CC BY-NC-ND 4.0 · Thromb Haemost 2019; 119(12): 2025-2033
DOI: 10.1055/s-0039-1696712
New Technologies, Diagnostic Tools and Drugs
Georg Thieme Verlag KG Stuttgart · New York

Rapid Centrifugation in the Routine Hemostasis Laboratory

Nathan Wolfensberger*
1   Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
,
Georgios Georgiou*
2   Unilabs Lausanne, Lausanne, Switzerland
,
Evelyne Giabbani
3   Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Marianne Reusser
3   Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Linet M. Njue
3   Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Martin Fiedler
4   University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Alexander B. Leichtle
4   University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
5   Insel Data Science Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Michael Nagler
3   Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
4   University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
› Author Affiliations
Further Information

Publication History

14 June 2019

21 July 2019

Publication Date:
10 October 2019 (online)

Abstract

Background The use of short and uniform centrifugation schemes contributes significantly to the successful automation of laboratory procedures. It is however unclear if this is applicable to the hemostasis laboratory.

Objectives This article assesses the accuracy of measurements obtained with a rapid, high-speed centrifugation scheme in a large set of hemostasis tests, covering the full spectrum of values obtained in clinical practice, and using meaningful statistical measures.

Methods Two citrated plasma samples were obtained from consecutive patients of a tertiary hospital with suspected abnormal hemostasis tests and processed with two centrifugation schemes in parallel: 1,500 × g for 10 minutes and 3,137 × g for 7 minutes. The following tests were conducted: prothrombin time (n = 125), international normalized ratio (n = 146), activated partial thromboplastin time (n = 119), thrombin time (n = 105), fibrinogen (n = 125), factor (F)II (n = 69), FV (n = 64), FVII (n = 64), FX (n = 67), FVIII (n = 55), FIX (n = 37), FXI (n = 35), and FXIII (n = 20), D-dimer (n = 34), antithrombin (n = 31), anti-Xa activity (n = 30), von Willebrand antigen (n = 25), and von Willebrand activity (VWF:GPIbM; n = 27).

Results A wide range of results were obtained in all tests. Spearman's rank correlation coefficient was at least 0.95 for all tests except FV, FIX, and FXI. The coverage probability π at a given deviation index κ of 15% was above 0.9 for all tests except FV, FVII, FX, FVIII, FIX, FXI, and VWF:GPIbM, suggesting a lack of agreement.

Conclusion Our results suggest that high-speed centrifugation is applicable to the majority of routine hemostasis parameters. The coverage probability was more sensitive than Spearman's rank correlation to detect disagreement among centrifugation schemes.

Authors' Contributions

N.W. contributed to study design, reviewed the analysis, and wrote the manuscript. G.G. contributed to study design and collected the data. E.G., M.R., and L.M.N. collected data. M.F. contributed to study design and provided the devices and reagents. A.B.L. contributed to study design and analysis plan and conducted the analysis. M.N. designed the study, collected data, conducted the analysis, and wrote the manuscript. All authors intellectually reviewed the manuscript.


* These authors contributed equally to this study.


