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Harmonizing factor assay-related testing performed in a large laboratory network. Blood Coagul Fibrinolysis 2022; 33:402-411. [PMID: 35867944 DOI: 10.1097/mbc.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coagulation factor testing is commonly performed within haemostasis laboratories, either to assess for bleeding disorders, such as haemophilia, or to investigate unexplained prolongation in routine coagulation assays. The aim of this evaluation was to harmonize procedures and normal reference ranges (NRRs) for investigation of coagulation factors on the ACL TOP 50 family of instruments in a large laboratory network. We employed comparative evaluations using newly installed ACL TOPs 550 and 750 and HemosIL reagents vs. existing 'reference' instrumentation and reagents, predominantly Stago and Siemens, as well as assessment of factor sensitivity in routine coagulation assays, prothrombin time (PT) and activated partial thromboplastin time (APTT). Also, establishment of coagulation factor NRRs using normal plasma samples. HemosIL factor assays showed good comparability with the existing reference methods (R > 0.9). Factor sensitivity for PT and APTT assays were acceptable at around 30 U/dl. NRRs were established and harmonized across the laboratory network. This evaluation of factor testing on ACL TOP 50 Family instruments identified overall acceptable performance using Werfen reagents and enabled harmonization of coagulation factor testing in our large network.
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Favaloro EJ, Mohammed S, Vong R, Chapman K, Swanepoel P, Kershaw G, Cai N, Just S, Connelly L, Brighton T, Pasalic L. A multi-laboratory assessment of lupus anticoagulant assays performed on the ACL TOP 50 family for harmonized testing in a large laboratory network. Int J Lab Hematol 2022; 44:654-665. [PMID: 35234361 PMCID: PMC9311435 DOI: 10.1111/ijlh.13818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/17/2022] [Indexed: 12/23/2022]
Abstract
Introduction Lupus anticoagulant (LA) testing is commonly performed within hemostasis laboratories, and the ACL TOP 50 family of instruments represent a new “single platform” of hemostasis instrumentation. Our aim was to evaluate these instruments and manufacturer reagents or alternatives for utility in LA testing. Methods Comparative evaluations of LA testing using newly installed ACL TOPs 550 and 750 as well as comparative assessments with existing “reference,” predominantly Stago, instrumentation, and reagents. Evaluations comprised both dilute Russell viper venom time (dRVVT) and activated partial thromboplastin time (APTT)‐based assays. Establishment of normal reference ranges (NRR). Results The HemosIL dRVVT‐based assays showed good comparability with the existing Stago reference method (R > 0.9) and could be considered as verified as fit for purpose. A variety of APTT assays was additionally evaluated for LA utility, and we identified from the assessment good utility of a non‐Werfen solution in Hyphen BioMed Cephen reagents. NRR were established based on ≥120 normal individual plasma samples. Conclusion This evaluation of LA reagents on ACL TOP 50 Family instruments identified overall acceptable performance of both dRVVT (Werfen solution) and APTT (non‐Werfen solution) to enable harmonization of LA testing in our large network.
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Affiliation(s)
- Emmanuel J Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia.,Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Soma Mohammed
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ronny Vong
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Kent Chapman
- Haematology, NSW Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Priscilla Swanepoel
- Haematology, NSW Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Geoffrey Kershaw
- Haematology, NSW Health Pathology, Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Nancy Cai
- Haematology, NSW Health Pathology, Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sarah Just
- Haematology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Lynne Connelly
- Haematology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Timothy Brighton
- Haematology, NSW Health Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Leonardo Pasalic
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia.,University of Sydney, Westmead, New South Wales, Australia
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A Case of a Patient Who Is Diagnosed with Mild Acquired Hemophilia A after Tooth Extraction Died of Acute Subdural Hematoma due to Head Injury. Case Rep Dent 2019; 2018:7185263. [PMID: 30627455 PMCID: PMC6304843 DOI: 10.1155/2018/7185263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/12/2018] [Accepted: 11/25/2018] [Indexed: 11/20/2022] Open
Abstract
Background Acquired hemophilia A (AHA) is a rare disorder which results from the presence of autoantibodies against blood coagulation factor VIII. The initial diagnosis is based on the detection of an isolated prolongation of the activated partial thromboplastin time (aPTT) with negative personal and family history of bleeding disorder. Definitive diagnosis is the identification of reduced FVIII levels with evidence of FVIII neutralizing activity. Case report We report a case of a 93-year-old female who was diagnosed as AHA after tooth extraction at her home clinic. Prolongation of aPTT and a reduction in factor VIII activity levels were observed with the presence of factor VIII inhibitor. AHA condition is mild. However, acute subdural hematoma of this patient occurred due to an unexpected accident in our hospital. Hematoma was gradually increased and the patient died 13 days after admission. Discussion Although AHA is mild, intracranial bleeding is a life-threatening condition. We also should pay attention to the presence of AHA patients when we extract teeth.
