scholarly journals Use of an Automated Coagulation Analyzer to Perform Heparin Neutralization With Polybrene in Blood Samples for Routine Coagulation Testing: Practical, Rapid, and Inexpensive

2013 ◽  
Vol 137 (11) ◽  
pp. 1641-1647 ◽  
Author(s):  
Panutsaya Tientadakul ◽  
Chulalak Kongkan ◽  
Wimol Chinswangwatanakul
Keyword(s):  
Prothrombin Time ◽  
Blood Samples ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Clinically Significant ◽  
Aptt Reagent ◽  
Heparin Neutralization ◽  
Coagulation Analyzer ◽  
Suitable Sequence ◽  
Routine Coagulation

Context.—Heparin contamination in blood samples may cause false prolongation of activated partial thromboplastin time (aPTT) and prothrombin time results. Polybrene can neutralize heparin, but it affects coagulation by itself. Objectives.——To determine the optimal concentration of polybrene to neutralize heparin, to determine the suitable sequence of reagents for the neutralization method performed on the analyzer at the same time as prothrombin time and aPTT testing, and to detect the heparin contamination in blood samples for coagulation tests in our hospital using this method. Design.—Various concentrations of heparin were added to 10 normal and 76 abnormal plasma samples to study the efficacy of polybrene. Two programs of reagent sequencing for aPTT with polybrene performed on the analyzer were tested. Samples suspected of heparin contamination according to our criteria were selected for neutralization during a 3-month period. Results.——The optimal final concentration of polybrene was 25 μg/mL. Polybrene should be added after the aPTT reagent to minimize its interference effect. Even though results of prothrombin time and aPTT after neutralization did not equal those before the spike of heparin, the differences might not be clinically significant. Eighty-one of 4921 samples (1.6%) were selected for aPTT with the neutralization method, and the detection rate of heparin contamination was 84% (68 of 81), giving an overall incidence of 1.4% (68 of 4921). Conclusions.—This method is inexpensive and can be performed rapidly with prothrombin time and aPTT on the automated analyzer, which makes it easy to practice with no need for extra plasma volumes.

Heparin and citrate additive carryover during blood collection

2019 ◽  
Vol 57 (12) ◽  
pp. 1888-1896 ◽  
Author(s):  
Martin H. Keppel ◽  
Simon Auer ◽  
Giuseppe Lippi ◽  
Alexander von Meyer ◽  
Michael Cornes ◽  
...  
Keyword(s):  
Clinical Chemistry ◽  
Relative Volume ◽  
Ionized Calcium ◽  
Blood Collection ◽  
Thrombin Time ◽  
Blood Samples ◽  
Published Evidence ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Clinically Significant

Abstract Background Published evidence on the risk of additive carryover during phlebotomy remains elusive. We aimed to assess potential carryover of citrated and heparinized blood and the relative volume needed to bias clinical chemistry and coagulation tests. Methods We simulated standardized phlebotomies to quantify the risk of carryover of citrate and heparin additives in distilled water, using sodium and lithium as surrogates. We also investigated the effects of contamination of heparinized blood samples with increasing volumes of citrated blood and pure citrate on measurements of sodium, potassium, chloride, magnesium, total and ionized calcium and phosphate. Likewise, we studied the effects of contamination of citrated blood samples with increasing volumes of heparinized blood on heparin (anti-Xa) activity, lithium, activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time (TT). We interpreted these results based on measurement deviations beyond analytical, biological and clinical significance. Results Standardized phlebotomy simulations revealed no significant differences in concentration of surrogate markers. Clinically significant alterations were observed after contamination of heparinized blood samples with volumes of citrated blood beyond 5–50 μL for ionized calcium and beyond 100–1000 μL for sodium, chloride and total calcium. Investigations of pure citrate carryover revealed similar results at somewhat lower volumes. Heparinized blood carryover showed clinically significant interference of coagulation testing at volumes beyond 5–100 μL. Conclusions Our results suggest that during a standardized phlebotomy, heparin or citrate contamination is highly unlikely. However, smaller volumes are sufficient to severely alter test results when deviating from phlebotomy guidelines.

