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DOI: 10.1055/s-0033-1364187
Algorithmic Approaches to Hemostasis Testing
Publikationsverlauf
Publikationsdatum:
07. Februar 2014 (online)
![](https://www.thieme-connect.de/media/sth/201402/lookinside/thumbnails/10.1055-s-0033-1364187-1.jpg)
Abstract
There are many unique issues that may make a pathologist's consultation helpful in hemostasis testing. Besides the rapidly expanding knowledge of both bleeding and thrombotic disorders and a wide test menu, hemostasis testing is very sensitive to preanalytical issues (hemolysis, fill volume, time, temperature, storage conditions) and the interference of many commonly prescribed drugs. The pathologist can serve an important role in the evaluation of a patient for a bleeding or thrombotic disorder. Using defined algorithms, hemostasis testing can proceed in a logical fashion and be reported using patient-specific comments that take into account clinical history and medication therapy. This approach can improve the diagnostic process, preventing misdiagnoses and leading to a decreased time to diagnosis and an improved utilization of laboratory resources.
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References
- 1 Lynn N. DHHS/OS/ASPE. Short term fixes to the sustainable growth rate process. Available at: http://aspe.hhs.gov/health/reports/08/sgr/sgr.html#es (accessed May 30, 2013)
- 2 Lippi G, Mattiuzzi C. Testing volume is not synonymous of cost, value and efficacy in laboratory diagnostics. Clin Chem Lab Med 2013; 51 (2) 243-245
- 3 Why do I need a pathology test?. http://www.rcpa.edu.au/getattachment/4501e94c-251e-4f17-91e8-fa695a7d6139/FctSht2-Why-Path-Test.aspx . Accessed January 16, 2014.
- 4 McGlynn EA, Asch SM, Adams J , et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003; 348 (26) 2635-2645
- 5 Plebani M, Lippi G. Closing the brain-to-brain loop in laboratory testing. Clin Chem Lab Med 2011; 49 (7) 1131-1133
- 6 Laposata M, Dighe A. “Pre-pre” and “post-post” analytical error: high-incidence patient safety hazards involving the clinical laboratory. Clin Chem Lab Med 2007; 45 (6) 712-719
- 7 Lippi G, Becan-McBride K, Behúlová D , et al. Preanalytical quality improvement: in quality we trust. Clin Chem Lab Med 2013; 51 (1) 229-241
- 8 Alonso-Cerezo MC, Martín JS, García Montes MA, de la Iglesia VM. Appropriate utilization of clinical laboratory tests. Clin Chem Lab Med 2009; 47 (12) 1461-1465
- 9 Calderon-Margalit R, Mor-Yosef S, Mayer M, Adler B, Shapira SC. An administrative intervention to improve the utilization of laboratory tests within a university hospital. Int J Qual Health Care 2005; 17 (3) 243-248
- 10 Zia HM, Singh G. Optimization of utilization of serum protein analysis: role of the electronic medical record in promoting consultation by pathology. Am J Clin Pathol 2013; 139 (6) 793-797
- 11 Levick DL, Stern G, Meyerhoefer CD, Levick A, Pucklavage D. “Reducing unnecessary testing in a CPOE system through implementation of a targeted CDS intervention”. BMC Med Inform Decis Mak 2013; 13: 43
- 12 CLSI. Collection, Transport and Processing of Blood Specimens for Testing Plasma-Based Coagulation Assays and Molecular Hemostasis Assays; Approved Guideline—Fifth Edition. CLSI document H21–A5. Wayne, PA: Clinical and Laboratory Standards Institute; 2008
- 13 Peters GL, Erwin PB, Pitlick MK, Stacy ZA. Utilization of coagulation assays in clinical therapeutics. Pharmacotherapy 2013; 33: 1214-1222
- 14 Favaloro EJ, Lippi G, Adcock DM. Preanalytical and postanalytical variables: the leading causes of diagnostic error in hemostasis?. Semin Thromb Hemost 2008; 34 (7) 612-634
- 15 Lippi G, Salvagno GL, Adcock DM, Gelati M, Guidi GC, Favaloro EJ. Right or wrong sample received for coagulation testing? Tentative algorithms for detection of an incorrect type of sample. Int J Lab Hematol 2010; 32 (1, Pt 2) 132-138
- 16 Lakos G. Interference in antiphospholipid antibody assays. Semin Thromb Hemost 2012; 38 (4) 353-359
- 17 Lippi G, Rossi R, Ippolito L , et al. Influence of residual platelet count on routine coagulation, factor VIII, and factor IX testing in postfreeze-thaw samples. Semin Thromb Hemost 2013; 39 (7) 834-839
- 18 Harenberg J, Giese C, Marx S, Krämer R. Determination of dabigatran in human plasma samples. Semin Thromb Hemost 2012; 38 (1) 16-22
- 19 Castellone DD, Van Cott EM. Laboratory monitoring of new anticoagulants. Am J Hematol 2010; 85 (3) 185-187
