scholarly journals Effect of storage time on prothrombin time and activated partial thromboplastin time: study at a tertiary care center in Kashmir valley

2018 ◽  
Vol 4 (7) ◽  
pp. 182
Author(s):  
Sajad Geelani ◽  
Gul Sajad Wani ◽  
Subuh Parvez Khan ◽  
Syed Mudasir Qadri ◽  
Javid Rasool ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Storage Temperature ◽  
Care Center ◽  
Tertiary Care ◽  
Activated Partial Thromboplastin Time ◽  
Time Interval ◽  
Tertiary Care Center ◽  
Kashmir Valley ◽  
Coagulation Tests

<p class="abstract"><strong>Background:</strong> Prothrombin time (PT) and activated partial thromboplastin time (APTT) are tests of haemostasis commonly employed in the evaluation of coagulopathies. Storage temperature and time interval between sample collection and testing can have a significant effect on results of coagulation tests. The aims of the study were investigate whether storage temperature and time influence the results of routine coagulation tests and whether any changes caused by delayed analysis results in a clinically relevant difference, as well as to establish our own acceptable storage temperature and time guidelines.</p><p class="abstract"><strong>Methods:</strong> This study was conducted at Department of Clinical Haematology, in a tertiary care center in Kashmir valley. This study included 50 cases. Individuals with chronic liver diseases or cardiovascular disorders, subjects on anticoagulant therapy were excluded. 25 samples were observed at room temperature (RT) and 25 samples at 2-8°C. PT and APTT was measured at 0, 2, 4, 8, 16 and 24 hours both at RT and 2-8°C. Findings at 0 hr were compared to findings at 2,4, 8,16 and 24 hours in both the groups.  </p><p class="abstract"><strong>Results:</strong> In case of PT, reliable results were obtained up to 24 hrs either kept at RT or at 2 to 8°C and for APTT reliable results were obtained up to 4 hours kept at RT or at 2 to 8°C as there was no significant change during this period.</p><p class="abstract"><strong>Conclusions:</strong> Coagulation test should be performed as soon as possible with PT being performed before 24 hours and APTT before 4 hours of collection of sample irrespective of whether the sample has been preserved at RT or in refrigerator.</p>

Can RoTEM®analysis be applied for haemostatic monitoring in paediatric congenital heart surgery?

2011 ◽  
Vol 21 (6) ◽  
pp. 684-691 ◽  
Author(s):  
Jo Bønding Andreasen ◽  
Anne-Mette Hvas ◽  
Kirsten Christiansen ◽  
Hanne Berg Ravn
Keyword(s):  
Cardiac Surgery ◽  
Platelet Count ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Activated Partial Thromboplastin Time ◽  
Clotting Time ◽  
Coagulation Tests

AbstractBackgroundSuccessful management of bleeding disorders after congenital heart surgery requires detection of specific coagulation disturbances. Whole-blood rotation thromboelastometry (RoTEM®) provides continuous qualitative haemostatic profiles, and the technique has shown promising results in adult cardiac surgery.SettingTo compare the performance of RoTEM®with that of conventional coagulation tests in children, we conducted a descriptive study in children undergoing congenital cardiac surgery. For that purpose, 60 children were enrolled and had blood samples taken before, immediately after, and 1 day after surgery. Conventional coagulation tests included: activated partial thromboplastin time, prothrombin time, fibrinogen, fibrin D-dimer, thrombin clotting time, factor XIII, and platelet count.ResultsPost-surgical haemostatic impairment was present to some degree in all children, as seen by pronounced changes in activated partial thromboplastin time, prothrombin time, thrombin clotting time, and platelet count, as well as RoTEM®analysis. RoTEM®showed marked changes in clotting time – prolonged by 7–18% – clot formation time – prolonged by 46–71% – maximum clot firmness – reduced by 10–19%, and maximum velocity – reduced by 29–39%. Comparison of the two techniques showed that conventional coagulation tests and RoTEM®performed equally well with regard to negative predictive values for excessive post-operative drain production – more than 20 millilitres per kilogram per 24 hours after surgery – with an area under the curve of approximately 0.65.ConclusionRoTEM®can detect haemostatic impairments in children undergoing cardiac surgery and the method should be considered as a supplement in the perioperative care of the children where targeted transfusion therapy is necessary to avoid volume overload.

scholarly journals Correlation of prothrombin time and activated partial thromboplastin time with serum immunoglobulins in newly diagnosed patients with plasma cell dyscrasias: an experience from tertiary care centre

