Interference of Blood Cell Lysis on Routine Coagulation Testing

2006 ◽  
Vol 130 (2) ◽  
pp. 181-184 ◽  
Author(s):  
Giuseppe Lippi ◽  
Martina Montagnana ◽  
Gian Luca Salvagno ◽  
Gian Cesare Guidi
Keyword(s):  
Blood Cell ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Cell Lysis ◽  
Activated Partial Thromboplastin Time ◽  
Analytical Quality ◽  
Coagulation Assays ◽  
Coagulation Testing ◽  
Quality Specifications ◽  
Routine Coagulation

Abstract Context.—Preanalytical factors influencing the reliability of laboratory testing are commonplace. It is traditionally accepted that hemolytic samples are unsuitable for coagulation assays because of the release of hemoglobin, intracellular components, and thromboplastic substances from damaged blood cells. Objective.—To evaluate the influence of blood cell lysis on routine coagulation testing. Design.—Twelve aliquots prepared by serial dilutions of homologous lysated samples collected from 10 different subjects, and displaying a final percentage of lysis ranging from 0% to 9.1%, were tested for prothrombin time, activated partial thromboplastin time, fibrinogen, and dimerized plasmin fragment D. Lysis was achieved by subjecting citrated whole blood to a freeze-thaw cycle. Outcome Measures.—Interference from blood cell lysis on routine coagulation testing. Results.—Statistically significant increases in prothrombin time and dimerized plasmin fragment D were observed in samples containing final lysate concentrations of 0.5% and 2.7% respectively, whereas significant decreases were observed in activated partial thromboplastin time and fibrinogen in samples containing a final lysate concentration of 0.9%. The current analytical quality specifications for desirable bias are ±2.0% for prothrombin time, ±2.3% for activated partial thromboplastin time, and ±4.8% for fibrinogen. Percent variations from the baseline values exceeding the current analytical quality specifications for desirable bias were achieved for lysate concentrations of 0.9% (prothrombin time and activated partial thromboplastin time) and 1.8% (fibrinogen), corresponding to average free plasma hemoglobin concentrations of 1.7 and 3.4 g/L, respectively. Conclusion.—Our results confirm that, although slightly hemolyzed specimens might still be analyzable, a moderate blood cell lysis, as low as 0.9%, influences the reliability of routine coagulation testing. Because the interference in coagulation assays has a wide interindividual bias, we do not recommend lysis correction and we suggest that the most appropriate corrective measure should be free hemoglobin quantification and sample recollection.

Properties of Optical Data from Activated Partial Thromboplastin Time and Prothrombin Time Assays

1997 ◽  
Vol 78 (03) ◽  
pp. 1079-1087 ◽  
Author(s):  
Paul J Braun ◽  
Thomas B Givens ◽  
Andrew G Stead ◽  
Lisa R Beck ◽  
Sheila A Gooch ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Optical Transmittance ◽  
Coagulation Factors ◽  
Activated Partial Thromboplastin Time ◽  
Optical Data ◽  
Change Rate ◽  
Coagulation Assays ◽  
Signal Change ◽  
Coagulation Proteins

SummaryChanges in characteristics of optical transmittance data from coagulation assays were examined as a function of concentration of coagulation proteins or anticoagulants. Transmittance data were collected for activated partial thromboplastin time (APTT) and prothrombin time (PT) assays from: 1) plasmas prepared by mixing normal plasmas with deficient plasmas to give varying levels of coagulation proteins; 2) plasmas containing added heparin; and 3) 200 specimen plasmas that were also assayed for fibrinogen, coagulation factors, and other components. Optical profiles were characterized using a set of parameters describing onset and completion of coagulation, magnitude of signal change, rate of coagulation and other properties. Results indicated that parameters other than those typically reported for APTT and PT are associated with individual deficiencies, but that diagnosis of specimen status on the basis of optical data is complex. These results suggest possibilities for expanded interpretation of PT/APTT optical data for clinical or research applications.

scholarly journals Influence of dabigatran and rivaroxaban on routine coagulation assays

2015 ◽  
Vol 113 (01) ◽  
pp. 154-164 ◽  
Author(s):  
Els Bailleul ◽  
Bernard Chatelain ◽  
Anne Demulder ◽  
Katrien Devreese ◽  
Jonathan Douxfils ◽  
...  
Keyword(s):  
External Quality Assessment ◽  
Nationwide Survey ◽  
Activated Partial Thromboplastin Time ◽  
Dependent Manner ◽  
Activity Assay ◽  
External Quality ◽  
External Quality Assessment Scheme ◽  
Coagulation Assays ◽  
Coagulation Testing ◽  
Routine Coagulation

