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Sokou R, Parastatidou S, Konstantinidi A, Tsantes AG, Iacovidou N, Piovani D, Bonovas S, Tsantes AE. Contemporary tools for evaluation of hemostasis in neonates. Where are we and where are we headed? Blood Rev 2024; 64:101157. [PMID: 38016836 DOI: 10.1016/j.blre.2023.101157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023]
Abstract
The assessment of hemostatic disorders in neonates is crucial, but remains challenging for clinicians. Although the concept of developmental hemostasis is widely accepted among hemostasis specialists globally, it is probably under-recognized by clinicians and laboratory practitioners. In parallel with age-dependent hemostatic status maturation, comprehension of the differences between normal values is crucial for the accurate diagnosis of potential hemorrhagic and thrombotic disorders of the vulnerable neonatal population. This review outlines the basics of developmental hemostasis and the features of the available coagulation testing methods, with a focus on novel tools for evaluating the neonatal hemostatic profile. Common errors, issues, and pitfalls during the assessment of neonatal hemostasis are discussed, along with their impact on patient management. Current knowledge gaps and research areas are addressed. Further studying to improve our understanding of developmental hemostasis and its reflection on everyday clinical practice is warranted.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece.
| | | | | | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
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2
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Sergi CM. Computer-assisted diagnostics. Contemp Clin Trials 2023; 132:107296. [PMID: 37453551 DOI: 10.1016/j.cct.2023.107296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
Healthcare is at the edge of a profound renovation or collapse due to the rapid inflow of machine learning protocols and procedures able to optimize several processes. Clinical trials are key for the progress of science and the correct interpretation of data. Rickard et al., in this journal, report that data on misidentification rates in medical trials are scarce. In five trials involving more than 800 blood or histology specimens examined, data clarification forms (DCFs) were issued for 21% of instances, and 67% were related to sample identification. The authors suggest that a suitable number of de- recognized data points is critical. Moreover, a formalized process involving the specimen accession employed in routine care is key to mitigate recognition errors and their potential profound impact on clinical research and outcome. We fully agree with the authors and their report is highly relevant today that we face transformation in healthcare. We suggest that 3D barcoding may mitigate several issues on misidentification.
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Affiliation(s)
- Consolato M Sergi
- Anatomic Pathology Division, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada; Department of Laboratory Medicine and Pathology, Stollery Children's Hospital, Edmonton, AB, Canada.
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3
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Joshi RK, Sarangi SC, Mohapatra S, Mallick S, Datta SK. A Comparative Review of ICMR, WHO, and EMA Guidelines for Good Clinical Laboratory Practices. J Lab Physicians 2022. [DOI: 10.1055/s-0042-1757237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractWith the advancement of clinical research and the increased burden on laboratory services, there is an unmet need for guidelines regarding proper laboratory functioning and reliable data generation. Several organizations from all over the world have published guidelines for these clinical and research laboratories. Good Clinical Laboratory Practices (GCLP) are stepwise procedures aimed at strengthening the quality of test results produced by all clinical laboratories engaged in human sample analysis. In this article, we attempt a comparison of the GCLP guidelines recently issued by the Indian Council of Medical Research with the guidelines released by the World Health Organization and the European Medicines Agency. Also, we have included and discussed several suggestions that, if included, will lead to the strengthening of the laboratory practices used for both research and patient care for overall improvement in the Indian healthcare system.