2018 ◽  
Vol 5 (2) ◽  
pp. 419
Author(s):  
Filza Shafi ◽  
Sajad Geelani ◽  
Javid Rasool ◽  
Subuh Parvez Khan ◽  
Syed Mudasir Qadri ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Prothrombin Time ◽  
Plasma Cell ◽  
Light Chain ◽  
Partial Thromboplastin Time ◽  
Tertiary Care ◽  
Activated Partial Thromboplastin Time ◽  
P Value ◽  
Newly Diagnosed ◽  
The Mean

Background: Plasma cell dyscrasia (PCD) is the term used to describe the disorders characterized by neoplastic proliferation of plasma cells with the abnormal production of immunoglobulins (Ig). Patients with multiple myeloma frequently have abnormal coagulation tests. Aim of the present study were to correlate prothrombin time (PT) and Activated Partial Thromboplastin time (aPTT) with Ig concentrations in patients with newly diagnosed with PCD and to compare PT and aPTT values in untreated and treated patients diagnosed with PCDMethods: This study was conducted in the department of clinical hematology of SKIMS, a tertiary care hospital in northern India from 2015 to 2016. Patients diagnosed with PCD were advised for coagulogram (PT, aPTT) as a base line investigation. A total of 72 patients were included in the study.Results: 37% of multiple myeloma cases (newly diagnosed) and 22% of light chain disease patients presented with prolonged PT whereas none of the patients in treated cases of PCD had prolonged PT. The mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values. In IgA myeloma, the mean immunoglobulin concentration was 3643 mg/dL with a mean PT and aPTT values of 18.8s and 36.6 (p value: 0.006). The mean free light chain concentration in kappa (k) light chain myeloma was 1727 mg/L with a mean PT value of 20.5 s, mean aPTT value of 37.4 s (p-value: 0.026).Conclusions: Patients with newly diagnosed myeloma presented with prolonged PT as compared to the treated cases. Also, mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values.

scholarly journals Evaluation of pancytopenia on bone marrow aspiration- study at a tertiary care center in Kashmir valley, India

2018 ◽  
Vol 5 (4) ◽  
pp. 946
Author(s):  
Subuh Parvez Khan ◽  
Sajad Geelani ◽  
Fiza Parvez Khan ◽  
Noorjahan Ali ◽  
Shazieya Akhter ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Megaloblastic Anemia ◽  
Care Center ◽  
Tertiary Care ◽  
Disease Process ◽  
Bone Marrow Aspiration ◽  
Deficiency Anemia ◽  
Total Leucocyte Count ◽  
Tertiary Care Center ◽  
Kashmir Valley

Background: Pancytopenia refers to combination of anaemia, leukopenia and thrombocytopenia. It may be a manifestation of a wide variety of disorders, which primarily or secondarily affect the bone marrow. However, aetiology of pancytopenia varies from one geographical region to another. Bone marrow aspiration plays an important role in identifying the cause of pancytopenia. This study was carried to identify the causes of pancytopenia and to find out the bone marrow morphology in cases of pancytopenia.Methods: This study was conducted in the department of haematology in a tertiary care center in Kashmir valley for a period of 3 years. Inclusion criteria: cases with hemoglobin less than 10 gm/dl, total leucocyte count of less than 4000/mm3 and platelet count less than 100,000/mm3 were included in the study.Exclusion criteria: Patients receiving chemotherapy/radiotherapy were excluded from the study. Bone marrow aspiration (BMA) was performed from posterior iliac crest of the patients. Bone marrow aspiration smears were stained with Leishman stain for microscopy.Results: A total of 334 cases were studied during a period of 3 years. Age of patients ranged from 1 year to 85 years with mean of 43.59 years.180 cases were male, and 154 cases were female with male:female ratio of 1.2 :1. The commonest cause of pancytopenia was megaloblastic anemia seen in 103 cases (30.8%) followed by dual deficiency anemia seen in 69 cases (20.7%).37 cases (11%) were of acute leukaemia. Aplastic anemia was seen in 35 cases(10.5%). Other causes of pancytopenia were myelodysplastic syndrome, multiple myeloma, iron deficiency anemia and hypersplenism.Conclusions: Bone marrow aspiration in patients of pancytopenia helps in the identification of the underlying cause in most of the cases. BMA is helpful for understanding the disease process; and in planning further investigations and management of cytopenia patients. 