SummaryThe Belgian national External Quality Assessment Scheme performed a nationwide survey using lyophilised plasma samples spiked with dabigatran or rivaroxaban to demonstrate to the Belgian clinical laboratories how these drugs affect their routine coagulation assays prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and antithrombin. Virtually all Belgian laboratories performing routine coagulation testing (189/192) participated in the survey. Both, dabigatran and rivaroxaban significantly prolonged the PT and aPTT in a concentration- and reagent-dependent manner. PT reagents were more influenced by rivaroxaban than by dabigatran and aPTT reagents more influenced by dabigatran than by rivaroxaban. Among PT reagents, Neoplastin R® was the most sensitive to rivaroxaban and Innovin ® and Thromborel S® the least sensitive. Converting PT results to INR only increased the variability between reagents. Among aPTT reagents, Actin FSL® was the least sensitive to dabigatran while the other aPTT reagents showed slightly higher sensitivities. The presence of dabigatran led to falsely reduced fibrinogen concentrations when measured with a low thrombin concentration reagent. The presence of dabigatran caused an overestimation of the antithrombin level when measured with a thrombin-based activity assay and the presence of rivaroxaban an overestimation of the antithrombin level when measured with a FXa-based assay. Instrument-related differences were found for all tested parameters. In conclusion, this paper provides detailed information on the effect of dabigatran and rivaroxaban on routine coagulation assays as performed with a large number of reagent/instrument combinations.

scholarly journals APTT (Activated Partial Thromboplastin Time) dan (Prothrombin Time) pada Penderita Diabetes Melitus Tipe 2 di RSUD dr. Doris Sylvanus Palangkaraya

2020 ◽  
Vol 2 (2) ◽  
pp. 125-129
Author(s):  
Rinny Ardina ◽  
Fera Sartika ◽  
Lidya Prihatini Nainggolan
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
Coagulation System ◽  
Hemostasis System ◽  
Diabetes Mellitus Management ◽  
Routine Coagulation

Patients with type 2 diabetes mellitus (T2DM) have a high risk of atherothrombotic events. Hyperglycemia and other metabolic disorders in T2DM are associated with abnormalities of hemostasis system and thrombosis that contribute to cardiovascular disease. Routine laboratory tests to examine the hemostasis system are Activated Partial Thromboplastin Time (APTT) and Prothrombin Time (PT). This study aimed to describe the abnormalities of APTT and PT in patients with T2DM in RSUD dr. Doris Sylvanus Palangkaraya. Twenty subjects with T2DM in RSUD dr. Doris Sylvanus Palangkaraya were obtained using purposive sampling techniques and blood samples were examined with a COATX Biosystem coagulation using photocolorimetric method. This study found that was 70% APTT are shortened, 5% APTT are prolonged and 25% APTT were normal. While the PT results were 25% PT are shortened and 75% APTT were normal. Abnormalities of APTT and PT in T2DM patients in RSUD dr. Doris Sylvanus Palangkaraya showed an abnormality of the coagulation system so as to allow a tendency for bleeding and cardiovascular disease in T2DM patients. Routine coagulation test should be continued to help better diabetes mellitus management in order to prevent micro or macrovascular complications.

Optimization of Heparinization in Clinical Double Filtration Plasmapheresis

1989 ◽  
Vol 12 (8) ◽  
pp. 544-548 ◽  
Author(s):  
S. Hosokawa ◽  
A. Oyamaguchi ◽  
O. Yoshida
Keyword(s):  
Body Weight ◽  
Blood Cell ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Bleeding Time ◽  
Activated Partial Thromboplastin Time ◽  
Plasma Fibrinogen ◽  
Double Filtration Plasmapheresis ◽  
Double Filtration ◽  
Plasma Heparin

Heparin has generally been used as an anticoagulant during plasmapheresis. In this study plasma heparin levels were studied in nine patients before double filtration plasmapheresis (DFPP), 30, 60 and 120 minutes after the start of DFPP and at the end of DFPP. Prothrombin time (PT), activated partial thromboplastin time (APTT), bleeding time (BT), plasma fibrinogen levels, FDP and general blood cell examination (CBC) were measured pre and post DFPP. Heparin levels in plasma were lower than 1 (IU/ml) under the dosage of heparin nearly 40 IU/kg/h of heparin administered during DFPP. APTT before DFPP (36.5 ± 8.2 sec) was nearly double the post-DFPP value (61.4 ± 12.2 sec). In two patients who were given 30 IU/kg/h of heparin during DFPP, clotting occurred in the DFPP circuit. In conclusion, the optimized dosage of heparin was 40 IU per kg of body weight per hour during DFPP.

scholarly journals Does Routine Repeat Testing of Critical Values Offer Any Advantage Over Single Testing?