Supplementary Material

 
  • References

  • 1 Genzen JR, Burnham CD, Felder RA, Hawker CD, Lippi G, Peck Palmer OM. Challenges and opportunities in implementing total laboratory automation. Clin Chem 2018; 64 (02) 259-264
  • 2 Hawker CD, Garr SB, Hamilton LT, Penrose JR, Ashwood ER, Weiss RL. Automated transport and sorting system in a large reference laboratory: part 1. Evaluation of needs and alternatives and development of a plan. Clin Chem 2002; 48 (10) 1751-1760
  • 3 Seaberg RS, Stallone RO, Statland BE. The role of total laboratory automation in a consolidated laboratory network. Clin Chem 2000; 46 (05) 751-756
  • 4 Lippi G, Da Rin G. Advantages and limitations of total laboratory automation: a personal overview. Clin Chem Lab Med 2019; 57 (06) 802-811
  • 5 Zaninotto M, Plebani M. The “hospital central laboratory”: automation, integration and clinical usefulness. Clin Chem Lab Med 2010; 48 (07) 911-917
  • 6 Evangelopoulos AA, Dalamaga M, Panoutsopoulos K, Dima K. Nomenclature and basic concepts in automation in the clinical laboratory setting: a practical glossary. Clin Lab 2013; 59 (11-12): 1197-1214
  • 7 Hawker CD, Roberts WL, Garr SB. , et al. Automated transport and sorting system in a large reference laboratory: part 2. Implementation of the system and performance measures over three years. Clin Chem 2002; 48 (10) 1761-1767
  • 8 Archetti C, Montanelli A, Finazzi D, Caimi L, Garrafa E. Clinical laboratory automation: a case study. J Public Health Res 2017; 6 (01) 881
  • 9 Yu HE, Lanzoni H, Steffen T. , et al. Improving laboratory processes with total laboratory automation. Lab Med 2019; 50 (01) 96-102
  • 10 Angeletti S, De Cesaris M, Hart JG. , et al. Laboratory automation and intra-laboratory turnaround time: experience at the University Hospital Campus Bio-Medico of Rome. J Lab Autom 2015; 20 (06) 652-658
  • 11 Dempfle CE, Töpfer G. Hemostaseology. In: Pre-Examination Procedures in Laboratory Diagnostics: Preanalytical Aspects and Their Impact on the Quality of Medical Laboratory Results. Berlin, Germany: De Gruyter; 2015: 273-281
  • 12 Funk D. Sample integrity and preanalytical variables. In: Quality in Laboratory Hemostasis and Thrombosis. West Sussex, United Kingdom: Wiley-Blackwell; 2013: 45-56
  • 13 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 (07) 834-839
  • 14 Aursnes I, Vikholm V. On a possible interaction between ADP and mechanical stimulation in platelet activation. Thromb Haemost 1984; 51 (01) 54-56
  • 15 Magnette A, Chatelain M, Chatelain B, Ten Cate H, Mullier F. Pre-analytical issues in the haemostasis laboratory: guidance for the clinical laboratories. Thromb J 2016; 14: 49
  • 16 Brulé J, Revy S, Faure C. , et al. Evaluation of a rapid centrifugation step (4500 g for 2 min) in coagulation assays to monitor direct oral anticoagulants. Clin Chem Lab Med 2018; 57 (02) e37-e40
  • 17 Boissier E, Sévin-Allouet M, Le Thuaut A. , et al. A 2-min at 4500 g rather than a 15-min at 2200 g centrifugation does not impact the reliability of 10 critical coagulation assays. Clin Chem Lab Med 2017; 55 (06) e118-e121
  • 18 CLSI. Collection, Transport, and Processing of Blood Specimens for Testing Plasma-Based Coagulation Assays and Molecular Hemostasis Assays; Approved Guideline - Fifth Edition. In: CLSI document H21–A5. Wayne, PA: Clinical and Laboratory Standards Institute; 2008
  • 19 Polack B, Schved JF, Boneu B. ; Groupe d'Etude sur l'Hémostase et la Thrombose' (GEHT). Preanalytical recommendations of the ‘Groupe d’Etude sur l'Hémostase et la Thrombose' (GEHT) for venous blood testing in hemostasis laboratories. Haemostasis 2001; 31 (01) 61-68
  • 20 Mackie I, Cooper P, Lawrie A, Kitchen S, Gray E, Laffan M. ; British Committee for Standards in Haematology. Guidelines on the laboratory aspects of assays used in haemostasis and thrombosis. Int J Lab Hematol 2013; 35 (01) 1-13
  • 21 Carroll WE, Wollitzer AO, Harris L, Ling MC, Whitaker WL, Jackson RD. The significance of platelet counts in coagulation studies. J Med 2001; 32 (1-2): 83-96
  • 22 Barnhart HX, Yow E, Crowley AL. , et al. Choice of agreement indices for assessing and improving measurement reproducibility in a core laboratory setting. Stat Methods Med Res 2016; 25 (06) 2939-2958
  • 23 Sédille-Mostafaie N, Engler H, Lutz S, Korte W. Advancing haemostasis automation--successful implementation of robotic centrifugation and sample processing in a tertiary service hospital. Clin Chem Lab Med 2013; 51 (06) 1273-1278
  • 24 Suchsland J, Friedrich N, Grotevendt A. , et al. Optimizing centrifugation of coagulation samples in laboratory automation. Clin Chem Lab Med 2014; 52 (08) 1187-1191
  • 25 Indevuyst C, Schuermans W, Bailleul E, Meeus P. The order of draw: much ado about nothing?. Int J Lab Hematol 2015; 37 (01) 50-55