Effects of a Pneumatic Tube System on Routine and Novel Hematology and Coagulation Parameters in Healthy Volunteers

2007 ◽  
Vol 131 (2) ◽  
pp. 293-296
Author(s):  
Alexander Kratz ◽  
Raneem O. Salem ◽  
Elizabeth M. Van Cott
Keyword(s):  
Healthy Volunteers ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
Tube System ◽  
Blood Samples ◽  
Pneumatic Tube ◽  
The Mean ◽  
Clinically Significant ◽  
Pneumatic Tube System

Abstract Context.—Technologic advances affecting analyzers used in clinical laboratories have changed the methods used to obtain many laboratory measurements, and many novel parameters are now available. The effects of specimen transport through a pneumatic tube system on laboratory results obtained with such modern instruments are unclear. Objective.—To determine the effects of sample transport through a pneumatic tube system on routine and novel hematology and coagulation parameters obtained on state-of-the-art analyzers. Design.—Paired blood samples from 33 healthy volunteers were either hand delivered to the clinical laboratory or transported through a pneumatic tube system. Results.—No statistically significant differences were observed for routine complete blood cell count and white cell differential parameters or markers of platelet activation, such as the mean platelet component, or of red cell fragmentation. When 2 donors who reported aspirin intake were excluded from the analysis, there was a statistically, but not clinically, significant impact of transport through the pneumatic tube system on the mean platelet component. There were no statistically significant differences for prothrombin time, activated partial thromboplastin time, waveform slopes for prothrombin time or activated partial thromboplastin time, fibrinogen, or fibrin monomers. Conclusions.—Although further study regarding the mean platelet component may be required, transport through a pneumatic tube system has no clinically significant effect on hematology and coagulation results obtained with certain modern instruments in blood samples from healthy volunteers.

scholarly journals Characteristics of routine coagulationtesting and thromboelastometry in polytrauma patients at admission

2021 ◽  
Vol 63 (9) ◽  
pp. 1-5
Author(s):  
Thi Hang Tran ◽  
◽  
Thi Thu Hien Trinh ◽  
Van Chinh Nguyen ◽  
An Son Doan ◽  
...  
Keyword(s):  
University Hospital ◽  
Clot Lysis ◽  
Whole Blood Assay ◽  
Coagulation Parameters ◽  
Blood Assay ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Polytrauma Patients ◽  
Old Men ◽  
Routine Coagulation

Background: polytrauma is one of the emergency surgeries with a high mortality rate. One of the leading causes of death is coagulopathy that is not detected early and treated promptly. Thromboelastometry (ROTEM) is a whole blood assay that evaluates the viscoelastic properties during clot formation and clot lysis. This method can detect coagulopathy rapidly and accurately, thereby improving the management of bleeding after trauma. Objectives: describing and evaluating the correlation between ROTEM parameters and routine coagulation tests in polytrauma patients at admission. Method: 110 patients admitted to the Emergency Department, Viet Duc University Hospital from May 2021 to July 2021 were diagnosed with polytrauma. All patients underwent routine coagulation testing and ROTEM parameters at admission. Result: the average age of patients is 41.4±14.7 years old, men accounts for 77.3%, average ISS score is 24.5±6.3. The proportion of the polytrauma patients with coagulopathy by routine coagulation testing was 50.9%. A significant correlation was found between routine coagulation parameters and ROTEM: between APTT with CFT-INTEM (r=0.65; p<0.01); between PT and CFT-EXTEM (r=0.64; p<0.01); between platelet count and MCF-INTEM (r=0.56; p=0.00) and MCF-EXTEM (r=0.57; p=0.00); between fibrinogen level and MCF-INTEM (r=0.71; p=0.00), MCF-EXTEM (r=0.71; p=0.00), and MCF-FIBTEM (r=0.91; p=0.00). Conclusion: proportion of the polytrauma patients with coagulopathy by routine coagulation testing was 50.9%. A significant correlation was found between routine coagulation parameters and ROTEM

scholarly journals Some normal value of coagulation tests, proteins concentration tests, iron concentration and copper concentration tests of local house cats in Baghdad city

