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van den Besselaar AMHP, Cobbaert CM. Assignment of international normalized ratio to frozen and freeze-dried pooled plasmas. Clin Chem Lab Med 2020; 58:2089-2097. [PMID: 32840098 DOI: 10.1515/cclm-2019-1321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/29/2020] [Indexed: 11/15/2022]
Abstract
Objectives Frozen and freeze-dried plasmas may be used for local prothrombin time system calibration, for direct international normalized ratio (INR) determination, and for quality assessment. The purpose of the present study was to evaluate the usefulness of INRs assigned with various types of thromboplastins to frozen and freeze-dried pooled plasmas obtained from patients treated with vitamin K antagonists. Methods INRs were calculated according to the international sensitivity index (ISI) model using various thromboplastins and instruments, i.e. International Standards for thromboplastin as well as six commercial reagents prepared from rabbit and bovine brain, and recombinant human tissue factor. The uncertainty of the INRs was assessed using the standard deviations of clotting times and ISI values. Commutability of the plasmas was assessed according to the approved Clinical and Laboratory Standards Institute (CLSI) Guideline EP30-A. Validation of a set of six frozen plasma pools for direct INR determination was performed according to the Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis (SSC/ISTH) guidelines. Results For all frozen and freeze-dried plasmas, the INRs calculated with bovine thromboplastin Thrombotest were lower than the INRs assigned with other thromboplastins. With a few exceptions, the frozen and freeze-dried pooled plasmas were commutable. When the set of six frozen plasma pools was used for local calibration, the analytical bias of the INR was less than ±10% for all commercial reagents except Thrombotest. Conclusions Processing of fresh plasmas to prepare pooled frozen plasmas and freeze-dried plasmas may lead to different INR assignments depending on the thromboplastin used. Despite minor INR differences, a set of six frozen plasma pools could be used for local calibration by direct INR determination.
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Affiliation(s)
- Antonius M H P van den Besselaar
- Coagulation Reference Laboratory, Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.,Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands, Phone: +31 71 526 1942
| | - Christa M Cobbaert
- Coagulation Reference Laboratory, Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Lee HJ, Kim JE, Lee HY, Lim HS, Kim HK. Significance of local international sensitivity index systems for monitoring warfarin and liver function. Am J Clin Pathol 2014; 141:542-50. [PMID: 24619756 DOI: 10.1309/ajcp2ry1pirrpuow] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Use of a local calibrator has been recommended for standardization of the international normalized ratio (INR) and international sensitivity index (ISI). We investigated the performance of two commercial local calibrators for warfarin monitoring and determined the significance of liver-specific INR. METHODS ISI values were determined using the World Health Organization (WHO) method and two commercial local calibrators. Liver-specific ISI was determined using plasma samples from patients with liver cirrhosis and normal controls. RESULTS In warfarin monitoring, the two local ISIs determined by the two local calibrators showed better consistency than uncorrected ISI, although they were inferior to the ISIs calibrated using the WHO method. Alternative calibration using calibration plasma from patients with liver cirrhosis instead of warfarinized plasma reduced the INR variability. CONCLUSIONS Local ISI determined by a commercial local calibrator improved INR standardization among thromboplastins. The alternative ISI calibration using liver-specific calibration plasma is expected to reduce INR variability for the evaluation of liver function.
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Affiliation(s)
- Hwa Jeen Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Eun Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Yeon Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Sook Lim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Kyung Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Use of INR calibrator plasmas in the routine coagulation laboratory: a study of two thrombolastin reagents. Thromb Res 2012; 130:e158-62. [PMID: 22682443 DOI: 10.1016/j.thromres.2012.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 04/29/2012] [Accepted: 05/11/2012] [Indexed: 11/22/2022]
Abstract
INR values may be either calculated with the ISI values supplied by thromboplastin manufacturers or are directly extrapolated from certified INR calibrator plasmas. We tested the principle of local INR calibration using INR calibrator plasmas (PT-Multi Calibrator, Siemens), two thromboplastin reagents (Neoplastin Plus, rabbit brain, Stago, coagulometer-specific ISI 1.31, and Innovin, recombinant human tissue factor, Siemens) and the same coagulometer (STA-R, Stago) in 100 patients on warfarin. Using a ISI value of 0.77 with Tomenson correction for Innovin (correction factor=1.09), INR values of patients were similar with the two reagents, with a bias of 0.03 INR units and no significant regression of the difference over the average INR by method comparison analysis. With the INR calibrator plasmas, INR values with Neoplastin Plus were lower than Innovin values with an average bias of 0.39 INR units and a significant regression of the difference over the average INR (r=-0.91). Significant bias (0.16 INR units, p<0.00001) and regression (r=-0.77) was also observed by comparison of Neoplastin Plus INRs with Innovin calibrated INRs. Based on a therapeutic INR interval of 2.0 to 3.5, discordance in warfarin dosing was approximately 3 times higher with INR calibration (27% vs 11%). Because of non commutability with fresh plasma samples, local INR calibration with lyophilized calibrator plasmas may not be valid for some reagent-instrument combinations.
