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Giuseppe Lippi - One of the best experts on this subject based on the ideXlab platform.
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international council for standardization in haematology icsh recommendations for processing of blood samples for Coagulation Testing
International Journal of Laboratory Hematology, 2021Co-Authors: S Kitchen, Giuseppe Lippi, Dorothy M Adcock, Richard A Marlar, Ray Dauer, Annhelen Kristoffersen, Ian J Mackie, Sukesh C NairAbstract:This guidance document has been prepared on behalf of the International Council for Standardization in Haematology (ICSH). The aim of the document is to provide guidance and recommendations for the processing of citrated blood samples for Coagulation tests in clinical laboratories in all regions of the world. The following areas are included in this document: Sample transport including use of pneumatic tubes systems; clots in citrated samples; centrifugation; primary tube storage and stability; interfering substances including haemolysis, icterus and lipaemia; secondary aliquots-transport, storage and processing; preanalytical variables for platelet function Testing. The following areas are excluded from this document, but are included in an associated ICSH document addressing collection of samples for Coagulation tests in clinical laboratories; ordering tests; sample collection tube and anticoagulant; preparation of the patient; sample collection device; venous stasis before sample collection; order of draw when different sample types are collected; sample labelling; blood-to-anticoagulant ratio (tube filling); influence of haematocrit. The recommendations are based on published data in peer-reviewed literature and expert opinion.
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guidance on the critical shortage of sodium citrate Coagulation tubes for hemostasis Testing
Journal of Thrombosis and Haemostasis, 2021Co-Authors: Robert C. Gosselin, Giuseppe Lippi, Emmanuel J Favaloro, Richard A Marlar, Annette E Bowyer, Jill M Johnsen, Keith B Neeves, Marian A RollinsravalAbstract:Recent manufacturing problems and increased utilization has created a shortage of 3.2% sodium citrate blood collection tubes used for Coagulation Testing, causing stakeholders such as hospitals, clinics and laboratories, to find suitable alternatives. Considerations for in-house citrate blood collection tube preparations or purchasing commercial products from unknown manufacturing sources is of particular concern to laboratories that perform Coagulation Testing. It is well recognized that variability exists between citrate blood collection tube manufacturers, thereby making any transition to new blood collection methods more challenging than simply switching to a new source. This document provides provisional guidance for validating alternative sources of sodium citrate blood collection tubes (commercial or in-house preparations) prior to clinical implementation.
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recent advances in mainstream hemostasis diagnostics and Coagulation Testing
Seminars in Thrombosis and Hemostasis, 2019Co-Authors: Emmanuel J Favaloro, Giuseppe LippiAbstract:The authors provide a narrative review of mainstream hemostasis analyzers. The review is presented in two parts. In the first part, the authors give voice to several internationally representative manufacturers of mainstream hemostasis analyzers. They ask these manufacturers to (1) answer a series of survey questions that may otherwise reflect common questions asked by users or potential users of their equipment, (2) provide a bullet list of their main focus areas, and (3) provide other information in regard to their instrumentation. The authors then offer their own personal perspective of the benefits of various aspects of such equipment, as well as a sampling of some hemostasis tests as currently available, or potentially in progress. It is hoped that this snapshot of mainstream hemostasis diagnostics and Coagulation Testing drives positive future changes that will ultimately provide the best outcomes for laboratories performing hemostasis assays and the patients they help diagnose and manage.
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sodium citrate blood contamination by k2 ethylenediaminetetraacetic acid edta impact on routine Coagulation Testing
International Journal of Laboratory Hematology, 2015Co-Authors: Gian Luca Salvagno, Gian Cesare Guidi, Gabriel Limaoliveira, Elisa Danese, E J Favaloro, Giuseppe LippiAbstract:SummaryIntroduction The potential cross-contamination of additives between primary blood tubes is a well-known problem during sample collection. The aim of this study was to assess the impact of citrated blood contamination with different amounts of dipotassium ethylenediaminetetraacetic (K2EDTA blood) on activated partial thromboplastin time (APTT), prothrombin time (PT), and fibrinogen. Methods Blood was collected from 15 ostensibly healthy volunteers into four 0.109 m citrate blood tubes followed by one K2EDTA blood tube. The citrate tubes of each subject were pooled and divided in five aliquots. The whole blood of the K2EDTA tube was then added in scalar amounts to autologous citrated blood aliquots, to obtain K2EDTA contamination ranging from 0% to 43%, and thus mimic potential pre-analytical contamination. Results A statistically and clinically significant prolongation was observed for both APTT and PT between 29% and 43% K2EDTA contamination, whereas the decrease of fibrinogen values became statistically and clinically significant at 43% K2EDTA contamination. Conclusion The results of this investigation show that contamination of citrated blood with as much as 29% of K2EDTA blood generates a significant bias in results of routine clotting assays. This has serious implications for patient safety and management.
