDiscs, and plasma quality was assessed by measuring hemolysis and blood cells from 10 subject specimens. The ZDisc successfully collected and processed samples from 134 subjects. ZDisc results agreed with reference PSTs for all 14 analytes with mean % biases well below clinically significant levels. Results were reproducible across different operators and ZDisc production lots, and plasma blood cell counts and hemolysis levels fell well below clinical acceptance thresholds. ZDiscs produce plasma samples equivalent to reference PSTs. Results support the suitability of the Torq System for remotely collecting and processing blood samples in decentralized settings.

scholarly journals Effect of 1 mg/kg oral prednisolone on biochemical analytes in ten dogs: a cross-over study

2021 ◽  
Author(s):  
Helena Pettersson ◽  
Carl Ekstrand ◽  
Anna Hillström ◽  
Inger Lilliehöök
Keyword(s):  
Clinical Relevance ◽  
Control Period ◽  
Iron Concentration ◽  
Oral Prednisolone ◽  
Reference Intervals ◽  
Specific Reference ◽  
Test Results ◽  
Prednisolone Treatment ◽  
Anti Inflammatory ◽  
And Control

AbstractPrednisolone is used for treatment of inflammatory, allergic, neoplastic, and immune-mediated diseases in dogs. As a glucocorticoid, prednisolone has biochemical effects, which may interfere with the interpretation of biochemistry test results. The aim of this study is to investigate the effects of prednisolone treatment in an anti-inflammatory dose on common biochemical analytes in dogs and to evaluate the clinical relevance of the changes. Ten beagle dogs, enrolled in a cross-over study, were treated with oral prednisolone (1 mg/kg 24 h) for 10 days. Blood samples were collected at day 0, 1, 3, 6, 9, 10, 12, 16, and 20. Data was analyzed using a general linear model with time and treatment as fixed factors. Pairwise comparisons were done between prednisolone and control period for each dog and sampling. Significant results were further evaluated for clinical relevance using laboratory-specific reference intervals and reference change values (RCVs), when available. Statistically significant changes were observed for ALP activity and iron concentration, which increased to levels exceeding the RCV, and several results were outside reference intervals. Phosphate and bile acids increased significantly, while amylase, lipase, and cholesterol decreased significantly, but with mean/median results remaining within reference intervals. Anti-inflammatory prednisolone treatment did not induce significant changes in ALT, GLDH, GGT, cPLI, glucose, or calcium. Treatment with an anti-inflammatory dose of prednisolone induced changes in several analytes. Only the increases in ALP and iron were of such magnitude that they are expected to affect the clinical interpretation of test results.

Pediatric reference interval verification for endocrine and fertility hormone assays on the Abbott Alinity system

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mary Kathryn Bohn ◽  
Siobhan Wilson ◽  
Alexandra Hall ◽  
Khosrow Adeli
Keyword(s):  
Clinical Decision Making ◽  
De Novo ◽  
Reference Interval ◽  
Clinical Decision ◽  
Reference Intervals ◽  
Healthy Children ◽  
Confidence Limits ◽  
Test Results ◽  
Serum Samples ◽  
Abbott Architect

Abstract Objectives The Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) has developed an extensive database of reference intervals (RIs) for several biomarkers on various analytical systems. In this study, pediatric RIs were verified for key immunoassays on the Abbott Alinity system based on the analysis of healthy children samples and comparison to comprehensive RIs previously established for Abbott ARCHITECT assays. Methods Analytical performance of Alinity immunoassays was first assessed. Subsequently, 100 serum samples from healthy children recruited with informed consent were analyzed for 16 Alinity immunoassays. The percentage of test results falling within published CALIPER ARCHITECT reference and confidence limits was determined. If ≥ 90% of test results fell within the confidence limits, they were considered verified based on CLSI guidelines. If <90% of test results fell within the confidence limits, additional samples were analyzed and new Alinity RIs were established. Results Of the 16 immunoassays assessed, 13 met the criteria for verification with test results from ≥ 90% of healthy serum samples falling within the published ARCHITECT confidence limits. New CALIPER RIs were established for free thyroxine and prolactin on the Alinity system. Estradiol required special considerations in early life. Conclusions Our data demonstrate excellent concordance between ARCHITECT and Alinity immunoassays, as well as the robustness of previously established CALIPER RIs for most immunoassays, eliminating the need for de novo RI studies for most parameters. Availability of pediatric RIs for immunoassays on the Alinity system will assist clinical laboratories using this new platform and contribute to improved clinical decision-making.

Acquired Circulating Anticoagulants in Children With Acquired Immunodeficiency Syndrome

PEDIATRICS ◽  
1988 ◽  
Vol 82 (5) ◽  
pp. 763-765
Author(s):  
Edward R. Burns ◽  
Ben-Zion Krieger ◽  
Larry Bernstein ◽  
Arye Rubinstein
Keyword(s):  
Acquired Immunodeficiency Syndrome ◽  
Pediatric Patients ◽  
Opportunistic Infections ◽  
Laboratory Diagnosis ◽  
Activated Partial Thromboplastin Time ◽  
Test Results ◽  
Coagulation Test ◽  
Intrinsic Pathway ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

The mechanism underlying the prolonged activated partial thromboplastin time (APTT) seen in some pediatric patients with acquired immunodeficiency syndrome (AIDS) and opportunistic infections was studied. A circulating inhibitor of coagulation was demonstrated in three patients. The inhibitor appears to be an immunoglobulin that interferes with some of the phospolipid-dependent coagulation reactions of the intrinsic pathway. This "AIDS anticoagulant" does not predispose the patient to clinical bleeding despite its ability to cause a marked prolongation of the APTT. As such, careful laboratory diagnosis of the cause of abnormal coagulation test results is necessary for children with AIDS.