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Gils C, Vinholt PJ, Nybo M. Falsely prolonged activated partial thromboplastin time - a pre- and post-analytical issue. Biochem Med (Zagreb) 2018; 29:011001. [PMID: 30591818 PMCID: PMC6294156 DOI: 10.11613/bm.2019.011001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/04/2018] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Charlotte Gils
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Falay M, Senes M, Korkmaz S, Turhan T, Okay M, Öztürk BA, Yücel D, Ozet G. Biological variation estimates of prothrombin time, activated partial thromboplastin time, and fibrinogen in 28 healthy individuals. Int J Lab Hematol 2018; 40:721-725. [DOI: 10.1111/ijlh.12910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/06/2018] [Accepted: 07/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Mesude Falay
- Hematology; Ankara Numune Training and Research Hospital; Ankara Turkey
| | - Mehmet Senes
- Biochemistry; Saglik Bakanligi Ankara Egitim ve Arastirma Hastanesi; Ankara Turkey
| | - Selcuk Korkmaz
- Biostatistics; Trakya Universitesi Tip Fakultesi; Edirne Turkey
| | - Turan Turhan
- Biochemistry; TC Saglik Bakanligi Ankara Numune Egitim ve Arastirma Hastanesi; Ankara Turkey
| | - Murat Okay
- Biochemistry; Ordu Devlet Hastanesi; Ordu Turkey
| | - Berna Afacan Öztürk
- Hematology; Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi; Ankara Turkey
| | - Doğan Yücel
- Biochemistry; Saglik Bakanligi Ankara Egitim ve Arastirma Hastanesi; Ankara Turkey
| | - Gulsum Ozet
- Hematology; Ankara Numune Training and Research Hospital; Ankara Turkey
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Favaloro EJ, Mohammed S, Lippi G. Postanalytical considerations that may improve the diagnosis or exclusion of haemophilia and von Willebrand disease. Haemophilia 2018; 24:849-861. [PMID: 30024638 DOI: 10.1111/hae.13587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/17/2018] [Indexed: 01/07/2023]
Abstract
von Willebrand disease (VWD) and haemophilia represent the most common inherited or acquired bleeding disorders. However, many laboratories and clinicians may be challenged by their accurate diagnosis or exclusion. Difficulties in diagnosis/exclusion may include analytical issues, where assays occasionally generate an incorrect result (ie representing an analytical error) or have limitations in their measurement range of and/or low analytical sensitivity. Also increasingly recognized is the influence of preanalytical issues on the diagnosis of VWD or haemophilia. Unfortunately, postanalytical considerations are often not well considered in the diagnostic process. Therefore, this narrative review aims to provide an overview of some important postanalytical considerations that may help improve the diagnosis of VWD and haemophilia. This review primarily discusses aspects around reporting of test results. However, we also discuss other less well-recognized postanalytical considerations, including the use of assay ratios to help identify differential diagnoses and then guide further investigation.
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Affiliation(s)
- Emmanuel J Favaloro
- Diagnostic Haemostasis Laboratory, Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, NSW, Australia
| | - Soma Mohammed
- Diagnostic Haemostasis Laboratory, Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Falay M, Senes M, Yücel D, Turhan T, Dagdaş S, Pekin M, Nazaroglu NK, Özet G. What should be the laboratory approach against isolated prolongation of a activated partial thromboplastin time? J Clin Lab Anal 2018; 32:e22415. [PMID: 29484705 DOI: 10.1002/jcla.22415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/26/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study is a retrospective evaluation of patients who were subject to mixing study in our laboratory due to prolonged APTT. The preliminary diagnoses, clinical manifestations, and results of additional ordered tests were reviewed. The study aims to investigate whether repeating APTT test with a different assay prior to performing mixed study in patients with prolonged APTT would be a better alternative algorithmic approach in order to save both time and costs. METHODS We retrospectively evaluated 166 patients (65 females and 101 males) who were subject to mixing study due to isolated prolonged APTT. Additional ordered tests to identify the etiology and clinical findings were reviewed. All patients who had prolonged APTT as a result of testing with Hemosil Synthasil APTT reagent in ACL TOP analyzer were repeated with Stago Cephascreen APTT reagent in STA-R coagulation analyzer. RESULTS APTT test was requested preoperatively in 72.2% of cases. Only 6.6% of the cases had history of bleeding. Correction with mixing study was achieved in 122 (73.5%) cases, among which 75 (45%) cases were found to have APTT test results within reference range when tested with Cephascreen reagent. In 44 (26.5%) cases, mixing study did not result in correction. Only 4 cases were confirmed to have lupus anticoagulants (LA), while 4 cases were diagnosed with hemophilia with inhibitors. CONCLUSION Prolonged APTT results should always be retested using a different assay prior to mixing study. The clinician and the laboratory specialist should collaborate at the postanalytical phase.
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Affiliation(s)
- Mesude Falay
- Department of Hematology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mehmet Senes
- Department of Medical Biochemistry, Ankara Training and Research Hospital, Ankara, Turkey
| | - Dogan Yücel
- Department of Medical Biochemistry, Ankara Training and Research Hospital, Ankara, Turkey
| | - Turan Turhan
- Department of Medical Biochemistry, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Simten Dagdaş
- Department of Hematology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Melike Pekin
- Department of Hematology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | | | - Gülsüm Özet
- Department of Hematology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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