Interferences in coagulation tests – evaluation of the 570-nm method on the Dade Behring BCS analyser

2005 ◽  
Vol 43 (2) ◽  
Author(s):  
Ralf Junker ◽  
Margit Käse ◽  
Helmut Schulte ◽  
Ruth Bäumer ◽  
Claus Langer ◽  
...  
Keyword(s):  
Optical Properties ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
Plasma Samples ◽  
Comparison Methods ◽  
Coagulation Tests ◽  
Elisa Technique ◽  
Roche Diagnostics ◽  
D Dimer

AbstractThe Dade Behring BCS is a coagulation analyser with optical reaction detection (standard 405nm). The present study was conducted to evaluate measurement at 570nm for analyses in interfering plasma samples. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and D-dimer in normal (n=50), lipaemic (n=60), icteric (n=113), and haemolytic (n=58) samples were measured at 405 and 570nm. As they are unaffected by the optical properties of the sample, the mechanical STAcompact analyser (Roche Diagnostics) and an ELISA technique were defined as the “comparison” methods. The percentage of valid PT results using the 570-nm method varied from 54% (lipaemic samples) to 97% (haemolytic samples). Valid aPTT measurements were found in 67% (lipaemic samples) up to 93% (icteric samples) of samples. Fibrinogen measurement revealed valid results in 58% (lipaemic samples) to 100% (haemolytic samples) of samples. The number of valid D-dimer results varied from 28% (lipaemic material) up to 100% (haemolytic material). Significant inter-method differences were found: aPTT in lipaemic (BCS 405 vs. 570nm) and icteric samples (STAcompact vs. BCS 405 and 570nm); fibrinogen in lipaemic (BCS 405 vs. 570nm), icteric (BCS 405 vs. 570nm; STAcompact vs. BCS 570nm) and haemolytic samples (STAcompact vs. BCS 405 and 570nm). Differences between the BCS 570-nm and the STAcompact methods were in most cases low and less pronounced than between the BCS 570- and 405-nm methods, making the BCS 570-nm method an alternative to measurement at 405nm. Limitations have to be taken into account regarding lipaemic plasma.

scholarly journals Rotational Thromboelastometry (ROTEM) for Assessing the Anticoagulant Effect of Rivaroxaban: A Single-Centre Cohort Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5018-5018
Author(s):  
Thomas Andrew Fox ◽  
Andrew Wood ◽  
Anne Riddell ◽  
Pratima Chowdary ◽  
Anja B Drebes
Keyword(s):  
Creatinine Clearance ◽  
Prothrombin Time ◽  
Board Of Directors ◽  
Partial Thromboplastin Time ◽  
Research Funding ◽  
Activated Partial Thromboplastin Time ◽  
Anticoagulant Effect ◽  
Advisory Committees ◽  
Rotational Thromboelastometry ◽  
Coagulation Tests

Abstract Background: The direct, oral, factor Xa inhibitor, rivaroxaban, is increasingly used to provide effective anticoagulation in atrial fibrillation and venous thromboembolism. Whilst rivaroxaban does not require therapeutic monitoring there are situations when it is useful to estimate the anticoagulant effect of the drug such as during bleeding episodes or before emergency surgery. It has previously been shown that conventional coagulation tests can provide a crude estimation of anticoagulant effect of rivaroxaban if a sensitive reagent is used. In this study we explore whether rotational thromboelastometry (ROTEM) would provide a more accurate measure of rivaroxaban effect. Methods: Peak serum rivaroxaban levels were taken 3-5 hours post-dose in 121 consecutive patients established on a once-daily anticoagulation regime with rivaroxaban. Conventional coagulation tests, prothrombin time (PT) and activated partial thromboplastin time (APTT) were performed alongside rivaroxaban level and rotational thromboelastometry (ROTEM, TEM Ltd, Germany) on native citrated whole blood. PT and APTT used HemosIL Recombiplastin 2G and SynthasIL reagents (Instrumentation Laboratory (IL), USA) respectively. Rivaroxaban levels were measured using HemosIL Liquid Anti Xa kit (IL, USA) with rivaroxaban calibrators from Hyphen Biomed, France on an ACL TOP 700 coagulometer (IL, USA)). Demographic and biochemical data was collected on each patient. Results were analysed to determine if ROTEM can be used to assess the anticoagulant effect of rivaroxaban in real-world patients with different demographics and organ function. Results: Significant positive correlation was seen between rivaroxaban level and prothrombin time (PT) (R=0.796, Pearson's correlation coefficient). Weaker correlation was observed between rivaroxaban level and activated partial thromboplastin time (APTT) (R=0.425). There was modest positive correlation between the clotting time (CT) parameter using ROTEM and rivaroxaban level (R=0.328). However, when grouped into low (<200ng/ml), intermediate (200-300ng/ml) and high (>300ng/ml) rivaroxaban levels, the CTs show no meaningful association and therefore cannot be used as a surrogate marker to predict anticoagulant effect. There is no significant difference between the mean rivaroxaban levels for patients on 15mg rivaroxaban, those on 20mg with creatinine clearance <60ml/min and those on 20mg with creatinine clearance >60ml/min (Analysis of Variance, n=121, F=2.009, P=0.159), suggesting that with dose adjustment a similar anticoagulant effect is achieved in patients with different renal function. Conclusion: Our data suggests that the correlation between rivaroxaban levels and ROTEM CT parameter is not sufficiently strong to reliably predict the anticoagulant effect of rivaroxaban and does not confer any advantage over conventional clotting tests. Disclosures Chowdary: Baxalta: Honoraria, Membership on an entity's Board of Directors or advisory committees; Biogen: Honoraria, Membership on an entity's Board of Directors or advisory committees; CSL Behring: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sobi: Honoraria; Bayer: Honoraria; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Drebes:Bayer: Consultancy; Bayer: Other: Educational Grant.