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VAN DEN BESSELAAR AMHP. Artificially depleted plasmas are not necessarily commutable with native patient plasmas for International Sensitivity Index calibration and International Normalized Ratio derivation: a reply to a rebuttal. J Thromb Haemost 2012. [DOI: 10.1111/j.1538-7836.2012.04730.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van den Besselaar AMHP. Artificially depleted plasmas are not necessarily commutable with native patient plasmas for International Sensitivity Index calibration and International Normalized Ratio derivation. J Thromb Haemost 2012; 10:303-5. [PMID: 22136646 DOI: 10.1111/j.1538-7836.2011.04582.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lehner G, Pechlaner C, Graziadei I, Joannidis M. [Monitoring of organ functions. Dysfunction of kidneys, liver, gastrointestinal tract, and coagulation]. Med Klin Intensivmed Notfmed 2012; 107:7-16. [PMID: 22349472 PMCID: PMC7095894 DOI: 10.1007/s00063-011-0032-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 12/13/2011] [Indexed: 01/31/2023]
Abstract
Monitoring of organ function is one of the core tasks of intensive care medicine. Although various monitoring devices and parameters have already been established for some organs, there are no or only few conditionally useful parameters or scores available for the kidneys, liver, gastrointestinal tract, and blood coagulation. Therefore, specific biomarkers and scores as well as combinations of both are currently investigated for better monitoring of these organs. This article gives a critical overview of currently used as well as investigational biomarkers, tests and scores in general, and shows some examples of the implications for common diseases, clinical situations and constellations in the intensive care unit.
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Affiliation(s)
- G.F. Lehner
- Universitätsklinik für Innere Medizin I, Medizinische Intensivstation, Medizinische Universität Innsbruck, Anichstr. 35, 6020 Innsbruck, Österreich
| | - C. Pechlaner
- Universitätsklinik für Innere Medizin I, Medizinische Intensivstation, Medizinische Universität Innsbruck, Anichstr. 35, 6020 Innsbruck, Österreich
| | - I.W. Graziadei
- Universitätsklinik für Innere Medizin II, Gastroenterologie und Hepatologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - M. Joannidis
- Universitätsklinik für Innere Medizin I, Medizinische Intensivstation, Medizinische Universität Innsbruck, Anichstr. 35, 6020 Innsbruck, Österreich
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Schouten J, Francque S, Van Vlierberghe H, Colle I, Nevens F, Delwaide J, Adler M, Starkel P, Ysebaert D, Gadisseur A, De Winter B, Smits J, Rahmel A, Michielsen P. The influence of laboratory-induced MELD score differences on liver allocation: more reality than myth. Clin Transplant 2011; 26:E62-70. [DOI: 10.1111/j.1399-0012.2011.01538.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ibrahim SA, Jespersen J, Pattison A, Poller L. Evaluation of European Concerted Action on Anticoagulation lyophilized plasmas for INR derivation using the PT/INR line. Am J Clin Pathol 2011; 135:732-40. [PMID: 21502427 DOI: 10.1309/ajcpekrpl4k8tzmf] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The prothrombin time/international normalized ratio (PT/INR) Line method based on 5 certified European Concerted Action on Anticoagulation (ECAA) plasmas provides reliable local INR values without conventional World Health Organization international sensitivity index calibrations. The present study investigated the use of different numbers and types of ECAA calibrant plasmas to derive accurate PT/INR Lines and reliable INR values. The numbers ranged from 3 to 10 plasmas in a set with normal or abnormal samples. Sets were selected, and sampling was repeated 1,000 times for each center to derive PT/INR Lines. The lines were selected randomly or from clusters. The INR values of 5 independent "validation" plasmas were compared before and after correction. In 56 calibrations, 5 ECAA plasmas gave better results than did fewer plasmas. Plasmas with wide-ranging INR values gave better results than randomly selected sets, and including a normal plasma was not essential. The INR deviations of validation plasmas from certified values were reduced with sets of human, bovine/combined, and rabbit reagents. Deviations of more than 10% from certified INR values were significantly reduced (P < .001).