2011 ◽  
Vol 135 (4) ◽  
pp. 440-444
Author(s):  
Adam D Toll ◽  
Jennifer M Liu ◽  
Gene Gulati ◽  
Eric M Behling ◽  
William D Kocher
Keyword(s):  
Blood Cell ◽  
Prothrombin Time ◽  
White Blood Cell ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
Blood Cell Count ◽  
Tolerance Limits ◽  
Repeat Testing ◽  
Absolute Value ◽  
Test Category

Abstract Context.—Before being communicated to the caregiver, critical laboratory values are verified by repeat testing to ensure their accuracy and to avoid reporting false or erroneous results. Objective.—To determine whether 2 testing runs offered any advantage over a single testing run in ensuring accuracy or in avoiding the reporting of false or erroneous results. Design.—Within the hematology laboratory, 5 tests were selected: hemoglobin level, white blood cell count, platelet count, prothrombin time, and activated partial thromboplastin time. A minimum of 500 consecutive critical laboratory test values were collected retrospectively for each test category. The absolute value and the percentage of change between the 2 testing runs for each critical value were calculated and averaged for each test category and then compared with our laboratory's preset, acceptable tolerance limits for reruns. Results.—The mean results obtained for the absolute value and the percentage of change between the testing runs were 0.08 g/dL (1.4%) for hemoglobin levels, 50 cells/µL (10.2%) for white blood cell counts, 1500 cells/µL (9.9%) for platelet counts, 0.7 seconds (1.4%) for prothrombin time, and 5.1 seconds (4.4%) for activated partial thromboplastin time (all within our laboratory's acceptable tolerance limits for reruns). The percentage of specimens with an absolute value or a mean percentage of change outside our laboratory's acceptable tolerance limits for reruns ranged between 0% and 2.2% among the test categories. No false or erroneous results were identified between the 2 testing runs in any category. Conclusions.—Routine, repeat testing of critical hemoglobin level, platelet count, white blood cell count, prothrombin time, and activated partial thromboplastin time results did not offer any advantage over a single run.

scholarly journals Falsely prolonged activated partial thromboplastin time – a pre- and post-analytical issue

2018 ◽  
Vol 29 (1) ◽  
pp. 157-161
Author(s):  
Charlotte Gils ◽  
Pernille Just Vinholt ◽  
Mads Nybo
Keyword(s):  
Gastrointestinal Bleeding ◽  
Partial Thromboplastin Time ◽  
Coagulation Factors ◽  
Activated Partial Thromboplastin Time ◽  
Coagulation Testing ◽  
Prolonged Aptt ◽  
Viii And Ix ◽  
Analytical Issue ◽  
Analytical Phase ◽  
Routine Coagulation

This case highlights two common pre-analytical problems identified in routine coagulation testing of activated partial thromboplastin time (aPTT), which were overlooked because of a concurrent flag code indicating no coagulation and the result was replaced by asterisks. It concerns a boy with gastrointestinal bleeding and prolonged aPTT > 300 seconds, which raised the suspicion of haemophilia. When all other coagulation parameters (including specific coagulation factors VIII and IX) turned out to be normal, aPTT was re-measured using another analysis principle, which revealed a normal aPTT. The primary aPTT result turned out to be aborted due to concurrent haemolysis and lipaemia, but was erroneously interpreted as prolonged coagulation. The lesson is awareness of the possibility of numerous flag codes on the same sample overruling each other, and awareness on the responsibility in the post-analytical phase that must be carried by increased educational focus and by the manufacturers.

EFFECTS OF NICKEL CHLORIDE ON INDICES OF HEMOCOAGULATION AND LIPID PEROXIDATION IN RATS

2019 ◽  
pp. 83-90
Author(s):  
Э.М. Гаглоева ◽  
В.Б. Брин ◽  
С.В. Скупневский ◽  
Н.В. Боциева ◽  
Т.В. Молдован
Keyword(s):  
Lipid Peroxidation ◽  
Antioxidant Enzymes ◽  
Platelet Aggregation ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Nickel Chloride ◽  
Activated Partial Thromboplastin Time ◽  
Fibrinogen Concentration ◽  
Thrombin Time ◽  
Hemostasis System