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Affiliation(s)
- Rajat Kumar Joshi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sarita Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Saumyaranjan Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudip Kumar Datta
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
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ALFadhalah T, Al Mudaf B, Al Tawalah H, Al Fouzan WA, Al Salem G, Alghanim HA, Ibrahim SZ, Elamir H, Al Kharji H. Baseline assessment of staff perception of critical value practices in government hospitals in Kuwait. BMC Health Serv Res 2022; 22:986. [PMID: 35918679 PMCID: PMC9347105 DOI: 10.1186/s12913-022-08329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Notification of laboratory-determined critical values is key for effective clinical decision making and is thus a consequential step in a patient’s health care and safety. This study presents an overview of staff reporting policies and procedures concerning critical values in Kuwaiti governmental hospitals. Methods A cross-sectional descriptive study design was adopted. Study subjects were affiliated with laboratories from five government hospitals (four general and one sub-specialty hospital). All laboratory staff in every hospital were included. The Statistical Package for the Social Sciences (version 23) was used to analyse the collected data at a significance level of ≤ 0.05. Quantitative data analysis included univariate descriptive (means, medians, standard deviations, frequencies, percentages) and bivariate (chi-squared, ANOVA and Kruskal–Wallis tests) analyses. These analyses provided associations between participating hospitals and staff perceptions towards the policies and procedures surrounding critical values. Results 559 questionnaires were returned, a total response of 30.5% after those of 79 phlebotomists were excluded (eligible sample size n = 1833). The notification of critical values differs between participated laboratories in delivering protocol and time duration. Linked protocols between laboratories did not exist regarding policies and guidelines for applying the same procedures for critical value notification. There are differences in critical value limits among the participating laboratories. Conclusion This study is the first to survey laboratory staff perceptions of critical value practices in Kuwaiti government hospitals. Enhancing critical value reporting and policy is crucial for improving patient safety and to develop high-quality health services. The findings of this study can help policy makers implement future intervention studies to enhance laboratory practices in the area of critical values and improve patient safety and the quality of government hospital systems.
Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08329-z.
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Affiliation(s)
- Talal ALFadhalah
- Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Buthaina Al Mudaf
- Assistant Undersecretary of Public Health Affairs, Ministry of Health, Kuwait City, Kuwait
| | - Haya Al Tawalah
- Laboratory Department, Ministry of Health, Yacoub Behbehani Center, Sulaibikhat, Kuwait.,Microbiology Department, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Wadha A Al Fouzan
- Microbiology Department, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.,Laboratory Department, Farwania Hospital, Ministry of Health, Farwania, Kuwait
| | - Gheed Al Salem
- Accreditation Affairs Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hanaa A Alghanim
- Safety Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Samaa Zenhom Ibrahim
- Department of Health Management, Planning and Policy, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Hossam Elamir
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hamad Al Kharji
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait.
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5
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Mullier F, Paridaens M, Evrard J, Baudar J, Guldenpfennig M, Devroye C, Miller L, Chatelain B, Lessire S, Jacqmin H. Evaluation of a new thromboplastin reagent STA‐NeoPTimal on a STA R Max analyzer for the measurement of prothrombin time, international normalized ratio and extrinsic factor levels. Int J Lab Hematol 2020; 42:650-660. [DOI: 10.1111/ijlh.13236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- François Mullier
- Department of Laboratory Medicine Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS) Yvoir Belgium
| | | | | | - Justine Baudar
- Department of Laboratory Medicine Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS) Yvoir Belgium
| | - Maité Guldenpfennig
- Department of Laboratory Medicine Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS) Yvoir Belgium
| | - Celia Devroye
- Department of Laboratory Medicine Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS) Yvoir Belgium
| | - Laurence Miller
- Department of Laboratory Medicine Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS) Yvoir Belgium
| | - Bernard Chatelain
- Department of Laboratory Medicine Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS) Yvoir Belgium
| | - Sarah Lessire
- Department of Anesthesiology Université catholique de LouvainCHU UCL NamurNamur Thrombosis and Hemostasis Center (NTHC)Namur Research Institute for Life Sciences (NARILIS) Yvoir Belgium
| | - Hugues Jacqmin
- Department of Laboratory Medicine Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS) Yvoir Belgium
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6