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dangers in the practice of defensive medicine in hemostasis Testing for investigation of bleeding or thrombosis part i routine Coagulation Testing
Seminars in Thrombosis and Hemostasis, 2014Co-Authors: Giuseppe Lippi, Emmanuel J Favaloro, Massimo FranchiniAbstract:Defensive medicine is a term conventionally used for defining the medical (mal)practice of ordering medically questionable diagnostic Testing, procedures, or visits, or to avoid high-risk patients or procedures. The practice of defensive medicine may primarily be aimed to reduce exposure to malpractice liability, to avoid patient criticism regarding “medical inaction,” or to avoid “missing” some otherwise potential identifiable defect(s). Although the precise impact of defensive medicine in the field of laboratory Testing is difficult to estimate from the current literature, the overuse or inappropriate use of laboratory resources ranges from 23 to 67%, and a large part of this can be attributed to medical liability concerns, with apparently little clinical awareness of the adverse consequences that may be associated with this practice. Essentially, performing inappropriate Testing remarkably increases the risk of obtaining false-positive results due to statistical, preanalytical, and analytical reasons, thus triggering further and potentially even more invasive follow-up Testing, inappropriate patient management, along with incremental increases of expenditure due to misuse of health care resources. As routine Coagulation Testing is commonly performed for the screening of patients with bleeding or thrombotic disorders, either a false-negative or a false-positive result may significantly impact on clinical outcomes and health care resources. The aim of this article is to describe the leading causes of physiological, pathological, therapeutic, and spurious variations of the prothrombin time, activated partial thromboplastin time, and D-dimer, as well as the potential clinical consequences emerging from the generation of false-negative and false-positive results with these tests.
Richard A Marlar - One of the best experts on this subject based on the ideXlab platform.
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international council for standardization in haematology icsh recommendations for processing of blood samples for Coagulation Testing
International Journal of Laboratory Hematology, 2021Co-Authors: S Kitchen, Giuseppe Lippi, Dorothy M Adcock, Richard A Marlar, Ray Dauer, Annhelen Kristoffersen, Ian J Mackie, Sukesh C NairAbstract:This guidance document has been prepared on behalf of the International Council for Standardization in Haematology (ICSH). The aim of the document is to provide guidance and recommendations for the processing of citrated blood samples for Coagulation tests in clinical laboratories in all regions of the world. The following areas are included in this document: Sample transport including use of pneumatic tubes systems; clots in citrated samples; centrifugation; primary tube storage and stability; interfering substances including haemolysis, icterus and lipaemia; secondary aliquots-transport, storage and processing; preanalytical variables for platelet function Testing. The following areas are excluded from this document, but are included in an associated ICSH document addressing collection of samples for Coagulation tests in clinical laboratories; ordering tests; sample collection tube and anticoagulant; preparation of the patient; sample collection device; venous stasis before sample collection; order of draw when different sample types are collected; sample labelling; blood-to-anticoagulant ratio (tube filling); influence of haematocrit. The recommendations are based on published data in peer-reviewed literature and expert opinion.
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guidance on the critical shortage of sodium citrate Coagulation tubes for hemostasis Testing
Journal of Thrombosis and Haemostasis, 2021Co-Authors: Robert C. Gosselin, Giuseppe Lippi, Emmanuel J Favaloro, Richard A Marlar, Annette E Bowyer, Jill M Johnsen, Keith B Neeves, Marian A RollinsravalAbstract:Recent manufacturing problems and increased utilization has created a shortage of 3.2% sodium citrate blood collection tubes used for Coagulation Testing, causing stakeholders such as hospitals, clinics and laboratories, to find suitable alternatives. Considerations for in-house citrate blood collection tube preparations or purchasing commercial products from unknown manufacturing sources is of particular concern to laboratories that perform Coagulation Testing. It is well recognized that variability exists between citrate blood collection tube manufacturers, thereby making any transition to new blood collection methods more challenging than simply switching to a new source. This document provides provisional guidance for validating alternative sources of sodium citrate blood collection tubes (commercial or in-house preparations) prior to clinical implementation.