scholarly journals COVID-19 related challenges faced by Medical Laboratory Staff: A Review of Literature

2021 ◽  
Vol 12 (2) ◽  
pp. 232-237
Author(s):  
Jignesh Sharma ◽  
Richard D. Nair
Keyword(s):  
Human Resources ◽  
Laboratory Testing ◽  
English Language ◽  
Turnaround Time ◽  
Medical Laboratory ◽  
Test Results ◽  
Review Of Literature ◽  
Medical Laboratory Science ◽  
Laboratory Staff ◽  
Laboratory Science

Laboratory testing on the confirmation of COVID-19 results is an essential component and without the expertise of trained laboratory technicians this is not possible. The aim of this study was to review the impacts of COVID-19 on medical laboratory staff. The literature search was done using Medline, Embase, Scopus, and Proquest databases, and relevant keywords were applied to find studies which have been conducted in the field of Medical Laboratory Science specifically looking at the impacts on staff caused by the Covid-19 pandemic. All the studies pertaining to the topic published in 2020 and 2021 in English language were reviewed and the main themes were identified. The results showed that impacts of COVID-19 were felt by the staff, as they were pushed to their limits causing stress and burnout. Apart from this laboratory staff were faced with issues such as; shortage in terms of human resources, consumables, testing kits and reagents. This was an added factor to delays in testing and disruption to the testing Turnaround time (TATs) and also contributed to the stress and burnout of staff. Laboratory professionals and other health care staffs were pushed to the limits to ensure patient care was not affected and each patient was attended too without delay. Laboratory personnel’s were pushed to their limits to ensure that test results were given on time.

scholarly journals Anormal coagulation test results in the pediatric patient without the bleeding: A case report

2016 ◽  
Author(s):  
Fatma Demet İnce ◽  
Pınar Bilgi ◽  
Neşe Doğan ◽  
Elif Merve Arı ◽  
Lale Aldemir
Keyword(s):  
Case Report ◽  
Pediatric Patient ◽  
Test Results ◽  
Coagulation Test

scholarly journals Comparison of the Clauss and Prothrombin Time-Derived Fibrinogen Methods in Patients with Dysfibrinogenemia, and Verification of their Reference Interval

2021 ◽  
Vol 2 (1) ◽  
pp. 44-57
Author(s):  
Emmanuel Oluwabori Bajo
Keyword(s):  
Cost Effectiveness ◽  
Reference Interval ◽  
Reference Intervals ◽  
Coagulation Disorder ◽  
Clinical Group ◽  
Fibrinogen Concentration ◽  
Main Study ◽  
Medical Field ◽  
Significant Difference ◽  
Missed Diagnosis

Introduction: Dysfibrinogenemia is a coagulation disorder caused by abnormal fibrinogen functions, with ever-growing concern in medical field. Therefore, it is critical to establish and optimise effective methods, both in terms of efficient and accurate clinical diagnosis and cost effectiveness. Methods: Fibrinogen assays; PT-derived and Clauss quantification are such method. This study, compared fibrinogen concentrations determined by the Clauss and PT-derived methods in 80 patients (diseased clinical group) and in 20 and 120 healthy patients (pilot and main study respectively). Reference interval verification was done following the Clinical and Laboratory Standards Institute guidelines. Results: There was a significant difference between Clauss fibrinogen and PT-derived fibrinogen irrespective of sample clinical groups, although, the discrepancy between these two assays appeared to correlate. Normal patients (mean PT-Fib 4.50 vs Clauss 3.07g/l, p <0.0001), r = 0.7567. Liver/renal dysfunction (mean PT-Fib 2.20 vs Clauss 1.75g/l, p = 0.0003), r = 0.8622. Critically-ill (mean PT-Fib 2.7 vs Clauss 2.17g/l, p <0.0001), r = 0.9553 and OAC (mean PT-Fib 3.49 vs Clauss 2.49g/l, p = 0.0004), r = 0.8158. 70% of PT-derived and 95% of Clauss fibrinogen results were within the reference interval 1.5 – 4.5 g/L. Verification of the published reference interval failed as >10% of the PT-derived results were outside the reference interval. Conclusion: Performing both PT-derived and Clauss methods on all clotting screen requests will prevent missed diagnosis, although, it will provide extra cost of £10,825. Thus, it is necessary to determine fibrinogen reference intervals for both the PT-derived and Clauss methods. Until further studies verify a reference interval for PT-Fib at the IH, the Clauss assay is a preferable diagnostic tool when treating patients with low fibrinogen concentrations. The PT-derived may erroneously report patients’ plasma fibrinogen concentration as normal.

Evaluation of Processes, Outcomes, and Use of Midline Peripheral Catheters for the Purpose of Blood Collection

2020 ◽  
Vol 25 (4) ◽  
pp. 8-17
Author(s):  
Daleen Penoyer ◽  
Melody Bennett ◽  
Patricia I. Geddie ◽  
Alyssa Nugent ◽  
Tara Volkerson
Keyword(s):  
Dwell Time ◽  
Blood Sampling ◽  
Blood Collection ◽  
Blood Withdrawal

Highlights Results added knowledge on use of midline catheters (MCs) for blood sampling. Using MCs for blood withdrawal resulted in low rates of hemolysis (0.69%). Dwell time was longer in those who had blood drawn from their MC. Nurse practices for blood sampling from MCs varied and learned from other nurses.

Sign in / Sign up

Export Citation Format

Share Document