2012 ◽  
Vol 36 (0A) ◽  
pp. 86-91
Author(s):  
Saleem Amin Hasso
Keyword(s):  
Prothrombin Time ◽  
Protein Concentration ◽  
Copper Concentration ◽  
Iron Concentration ◽  
Fibrinogen Concentration ◽  
Clotting Time ◽  
Total Protein Concentration ◽  
Blood Samples ◽  
Male And Female ◽  
Coagulation Tests

Forty seven blood samples were collected from local house cats 25 male , 22 female , ranging in age from 1-15 year for both sexes for measuring the following parameters coagulation tests (total Platelets count, Clotting time, Prothrombin Time & Fibrinogen concentration ) and proteins concentration tests (Total protein concentration, Albumin , Globulin concentration ) and iron and copper concentration tests .the results as were follow (228.5 –1,537) X 109\L , (2-5)min , (6 - 15) sec , (0.5 -4) g\L , ( 61 - 83 ) g\L , (23.1 -38.2) g\L , (25.9-54.2) g\L , (5.21 – 45.56) μmol/L , (2.29 - 36.52) μmol/L) .the result showed significant differences at level (P<0.05) between the male and female of local house cats in total Platelets count and Prothrombin Time . Other studied parameters showed no significant differences at level (P<0.05) between the male and female in local house cats.

scholarly journals The effects of fructose diphosphate on routine coagulation tests in vitro

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Tongqing Chen ◽  
Duan Chen ◽  
Lu Chen ◽  
Zhengxu Chen ◽  
Baolong Wang ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Blood Coagulation ◽  
Detection System ◽  
Coagulation System ◽  
Thrombin Time ◽  
Aggregation Rate ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Routine Coagulation

AbstractTo evaluate the effects of fructose diphosphate (FDP) on routine coagulation tests in vitro, we added FDP into the mixed normal plasma to obtain the final concentration of 0, 1, 2, 3, 4, 5, 6, 10, 15, 20, 25, 30 and 35 mg/mL of drug. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (FBG) and thrombin time (TT) of samples were analyzed with blood coagulation analyzers from four different manufacturers(Sysmex, Stago, SEKISUI and Werfen) and their corresponding reagents, respectively. Before the experiment, we also observed whether there were significant differences in coagulation test results of different lots of reagents produced by each manufacturer. At the same time as the four routine clotting tests, the Sysmex blood coagulation analyzer and its proprietary analysis software were used to detect the change of maximum platelet aggregation rate in platelet-rich plasma after adding FDP (0, 1, 2, 3, 4, 5 and 6 mg/mL). The results of PT, aPTT and TT showed a FDP (0–35 mg/mL) concentration-dependent increase and a FBG concentration-dependent decrease. The degree of change (increase or decrease) varied depending on the assay system, with PT and aPTT being more affected by the Sysmex blood coagulation testing instrument reagent system and less affected by CEKISUI, TT less affected by CEKISUI and more affected by Stago, and FBG less affected by Stago and more affected by Sysmex. The results of PT, aPTT and TT were statistically positively correlated with their FDP concentrations, while FBG was negatively correlated. The correlation coefficients between FDP and the coagulation testing systems of Sysmex, Stago, Werfen and SEKISUI were 0.975, 0.988, 0.967, 0.986 for PT, and 0.993, 0.989, 0.990 and 0.962 for aPTT, 0.994, 0.960, 0.977 and 0.982 for TT, − 0.990, − 0.983, − 0.989 and − 0.954 for FBG, respectively. Different concentrations of FDP (0, 1, 2, 3, 4, 5 and 6 mg/mL) had different effects on the maximum aggregation rate of platelet induced by the agonists of adenosine diphosphate (ADP, 5 µmol/L), arachidonic acid (Ara, 1 mmol/L), collagen (Col, 2.5 µg/mL) and epinephrine (Epi,10 µmol/L), but the overall downward trend was consistent, that is, with the increase of FDP concentration, the platelet aggregation rate decreased significantly. Our experimental study demonstrated a possible effect of FDP on the assays of coagulation and Platelet aggregation, which may arise because the drug interferes with the coagulation and platelet aggregation detection system, or it may affect our in vivo coagulation system and Platelet aggregation function, the real mechanism of which remains to be further verified and studied.