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preanalytical variables in Coagulation Testing setting the stage for accurate results
Seminars in Thrombosis and Hemostasis, 2019Co-Authors: Robert C. Gosselin, Richard A MarlarAbstract:Many preanalytical variables may affect the results of routine Coagulation assays. While advances in laboratory instrumentation have partially addressed the laboratory's ability to recognize some of these variables, there remains an increased reliance on laboratory personnel to recognize the three potential areas where Coagulation Testing preanalytical issues may arise: (1) specimen collection (including patient selection), (2) specimen transportation and stability, and (3) specimen processing and storage. The purpose of this article is to identify the preanalytical variables associated with Coagulation-related Testing and provide laboratory practice recommendations in an effort to improve the quality of Coagulation Testing and accuracy of result reporting.
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effect on routine and special Coagulation Testing values of citrate anticoagulant adjustment in patients with high hematocrit values
American Journal of Clinical Pathology, 2006Co-Authors: Richard A Marlar, Robyn M Potts, Audrey A MarlarAbstract:Recommendations to adjust citrate concentration for blood Coagulation specimens with high hematocrit values are based on indirect experimental studies and not direct studies of patient samples with high hematocrit values. We compared the effect of adjusted and non-adjusted citrate concentrations on Coagulation test results in samples from 28 patients with high hematocrit values (55%-72% [0.55-0.72]). Prothrombin time (PT) and activated partial thromboplastin time (aPTT) results from nonadjusted and adjusted samples were statistically different and exponentially increased with increasing hematocrit values. Results for fibrinogen, factor VIII, and protein C activity were statistically different and increased linearly with increasing hematocrit values; however, the difference was not as clinically significant. The protein C antigen value increased with increasing hematocrit values but was not significant. The effects on PT and aPTT are due to a dilutional effect of plasma and an interference effect of the higher final citrate concentration on the clotting test result. For patients with high hematocrit values, citrate concentrations must be adjusted for accurate results.
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minimum specimen volume requirements for routine Coagulation Testing dependence on citrate concentration
American Journal of Clinical Pathology, 1998Co-Authors: Dorothy M Adcock, Richard A Marlar, David C KressinAbstract:We evaluated the effect of sample volume and citrate concentration on results of routine Coagulation assays (prothrombin time [PT] and activated partial thromboplastin time [APTT]). The study was performed on samples obtained from healthy persons and patients receiving oral anticoagulant therapy. Standard evacuated tubes (3.2% and 3.8% sodium citrate) were filled to varying total sample volumes ranging from 3.0 to 5.0 mL, and results of routine Coagulation tests were compared. Underfilling may significantly affect the APTT and PT, resulting in artifactual prolongation of results. This effect is most pronounced in samples drawn into 3.8% citrate. By using 3.8% citrate, there is a statistically significant difference in the results of PT assays in the samples less than 80% filled compared with those that are 100% filled. For APTT assays performed on samples drawn into 3.8% citrate, a statistical difference occurred at less than 90% filled. This effect was less pronounced when samples were drawn into 3.2% sodium citrate. We found no statistically significant difference in PT results from a 3.2% citrate tube between fill volumes of 60% and 100% and none for APTT results between fill volumes of 70% and 100%. This study further supports the recommendation to use 3.2% sodium citrate concentration, because 60% of the optimum filled volume for PT and 70% of the optimum filled volume for APTT are acceptable.
Jan C Purrucker - One of the best experts on this subject based on the ideXlab platform.