scholarly journals Pleuropulmonary Tuberculosis Following Chemotherapy for Lung Cancer at a Tertiary Care Center in India

2013 ◽  
Vol 47 (4) ◽  
pp. 177-180
Author(s):  
Ashim Das ◽  
Digambar Behera ◽  
Navneet Singh ◽  
Ashutosh N Aggarwal
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Cancer Chemotherapy ◽  
Care Center ◽  
Tertiary Care ◽  
Time Interval ◽  
Tertiary Care Center ◽  
Lung Cancer Patients ◽  
Response To Chemotherapy

ABSTRACT Background Chemotherapy is a risk factor for occurrence of infections. Tuberculosis is a common infection in high prevalence countries. Data on incidence of tuberculosis following lung cancer chemotherapy is limited. The current study was conducted to assess the spectrum and clinical profile of pleuro-pulmonary tuberculosis following lung cancer chemotherapy at a tertiary care institute in North India. Methods Retrospective data analysis of newly diagnosed lung cancer patients undergoing chemotherapy over a three-and-half year period. Diagnosis of tuberculosis was made by presence of suggestive clinicoradiological features (fever, cough, pleuritic chest pain, new parenchymal infiltrates or new onset pleural effusion on chest imaging) along with demonstration of acid fast bacilli (AFB) in sputum/pleural fluid/bronchoalveolar lavage (BAL) fluid and/or growth of Mycobacterium tuberculosis on culture. For biopsy/cytology specimens, tuberculosis was diagnosed by demonstration of granulomatous inflammation with AFB. Results Overall six (0.9%) of 662 lung cancer patients developed tuberculosis [four pulmonary (PTB) and two pleural (TB-PE)]. Occurrence of PTB/TB-PE and of smear-positive PTB after lung cancer chemotherapy was at a rate of 2.59 per 1000 patients/year and 1.73 per 1000 patients/year respectively, compared with national incidences of 1.85 per 1000 population/year and 0.75 per 1000 population/year respectively. Four patients had objective response to chemotherapy. Diagnosis of PTB/TB-PE was established by sputum microscopy, BAL fluid microscopy and pleural biopsy in two patients each. All patients developed tuberculosis on same side as primary tumor. All patients received standard four-drug anti-tubercular therapy (ATT). Median time interval between diagnosis of lung cancer and that of tuberculosis was 144 (56-317) days while time interval between last chemotherapy cycle and diagnosis of tuberculosis was 55 (36-182) days. Median overall survival and survival after diagnosis of tuberculosis were 312 (141-504) days and 174 (41-199) days respectively. Conclusion Occurrence of PTB/TB-PE after lung cancer chemotherapy is higher than the corresponding incidence of tuberculosis observed in the general Indian population. Overall survival of these patients is similar to lung cancer patients in general if clinical suspicion of tuberculosis is actively pursued and ATT initiated promptly following diagnosis of tuberculosis. How to cite this article Singh N, Madan K, Aggarwal AN, Gupta N, Das A, Behera D. Pleuropulmonary Tuberculosis Following Chemotherapy for Lung Cancer at a Tertiary Care Center in India. J Postgrad Med Edu Res 2013;47(4):177-180.

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