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Blennerhassett R, Favaloro E, Pasalic L. Coagulation studies: achieving the right mix in a large laboratory network. Pathology 2019; 51:718-722. [DOI: 10.1016/j.pathol.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 10/25/2022]
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7
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Dorgalaleh A, Shiravand Y, Dabbagh A, Tabibian S, Hosseini MS, Mansouri Tourghabeh H, Rashidpanah J, Narouei F, Shams M, Gholami MS, Saneei Moghaddam E, Shahreki H. Hemostasis critical values among Iranian clinical laboratories "National Survey of 157 Clinical Laboratories". Int J Lab Hematol 2019; 41:778-781. [PMID: 31560450 DOI: 10.1111/ijlh.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immediate reporting of critical values or test results significantly outside the normal range has a growing role in the management of patients, especially in life-threatening conditions. Due to the lack of international consensus, diverse approaches are used for determination of thresholds, reporting, documentation, and follow-up. In this study, we assessed how Iranian laboratories manage critical values for hemostasis. METHODS We designed a standard questionnaire to assess different aspects of hemostasis critical values, including the number of coagulation tests with a defined critical value, critical values reporting, documentation, and follow-up policies. All results were self-reported and correctness of the data was not assessed by the authors. RESULTS A total of 166 (66.4%) out of 250 laboratories completed the questionnaire; most (52.4%) were private. About 97% of responding laboratories had a critical values policy. These were defined for 64.3% (n: 27) of all coagulation tests (n: 42) performed in Iranian laboratories. Activated partial thromboplastin time (APTT), prothrombin time/international normalized ratio (PT/INR), platelet count, factor XI, and factor XIII assays had defined critical values among all laboratories performing these tests. Almost all laboratories reported critical values within 1 hour, after confirmation of the result on the same sample (70% of the laboratories) or a new one (13.4% of the laboratories). State and private laboratories had the same critical value reporting policy for in and outpatients, with laboratory technicians reporting critical results to nurses, for the most part. CONCLUSION Although critical value policy is widely used among Iranian laboratories, there is no consensus policy for the reporting of hemostasis critical values, or documentation, threshold determination, and follow-up processes. It is impossible to determine whether non-responding laboratories had any critical values reporting policy. Results thus are biased toward laboratories that did.
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Affiliation(s)
- Akbar Dorgalaleh
- Anesthesiology Department, Anesthesiology Research Center, Shahid Beheshti University of Medicine, Tehran, Iran.,Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Yavar Shiravand
- Department of Hematology and Blood Transfusion, School of Allied Medicine, TH University of Medical Sciences, Tehran, Iran
| | - Ali Dabbagh
- Anesthesiology Department, Anesthesiology Research Center, Shahid Beheshti University of Medicine, Tehran, Iran
| | - Shadi Tabibian
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Sadat Hosseini
- Department of Hematology and Blood Transfusion, School of Allied Medicine, TH University of Medical Sciences, Tehran, Iran.,Department of Hematology and Blood Transfusion, School of Allied Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Jamal Rashidpanah
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Narouei
- Khatam o Alanbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahmood Shams
- Department of Medical Laboratory, Faculty of Paramedical Science, Babol University of Medical Science, Babol, Iran
| | - Mohammad Saeed Gholami
- Skull Base Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Student Research Committee, Faculty of Allied Medicine Branch, Iran University of Medical Sciences, Tehran, Iran
| | | | - Hojat Shahreki
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
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Bronić A, Coen Herak D, Margetić S, Milić M. Croatian Society of Medical Biochemistry and Laboratory Medicine: National recommendations for blood collection, processing, performance and reporting of results for coagulation screening assays prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and D-dimer. Biochem Med (Zagreb) 2019; 29:020503. [PMID: 31223257 PMCID: PMC6559624 DOI: 10.11613/bm.2019.020503] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 08/07/2018] [Indexed: 12/20/2022] Open
Abstract
A modern diagnostic laboratory offers wide spectrum of coagulation assays utilized in the diagnosis and management of patients with haemostatic disorders, preoperative screening and anticoagulation therapy monitoring. The recent survey conducted among Croatian medical biochemistry and transfusion laboratories showed the existence of different practice policies in particular phases of laboratory process during coagulation testing and highlighted areas that need improvement. Lack of assay standardization together with non-harmonized test results between different measurement methods, can potentially lead to incorrect decisions in patient’s treatment. Consequently, patient safety could be compromised. Therefore, recommended procedures related to preanalytical, analytical and postanalytical phases of prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and D-dimer testing are provided in this review, aiming to help laboratories to generate accurate and reliable test results.