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Coagulation Testing in intracerebral hemorrhage related to non vitamin k antagonist oral anticoagulants
Neurocritical Care, 2017Co-Authors: Jan C Purrucker, Kirsten Haas, Timolaos Rizos, Shujah Khan, Marcel Wolf, Peter U Heuschmann, Roland Veltkamp, Rasunoa InvestigatorsAbstract:Intracerebral hemorrhage (ICH) is a life-threatening complication of non-vitamin K antagonist oral anticoagulants (NOAC). Little is known about the effect of intensity of antiCoagulation on NOAC-ICH. We describe the current use of Coagulation Testing in the emergency setting and explore associations with baseline size and expansion of hematoma as determined in a previous study. Data from the prospective multicenter RASUNOA registry were analyzed. Patients with NOAC-ICH were enrolled between February 2012 and December 2014. Frequency of local test performance of specific (anti-factor Xa tests, diluted thrombin time) and non-specific tests (international normalized ratio (INR), activated partial thromboplastin time (aPTT), thrombin time) was analyzed. The association of antiCoagulation intensity at admission with hematoma volume and hematoma expansion was explored. In 61 NOAC-ICH patients enrolled at 21 centers, drug-specific Coagulation Testing was performed in 16 cases (26%), and only 29% of centers appeared to use drug-specific tests in NOAC-ICH at all. In some cases, INR and aPTT values were normal despite drug concentrations in the peak range. In patients with available drug-specific concentrations, 50% had drug levels in the peak range at admission. Higher intensity of antiCoagulation was not associated with higher hematoma volume at admission or with subsequent hematoma expansion. Drug-specific tests are only infrequently used in NOAC-ICH. Normal results in non-specific Coagulation do not reliably rule out peak range concentrations. AntiCoagulation intensity at admission does not predict baseline hematoma volume or subsequent hematoma expansion.
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Coagulation Testing in acute ischemic stroke patients taking non vitamin k antagonist oral anticoagulants
Stroke, 2017Co-Authors: Jan C Purrucker, Kirsten Haas, Timolaos Rizos, Shujah Khan, Sven Poli, Peter Kraft, Christoph Kleinschnitz, Rainer Dziewas, Andreas Binder, Frederick PalmAbstract:Background and Purpose—In patients who present with acute ischemic stroke while on treatment with non–vitamin K antagonist oral anticoagulants (NOACs), Coagulation Testing is necessary to confirm t...
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Coagulation Testing in Acute Ischemic Stroke Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants
'Ovid Technologies (Wolters Kluwer Health)', 2016Co-Authors: Jan C Purrucker, Haas K, Rizos T, Khan S, Poli S, Kraft P, Kleinschnitz C, Dziewas R, Binder A, Palm FAbstract:Background and Purpose—In patients who present with acute ischemic stroke while on treatment with non–vitamin K antagonist oral anticoagulants (NOACs), Coagulation Testing is necessary to confirm the eligibility for thrombolytic therapy. We evaluated the current use of Coagulation Testing in routine clinical practice in patients who were on NOAC treatment at the time of acute ischemic stroke. Methods—Prospective multicenter observational RASUNOA registry (Registry of Acute Stroke Under New Oral Anticoagulants; February 2012–2015). Results of locally performed nonspecific (international normalized ratio, activated partial thromboplastin time, and thrombin time) and specific (antifactor Xa tests, hemoclot assay) Coagulation tests were documented. The implications of test results for thrombolysis decision-making were explored. Results—In the 290 patients enrolled, nonspecific Coagulation tests were performed in ≥95% and specific Coagulation tests in 26.9% of patients. Normal values of activated partial thromboplastin time and international normalized ratio did not reliably rule out peak drug levels at the time of the diagnostic tests (false-negative rates 11%–44% [95% confidence interval 1%–69%]). Twelve percent of patients apparently failed to take the prescribed NOAC prior to the acute event. Only 5.7% (9/159) of patients in the 4.5-hour time window received thrombolysis, and NOAC treatment was documented as main reason for not administering thrombolysis in 52.7% (79/150) of patients. Conclusions—NOAC treatment currently poses a significant barrier to thrombolysis in ischemic stroke. Because nonspecific Coagulation test results within normal range have a high false-negative rate for detection of relevant drug concentrations, rapid drug-specific tests for thrombolysis decision-making should be established
Kenichi A Tanaka - One of the best experts on this subject based on the ideXlab platform.
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point of care Coagulation Testing in cardiac surgery
Seminars in Thrombosis and Hemostasis, 2017Co-Authors: Daniel Bolliger, Kenichi A TanakaAbstract:Bleeding complications after cardiac surgery are common and are associated with increased morbidity and mortality. Their etiology is multifactorial, and treatment decisions are time sensitive. Point-of-care (POC) Testing has an advantage over standard laboratory tests for faster turn-around times, and timely decision on Coagulation intervention(s). The most common POC Coagulation Testing is the activated clotting time (ACT), used to monitor heparin therapy while on cardiopulmonary bypass. Viscoelastic Coagulation tests including thromboelastometry (ROTEM) and thromboelastography (TEG) have been recommended for the treatment of postoperative bleeding after cardiac surgery because the ROTEM/TEG-guided treatment algorithms reduced the use of blood products. Other POC tests are commercially available, but there is sparse evidence for their routine use in cardiac surgery. These devices include heparin management systems, POC prothrombin time and activated partial thromboplastin time, POC fibrinogen assay, and whole blood platelet function tests. There are multiple confounding elements and conditions associated with cardiac surgery, which can significantly alter test results. Anemia and thrombocytopenia are regularly associated with deviations in many POC devices. In summary, POC Coagulation Testing allows for rapid clinical decisions in hematological interventions, and, when used in conjunction with a proper transfusion algorithm, may reduce blood product usage, and potentially complications associated with blood transfusion.