- 20 Mani H, Hesse C, Stratmann G, Lindhoff-Last E. Ex vivo effects of low-dose rivaroxaban on specific coagulation assays and coagulation factor activities in patients under real life conditions. Thromb Haemost 2013; 109 (1) 127-136
- 21 Favaloro EJ, Lippi G. Problems in laboratory testing: hemophilia and beyond. J Thromb Haemost 2010; 8 (5) 1119-1120
- 22 Page DA. Change designation of clotting factors to Arabic numerals. J Thromb Haemost 2009; 7 (9) 1599
- 23 Marques MB, Anastasi J, Ashwood E , et al; Academy of Clinical Laboratory Physicians and Scientists. The clinical pathologist as consultant. Am J Clin Pathol 2011; 135 (1) 11-12
- 24 Kottke-Marchant K , ed. An Algorithmic Approach to Hemostasis Testing. Northfield, IL: College of American Pathologists; 2008
- 25 Laposata ME, Laposata M, Van Cott EM, Buchner DS, Kashalo MS, Dighe AS. Physician survey of a laboratory medicine interpretive service and evaluation of the influence of interpretations on laboratory test ordering. Arch Pathol Lab Med 2004; 128 (12) 1424-1427
- 26 Hayward CP, Moffat KA, Plumhoff E, Van Cott EM. Approaches to investigating common bleeding disorders: an evaluation of North American coagulation laboratory practices. Am J Hematol 2012; 87 (Suppl. 01) S45-S50
- 27 Kratz A, Soderberg BL, Szczepiorkowski ZM, Dighe AS, Versalovic J, Laposata M. The generation of narrative interpretations in laboratory medicine: a description of service-specific sign-out rounds. Am J Clin Pathol 2001; 116 (Suppl): S133-S140
- 28 Marlar RA, Potts RM, Marlar AA. Effect on routine and special coagulation testing values of citrate anticoagulant adjustment in patients with high hematocrit values. Am J Clin Pathol 2006; 126 (3) 400-405
- 29 Manco-Johnson MJ, Nuss R, Jacobson LJ. Heparin neutralization is essential for accurate measurement of factor VIII activity and inhibitor assays in blood samples drawn from implanted venous access devices. J Lab Clin Med 2000; 136 (1) 74-79
- 30 Keller FG, DeFazio J, Jencks F, Steiner M, Rogers J, Ritchey AK. The use of heparinase to neutralize residual heparin in blood samples drawn through pediatric indwelling central venous catheters. J Pediatr 1998; 132 (1) 165-167
- 31 Kershaw G, Orellana D. Mixing tests: diagnostic aides in the investigation of prolonged prothrombin times and activated partial thromboplastin times. Semin Thromb Hemost 2013; 39 (3) 283-290
- 32 Ledford-Kraemer MR. Laboratory testing for lupus anticoagulants: pre-examination variables, mixing studies and diagnostic criteria. Semin Thromb Hemost 2008; 34: 380-388
- 33 Ortel TL. Laboratory diagnosis of the lupus anticoagulant. Curr Rheumatol Rep 2012; 14 (1) 64-70
- 34 Pengo V. ISTH guidelines on lupus anticoagulant testing. Thromb Res 2012; 130 (Suppl. 01) S76-S77
- 35 Sahud MA. Factor VIII inhibitors. Laboratory diagnosis of inhibitors. Semin Thromb Hemost 2000; 26 (2) 195-203
- 36 Nichols WL, Rick ME, Ortel TL , et al. Clinical and laboratory diagnosis of von Willebrand disease: a synopsis of the 2008 NHLBI/NIH guidelines. Am J Hematol 2009; 84 (6) 366-370
- 37 Favaloro EJ. Laboratory testing in disseminated intravascular coagulation. Semin Thromb Hemost 2010; 36 (4) 458-467
- 38 Margetic S. Diagnostic algorithm for thrombophilia screening. Clin Chem Lab Med 2010; 48 (Suppl. 01) S27-S39
- 39 Chong LY, Fenu E, Stansby G, Hodgkinson S ; Guideline Development Group. Management of venous thromboembolic diseases and the role of thrombophilia testing: summary of NICE guidance. BMJ 2012; 344: e3979
- 40 Laposata M. Patient-specific narrative interpretations of complex clinical laboratory evaluations: who is competent to provide them?. Clin Chem 2004; 50 (3) 471-472
- 41 Lim EM, Sikaris KA, Gill J , et al. Quality assessment of interpretative commenting in clinical chemistry. Clin Chem 2004; 50 (3) 632-637
- 42 Hayward CP, Moffat KA, Plumhoff E , et al. External quality assessment of platelet disorder investigations: results of international surveys on diagnostic tests for dense granule deficiency and platelet aggregometry interpretation. Semin Thromb Hemost 2012; 38 (6) 622-631
- 43 Hayward CP, Moffat KA, Raby A , et al. Development of North American consensus guidelines for medical laboratories that perform and interpret platelet function testing using light transmission aggregometry. Am J Clin Pathol 2010; 134 (6) 955-963