The effects of transport by car on coagulation tests

2017 ◽  
Vol 55 (12) ◽  
Author(s):  
Merve Ergin ◽  
Serpil Erdogan ◽  
Onur Akturk ◽  
Ozcan Erel
Keyword(s):  
Clinical Decision ◽  
Control Group ◽  
Test Results ◽  
Mechanical Agitation ◽  
Blood Samples ◽  
Decision Level ◽  
Baseline Group ◽  
Coagulation Tests ◽  
The Mean ◽  
Clinically Significant

AbstractBackground:This research investigated the effects of the transport of blood samples between centers/laboratories by car on coagulation tests.Methods:Five tubes of blood samples were taken from 20 healthy volunteers. The samples consisted of a baseline (control) group, centrifuged and noncentrifuged transported samples; centrifuged and noncentrifuged untransported samples. The groups of centrifuged and noncentrifuged samples were transported by car for 2 h. The centrifuged and noncentrifuged untransported samples were incubated in the laboratory until the transported samples arrived. Prothrombin time (PT) and activated partial thromboplastin time (APTT) tests were conducted for all samples.Results:Significant differences between the baseline group and the centrifuged and noncentrifuged transported samples and the noncentrifuged untransported samples were found for APTT levels (p<0.05, for all). In addition, significant mean percentage differences in PT values were found between the baseline group and the noncentrifuged transported samples (p<0.001) and the noncentrifuged untransported samples (p=0.005). The mean level of PT in the noncentrifuged transported samples was outside the upper limit of the clinical decision level.Conclusions:Noncentrifuged transported samples showed clinically significant differences in PT test results that may have stemmed from mechanical agitation during transportation. Therefore, we recommend not transporting noncentrifuged specimens for PT testing by car.

scholarly journals Comparison of various principles of coagulation tests in handling hemolysed blood samples

2021 ◽  
Vol 7 (4) ◽  
pp. 188-193
Author(s):  
Dr. Vani Krishnamurthy ◽  
◽  
Rubiya Ahmad ◽  
Keyword(s):  
Prothrombin Time ◽  
Test Results ◽  
Coagulation Test ◽  
Predictive Values ◽  
Background Rejection ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
The Mean ◽  
Repeat Sampling ◽  
Lost Opportunity

Background: Rejection of hemolysed samples for coagulation test is the standard practice.However, when clinicians deal with extremely sick patients where repeat sampling is difficult toobtain, rejection of the sample is a lost opportunity for the lab physician to assist inpatient care.Proceeding with the test and providing a clinically helpful interpretation of the results will ensure theactive participation of the laboratory physician. Different principles of coagulation testing handle thehemolysed samples differently. It is essential to know the best principle to proceed with thehemolysed sample if need be. This study set out to estimate the predictive values of post-hemolyticsample coagulation test results with various coagulation test principles. Methods: This is aprospective experimental study where the non-hemolysed samples were processed for coagulationtests. Part of the sample was deliberately hemolysed, and the coagulation tests were repeated.Results: Two hundred and forty-eight samples were studied. A median of 11% hemolysis wasachieved experimentally. The mean difference in prothrombin time between pre and post hemolyticsamples with normal PT was 0.9 and with abnormal PT, it was 1.1 seconds. The same for APTT was4.9 and 1.1 seconds, respectively. The majority of the samples showed prolonged coagulation posthemolysis. Positive (PPV) and negative (NPV) predictive values for prothrombin time are 97.3 and73.4%, respectively. Similarly, PPV and NPV for APTT are 97.4 and 47.1%, respectively.Conclusions: Samples with normal values after hemolysis are more likely to be normal.