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Poller L, Ibrahim S, Keown M, Pattison A, Jespersen J. The prothrombin time/international normalized ratio (PT/INR) Line: derivation of local INR with commercial thromboplastins and coagulometers--two independent studies. J Thromb Haemost 2011; 9:140-8. [PMID: 20942851 DOI: 10.1111/j.1538-7836.2010.04109.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The WHO scheme for prothrombin time (PT) standardization has been limited in application, because of its difficulties in implementation, particularly the need for mandatory manual PT testing and for local provision of thromboplastin international reference preparations (IRP). METHODS The value of a new simpler procedure to derive international normalized ratio (INR), the PT/INR Line, based on only five European Concerted Action on Anticoagulation (ECAA) calibrant plasmas certified by experienced centres has been assessed in two independent exercises using a range of commercial thromboplastins and coagulometers. INRs were compared with manual certified values with thromboplastin IRP from expert centres and in the second study also with INRs from local ISI calibrations. RESULTS In the first study with the PT/INR Line, 8.7% deviation from certified INRs was reduced to 1.1% with human reagents, and from 7.0% to 2.6% with rabbit reagents. In the second study, deviation was reduced from 11.2% to 0.4% with human reagents by both local ISI calibration and the PT/INR Line. With rabbit reagents, 10.4% deviation was reduced to 1.1% with both procedures; 4.9% deviation was reduced to 0.5% with bovine/combined reagents with local ISI calibrations and to 2.9% with the PT/INR Line. Mean INR dispersion was reduced with all thromboplastins and automated systems using the PT/INR Line. CONCLUSIONS The procedure using the PT/INR Line provides reliable INR derivation without the need for WHO ISI calibration across the range of locally used commercial thromboplastins and automated PT systems included in two independent international studies.
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Affiliation(s)
- L Poller
- EAA Central Facility, Faculty of Life Sciences, University of Manchester, Manchester, UK.
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Poller L, Ibrahim S, Keown M, Pattison A, Jespersen J. Simplified Method for International Normalized Ratio (INR) Derivation Based on the Prothrombin Time/INR Line: An International Study. Clin Chem 2010; 56:1608-17. [DOI: 10.1373/clinchem.2009.141937] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND
The need to perform local International Sensitivity Index (ISI) calibrations and in particular the requirement for a manual method for prothrombin time (PT) determination, have proved to be obstacles to application of the WHO scheme for PT standardization.
METHODS
We used international normalized ratio (INR) derived with a set of only 5 European Concerted Action on Anticoagulation (ECAA) lyophilized calibrant plasmas, certified manually by expert centers with reference thromboplastins, to determine a local PT/INR Line. We compared results of an independent set of validation plasmas with INRs from conventional ISI calibrations and with manually certified INRs.
RESULTS
The mean certified INR of 5 lyophilized validation plasmas was 2.41 with human thromboplastin, 2.04 with bovine/combined, and 2.80 with rabbit. With 42 human reagents, the mean observed INR of the validation plasmas was 2.68 (11.2% deviation from certified INR). Deviation was reduced to 0.4% with both local ISI calibration and the PT/INR Line. Eight results based on bovine/combined thromboplastin gave an INR deviation of 4.9%, becoming 0.5% after ISI calibration and 2.4% with the PT/INR Line. Six results with rabbit reagents deviated from certified INR by 2.5%. After ISI calibration, deviation became 1.1%, and with the PT/INR Line, 0.7%. The PT/INR Line gave similar results with both linear and orthogonal regression analysis. The total proportion of validation plasmas giving INR within 10% deviation from certified values was 42.5% with uncorrected INR, which increased to 92.1% with local ISI calibration and 93.2% with the PT/INR Line.
CONCLUSIONS
The PT/INR Line procedure with 5 ECAA calibrant plasmas successfully substitutes for local ISI calibrations in deriving reliable INRs.
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Affiliation(s)
- Leon Poller
- European Action on Anticoagulation (EAA) Central Facility, Faculty of Life Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Saied Ibrahim
- European Action on Anticoagulation (EAA) Central Facility, Faculty of Life Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Michelle Keown
- European Action on Anticoagulation (EAA) Central Facility, Faculty of Life Sciences, University of Manchester, Oxford Road, Manchester, UK
| | | | - Jørgen Jespersen
- Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, and Department for Thrombosis Research, Institute of Public Health, University of Southern Denmark, Esbjerg, Denmark
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Pötzsch B, Madlener K. Globaltests und Einzelfaktoren. Hamostaseologie 2010. [DOI: 10.1007/978-3-642-01544-1_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Oh S, Cornell B, Smith D, Higgins G, Burrell C, Kok T. Rapid detection of influenza A virus in clinical samples using an ion channel switch biosensor. Biosens Bioelectron 2008; 23:1161-5. [DOI: 10.1016/j.bios.2007.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 09/07/2007] [Accepted: 10/23/2007] [Indexed: 11/16/2022]
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