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practical use of thromboelastometry in the management of perioperative coagulopathy and bleeding
Transfusion Medicine Reviews, 2017Co-Authors: Brittney Williams, John S Mcneil, Andrew Crabbe, Kenichi A TanakaAbstract:Achieving hemostasis after complex cardiovascular and transplant surgical procedures is one of the greatest challenges anesthesiologists face. Preoperative Coagulation disturbances due to underlying disease or antithrombotic therapy are common, and they are worsened by intraoperative blood loss and fluid replacement. The Coagulation reactions in vivo are incredibly complex interactions among blood cells, proteins, and vasculature, standing in sharp contrast to rather simple treatment options including transfusion of platelets, plasma, and cryoprecipitate. The long turnaround time of laboratory Coagulation Testing, and intraoperative heparin use also make timely Coagulation assessment difficult during cardiopulmonary bypass, and thus, hemostatic components are often empirically ordered and administered without knowing their actual need or efficacy. However, increasing clinical experience with viscoelastic Coagulation Testing in cardiac and transplant anesthesia has introduced a paradigm shift, enabling clinicians to obtain clinically relevant Coagulation data in a timely fashion and to treat a specific element of Coagulation that is dysfunctional. Viscoelastic Coagulation Testing may facilitate an optimal use of blood components and other hemostatic agents, but its application is often practice specific (ie, type of surgery), and there are technical limitations and learning curves. The aims of this review are thus to summarize recent clinical data on viscoelastic Coagulation Testing and to provide practical examples of its use in complex cardiac surgical and transplant cases.
Gian Cesare Guidi - One of the best experts on this subject based on the ideXlab platform.
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sodium citrate blood contamination by k2 ethylenediaminetetraacetic acid edta impact on routine Coagulation Testing
International Journal of Laboratory Hematology, 2015Co-Authors: Gian Luca Salvagno, Gian Cesare Guidi, Gabriel Limaoliveira, Elisa Danese, E J Favaloro, Giuseppe LippiAbstract:SummaryIntroduction The potential cross-contamination of additives between primary blood tubes is a well-known problem during sample collection. The aim of this study was to assess the impact of citrated blood contamination with different amounts of dipotassium ethylenediaminetetraacetic (K2EDTA blood) on activated partial thromboplastin time (APTT), prothrombin time (PT), and fibrinogen. Methods Blood was collected from 15 ostensibly healthy volunteers into four 0.109 m citrate blood tubes followed by one K2EDTA blood tube. The citrate tubes of each subject were pooled and divided in five aliquots. The whole blood of the K2EDTA tube was then added in scalar amounts to autologous citrated blood aliquots, to obtain K2EDTA contamination ranging from 0% to 43%, and thus mimic potential pre-analytical contamination. Results A statistically and clinically significant prolongation was observed for both APTT and PT between 29% and 43% K2EDTA contamination, whereas the decrease of fibrinogen values became statistically and clinically significant at 43% K2EDTA contamination. Conclusion The results of this investigation show that contamination of citrated blood with as much as 29% of K2EDTA blood generates a significant bias in results of routine clotting assays. This has serious implications for patient safety and management.