Цель исследования - изучить состояние системы гемостаза при хронической интоксикации хлоридом никеля, исследовать взаимосвязь показателей гемокоагуляции с процессами липопероксидации у крыс в эксперименте. Методика. Опыты проводили на крысах-самцах Вистар (n=50, 230-250 г). Раствор NiCl2 (5 мг/кг) вводили внутрижелудочно ежедневно в течение 2 нед, 1 и 2 мес. По завершении эксперимента исследовали состояние тромбоцитарного и коагуляционного звеньев гемостаза, антикоагулянтную и фибринолитическую активность крови, а также определяли активность процессов перекисного окисления липидов и антиоксидантных ферментов. Результаты. Установлено, что через 2 нед и 1 мес интоксикации у крыс отмечались гиперкоагуляционные изменения показателей свертывающей системы крови: повышение агрегационной активности тромбоцитов, увеличение концентрации фибриногена, снижение активированного частичного тромбопластинового времени (АЧТВ) и протромбинового времени. В этот период регистрировалось увеличение антитромбиновой и фибринолитической активности крови. Через 2 мес наблюдалось подавление активности клеточного звена гемостаза - тромбоцитопения, ослабление степени АДФ-индуцируемой агрегации тромбоцитов. Выявлялась тенденция к уменьшению концентрации фибриногена. На фоне снижения АЧТВ и тромбинового времени отмечалось увеличение протромбинового времени. В то же время регистрировалось угнетение противосвертывающего звена системы гемостаза (снижалась активность антитромбина III), наблюдалось истощение резервных возможностей фибринолитического звена (замедление фXIIа-зависимого эуглобулинового лизиса) и увеличение содержания растворимых фибрин мономерных комплексов, что свидетельствует о наличии тромбинемии. Через 2 нед, один и два месяца интоксикации у животных выявлялись корреляционные связи между основными показателями системы гемостаза и активностью процессов перекисного окисления липидов и антиоксидантных ферментов. Заключение. Полученные данные подтверждают наличие взаимосвязи активности процессов липопероксидации и системы гемостаза, в том числе при хронической никелевой интоксикации. Результаты исследования позволяют рекомендовать применение антиоксидантов для разработки способов коррекции гемостатических сдвигов при воздействии на организм тяжелых металлов. The aim. To study the state of the hemostasis system in chronic nickel intoxication and to investigate the relationship between hemocoagulation indices and lipoperoxidation processes in rats. Methods. Experiments were carried out on male Wistar rats (n=50, 230-250 g). A solution of nickel chloride (5 mg/kg) was administered daily intragastrically for two weeks, one and two months. At the end of the experiments, indices of platelet and coagulation hemostasis systems, anticoagulant and fibrinolytic activity of blood plasma, and activities of lipid peroxidation and antioxidant enzymes were studied. Results. Hypercoagulative changes in indices of the coagulation system were observed in rats after two weeks and one month of intoxication, including increased platelet aggregation and fibrinogen concentration and shortened activated partial thromboplastin time and prothrombin time. During the same period, increased antithrombin and fibrinolytic activities were observed. The depressed activity of the cellular component of hemostasis evident as thrombocytopenia and impaired ADP-induced platelet aggregation was detected after two months of intoxication. A tendency to decrease in fibrinogen concentration was observed. The shortened activated partial thromboplastin time and thrombin time were associated with prolonged prothrombin time. At the same time, inhibition of the anticoagulant component of hemostasis (decreased antithrombin III activity), exhaustion of the fibrinolysis system reserve (delayed fXIIa-dependent euglobulin lysis), and a significant increase in soluble fibrin monomeric complexes indicative of thrombinemia were observed. After two weeks, one and two months of nickel intoxication, a correlation was found between the major indices of the hemostasis system and the activities of lipid peroxidation and antioxidant enzymes. Conclusion. The study confirmed a relationship between the lipid peroxidation activity and the hemostasis system, specifically in chronic nickel intoxication. This result allows to recommend the use of antioxidants in developing methods for correction of hemostatic induced affected by heavy metals.

Antihemostatic Effect of Hsien-Ho-T'sao (Agrimonia pilosa)

1984 ◽  
Vol 12 (01n04) ◽  
pp. 116-123 ◽  
Author(s):  
Jih-Pyang Wang ◽  
Mei-Feng Hsu ◽  
Che-Ming Teng
Keyword(s):  
Prothrombin Time ◽  
Blood Coagulation ◽  
Partial Thromboplastin Time ◽  
Bleeding Time ◽  
Fibrinogen Level ◽  
Platelet Rich Plasma ◽  
Water Extract ◽  
Activated Partial Thromboplastin Time ◽  
Thrombin Time

Bleeding time in rats was markedly prolonged after the adminstration of the water extract of Hsien-Ho-T'sao. This antihemostatic effect was more marked in the group of i.p. injection of the drug than in the group of p.o. administration for 2 to 7 consecutive days. Blood coagulation studies showed that plasma prothrombin time, activated partial thromboplastin time and stypven time were prolonged, while thrombin time adnd fibrinogen level were not changed. The thromboelastographic recording showed that reation time was prolonged and maximal elasticity of clot was decreased. In addition, ADP- and collagen- induced aggregations of platelet-rich plasma was suppressed. In conclusion, the prolongation of the bleeding time might be due to both anticoagulant and antiplatelet action of the drug.

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