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Affiliation(s)
- Ana Bronić
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Desiree Coen Herak
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sandra Margetić
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marija Milić
- Department of Clinical Laboratory Diagnostics, Osijek University Hospital, Osijek, Croatia.,Faculty of Medicine, University of Osijek, Osijek, Croatia
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Lippi G, Cadamuro J, von Meyer A, Simundic AM. Practical recommendations for managing hemolyzed samples in clinical chemistry testing. Clin Chem Lab Med 2019; 56:718-727. [PMID: 29373316 DOI: 10.1515/cclm-2017-1104] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/15/2017] [Indexed: 01/04/2023]
Abstract
We suggest here a pragmatic approach for managing results of clinical chemistry testing in hemolyzed samples collected from adults/older children, attempting to balance the need to produce quality laboratory data with clinical urgency of releasing test results. Automatic measurement of the hemolysis index (H-index) in serum or plasma is highly advisable, whilst low-quality assessment of this test remains less good than a visual inspection. Regarding its practical use, when the H-index value does not generate an analytically significant bias, results can be released, whilst when the value is associated with analyte variation in a range between analytically and clinically significant bias (i.e. variation does not exceed the reference change value [RCV]), results of hemolysis-sensitive tests can be released in association with a comment describing the direction in which data are potentially altered, suggesting the need to collect another sample. When the H-index is associated with analyte variation exceeding clinically significant bias (i.e. variation exceeds the RCV), results of hemolysis-sensitive tests should be suppressed and replaced with a comment that biased results cannot be released because the sample is preanalytically compromised and advising the recollection of another sample. If H-index values reach an even higher critical cut-off (i.e. H-index corresponding to a cell-free hemoglobin concentration ≥10 g/L), all laboratory data may be unreliable and should hence be suppressed and replaced with a comment that all data cannot be released because the sample is grossly hemolyzed, also suggesting the recollection of another sample. Due to inaccuracy and imprecision, the use of corrective formulas for adjusting data of hemolysis-sensitive tests is discouraged.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37100 - Verona, Italy
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Alexander von Meyer
- Institute for Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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Sergi C. Promptly reporting of critical laboratory values in pediatrics: A work in progress. World J Clin Pediatr 2018; 7:105-110. [PMID: 30479975 PMCID: PMC6242778 DOI: 10.5409/wjcp.v7.i5.105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/30/2018] [Accepted: 10/17/2018] [Indexed: 02/06/2023] Open
Abstract
In the 21st century, the determination of alert thresholds remains the most challenging and controversial issue in clinical pediatrics. Pre-analytical, analytical, and post-analytical matters will consolidate or undermine the fate of any laboratory process. Pre-analytical issues need to be cleared off before the laboratory physician can dispatch the result to the pediatrician in charge. Once it is cleared off, the classification of essential laboratory results is paramount. It is more than an academic exercise and may be subdivided in the order of priority we handle it to inform promptly and safely the primary physicians. Currently, we are applying new modes of making sure relevant information is transmitted without interrupting the standard workflow of the primary physicians in charge for the child, who eventually need a fast line of action for results that may be life-threatening.
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Affiliation(s)
- Consolato Sergi
- Department of Laboratory Medicine and Pathology, Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada
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11
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Favaloro EJ, Lippi G. On the complexity of hemostasis and the need for harmonization of test practice. ACTA ACUST UNITED AC 2018; 56:1568-1574. [DOI: 10.1515/cclm-2018-0174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Emmanuel J. Favaloro
- Department of Haematology , Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital , Westmead, NSW, 2145 , Australia
- Sydney Centres for Thrombosis and Haemostasis , Westmead, NSW , Australia , Phone: +(612) 8890 6618, Fax: +(612) 9689 2331
| | - Giuseppe Lippi
- Section of Clinical Biochemistry , Department of Neurological, Biomedical and Movement Sciences , University of Verona , Verona , Italy
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