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sodium citrate vacuum tubes validation preventing preanalytical variability in routine Coagulation Testing
Blood Coagulation & Fibrinolysis, 2013Co-Authors: Gabriel Limaoliveira, Martina Montagnana, Gian Luca Salvagno, Giuseppe Lippi, Geraldo Picheth, Gian Cesare GuidiAbstract:Sometimes in-vitro diagnostic devices (e.g. blood collection tubes) are not validated before use or when the producer's brand is changed. The aim of this study was to validate five brands of sodium citrate vacuum tubes. Blood specimens from 50 volunteers were collected in five different tube brands (I: Venosafe, II: VACUETTE, III: BD Vacutainer, IV: LABOR IMPORT and V: S-Monovette). Routine Coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time (PT), and fibrinogen (FIB)] were performed on ACL TOP instrument using HemosIL reagents. The significance of the differences between samples was assessed by paired Student's t-test, set at P < 0.005. Significant differences were observed for: PT when comparing I vs. II, I vs. III, I vs. V, II vs. III, II vs. IV, II vs. V, III vs. IV, III vs. V and IV vs. V; aPTT when comparing I vs. II, I vs. III, I vs. IV, II vs. IV, III vs. IV and IV vs. V. No differences were observed among brands for FIB determination. We suggest that every laboratory management should both standardize the procedures and frequently evaluate the quality of in-vitro diagnostic devices.
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quality standards for sample collection in Coagulation Testing
Seminars in Thrombosis and Hemostasis, 2012Co-Authors: Giuseppe Lippi, Martina Montagnana, Gian Luca Salvagno, Gian Cesare Guidi, Gabriel Limaoliveira, Emmanuel J FavaloroAbstract:Preanalytical activities, especially those directly connected with blood sample collection and handling, are the most vulnerable steps throughout the Testing process. The receipt of unsuitable samples is commonplace in laboratory practice and represents a serious problem, given the reliability of test results can be adversely compromised following analysis of these specimens. The basic criteria for an appropriate and safe venipuncture are nearly identical to those used for collecting blood for clinical chemistry and immunochemistry Testing, and entail proper patient identification, use of the correct technique, as well as appropriate devices and needles. There are, however, some peculiar aspects, which are deemed to be particularly critical when collecting quality specimens for clot-based tests, and these require clearer recognition. These include prevention of prolonged venous stasis, collection of nonhemolyzed specimens, order of draw, and appropriate filling and mixing of the primary collection tubes. All of these important preanalytical issues are discussed in this article, and evidence-based suggestions as well as recommendations on how to obtain a high-quality sample for Coagulation Testing are also illustrated. We have also performed an investigation aimed to identify variation of test results due to underfilling of primary blood tubes, and have identified a clinically significant bias in test results when tubes are drawn at less than 89% of total fill for activated partial thromboplastin time, less than 78% for fibrinogen, and less than 67% for Coagulation factor VIII, whereas prothrombin time and activated protein C resistance remain relatively reliable even in tubes drawn at 67% of the nominal volume.
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right or wrong sample received for Coagulation Testing tentative algorithms for detection of an incorrect type of sample
International Journal of Laboratory Hematology, 2010Co-Authors: Giuseppe Lippi, Gian Luca Salvagno, Gian Cesare Guidi, Dorothy M Adcock, Matteo Gelati, Emmanuel J FavaloroAbstract:Inappropriate blood collection potentially comprises the major pre-analytical problem for Coagulation Testing. Inappropriate samples are most difficult to detect when received as secondary aliquots, common for referred tests. This study aimed to identify a simple, quick and inexpensive process to help laboratories distinguish the type of sample, should there be suspicion of inappropriate collection. Samples from 15 patients [selected on the basis that four different primary tubes were available: serum, citrated plasma, ethylene diamine tetraacetic acid (EDTA) plasma, lithium-heparin plasma], were tested for common electrolytes that might substantially differ according to the type of sample. In citrated plasma, potassium, chloride, calcium and magnesium were significantly decreased compared with serum and lithium-heparin plasma, while sodium was markedly increased. In EDTA plasma, sodium and chloride were significantly decreased compared with both serum and lithium-heparin plasma, potassium was always >14 mmol/l, whereas magnesium and calcium were virtually undetectable. These data allowed development of two algorithms for differential identification of citrated plasma vs. other samples with 100% sensitivity and specificity, the former based on the sequential measurement of potassium, calcium and sodium, the latter on potassium and sodium. These simple assays can supplement classical Coagulation test methods to identify most inappropriate blood collections and validate sample rejection.
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interference of blood cell lysis on routine Coagulation Testing
Archives of Pathology & Laboratory Medicine, 2009Co-Authors: Giuseppe Lippi, Martina Montagnana, Gian Luca Salvagno, Gian Cesare GuidiAbstract:Abstract Context.—Preanalytical factors influencing the reliability of laboratory Testing are commonplace. It is traditionally accepted that hemolytic samples are unsuitable for Coagulation assays ...