Monitoring Treatments with Unfractionated Heparin: CTAD Must Be Used Instead of Citrate as the Anticoagulant Solution When Using Partial-Draw Collection Tubes.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2091-2091
Author(s):  
Pierre A. Toulon ◽  
Lién Abecassis ◽  
Motalib Smahi ◽  
Catherine Ternisien
Keyword(s):  
Unfractionated Heparin ◽  
Platelet Activation ◽  
Conflicts Of Interest ◽  
Vitamin K Antagonists ◽  
Heparin Therapy ◽  
Factor V ◽  
Test Results ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Routine Coagulation

Abstract Abstract 2091 Poster Board II-68 Collecting small volumes of blood may be necessary, particularly in pediatrics, or in case of difficult or recurrent sampling. The aim of this multicenter study, involving four hemostasis laboratories, was to compare hemostasis test results in plasma samples obtained using partial- and full-draw evacuated polymer collection tubes containing 0.109 M sodium citrate (1 vol./9 vol.) as the anticoagulant solution (VenoSafeTM, Terumo Europe, Leuven, Belgium). For that purpose, blood was collected into one full- and one partial-draw tube from patients on vitamin K antagonists (VKA, n=100), unfractionated heparin (UFH, n=89), or a low molecular weight derivative (LMWH, n=52), as well as from 136 untreated patients, including 13 hemophiliacs. Routine coagulation tests i.e. PT/INR, aPTT, fibrinogen, and factor V, as well as factor VIII and anti-FXa activity when applicable, were measured using the routine techniques at each participating center. In addition, plasma PF-4 level, evaluated using an ELISA, was investigated in a subset of 36 healthy controls. In untreated patients incl. hemophiliacs as well as in those on either VKA or LMWH, no significantly relevant discrepancy (Bland-Altman) was found between tests results obtained using full- and partial-draw tubes. In contrast, anti-FXa activity in patients on UFH was significantly lower in partial- than in full-draw tubes [median=0.33 IU/mL (range: 0.00-1.11) vs. 0.39 (range: 0.05-1.32) respectively, p<0.0001]. Similarly, aPTT was significantly shorter in partial- than in the full-draw tubes, whereas other test results were not significantly different in the two tubes. That discrepancy was likely to be related to higher amount of PF4 released in plasma after increased platelet activation in partial-draw than in full-draw tubes [392 U/mL (range: 138-971) vs. 177 (range: 52-460) respectively, n=36; p<0.005)]. To further support that hypothesis, blood was collected, from 101 patients on UFH and from 104 untreated patients, into one partial-draw collection tube containing CTAD, a mixture of citrate and inhibitors of platelet activation, as the anticoagulant solution and one full-draw citrated tube, obtained from the same manufacturer. Comparison performed according to Bland-Altman of anti-FXa obtained in the two tubes failed to demonstrate any relevant difference, with a mean bias of +0.02 IU/mL that was identical throughout the measuring range of values [median=0.22 IU/mL (range: 0.06-1.16) vs. 0.20 (range: 0.03-1.15) respectively, n=101]. Moreover, in those patients on UFH, aPTT and other routine coagulation tests were not significantly different in the two tubes and the same applied to test results obtained in the plasma from untreated patients. These results suggest that samples collected into partial-draw citrated tubes allow accurate routine coagulation testing in all patients but those requiring UFH assessment, in which their use could lead to a significant underestimation of anticoagulation. In such cases, partial-draw tubes containing CTAD could be validly used to monitor heparin therapy, as well as to perform routine coagulation testing. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Coagulation tests or Standardized questionnaire, which is better as a predictor of bleeding? A prospective study among children before tonsillectomy and/or adenoidectomy.

2020 ◽  
Author(s):  
Muhamed Masalha ◽  
Ari DeRowe ◽  
Salim Mazzawi ◽  
Tzvi chen ◽  
Rami Ghanayim ◽  
...  
Keyword(s):  
Prospective Study ◽  
Bleeding Events ◽  
Risk Of Bleeding ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
A Prospective Study ◽  
Medical Questionnaire ◽  
Age Range ◽  
Routine Coagulation

Abstract Objective: The value of pre-operative coagulation testing for adenotonsillar surgery is controversial. The purpose of this study was to evaluate the role of routine coagulation tests and a standardized questionnaire in children before tonsillectomy and/or adenoidectomy. Results: A total of 143 children were prospectively enrolled in the study between 2013 and 2017, 81 males (56.6%) and 62 females (43.4%), age range 1 to 18 years (median age 5 years). Eighteen bleeding events were documented, three of them required treatment in the operating room. Abnormal coagulation tests were not associated with higher odds of bleeding after surgery. Higher risk of bleeding (p=0.01) was associated with an abnormal standardized medical questionnaire.

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