1
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Tsuchida T, Hayakawa M, Kumano O. Characterization and Usefulness of Clot-Fibrinolysis Waveform Analysis in Critical Care Patients with Enhanced or Suppressed Fibrinolysis. Thromb Haemost 2024; 124:40-48. [PMID: 37527783 PMCID: PMC10783976 DOI: 10.1055/a-2145-7139] [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: 03/05/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Recently, clot-fibrinolysis waveform analysis (CFWA), which is a coagulation and fibrinolysis global assay based on assessing the activated partial thromboplastin time with tissue-type plasminogen activator, was developed. This study aimed to investigate the characteristics of CFWA using plasma samples from patients in the critical care unit. MATERIALS AND METHODS The fibrinolysis times using CFWA were measured in 298 plasma samples. These samples were divided into three groups based on the reference interval (RI) of fibrinolysis time using CFWA: shortened group, less than RI; within group, within RI; prolonged group, more than RI. The coagulation and fibrinolysis markers, including D-dimer, plasmin-α2 plasmin inhibitor complex (PIC), fibrin monomer complex (FMC), plasmin-α2 plasmin inhibitor (α2-PI), plasminogen (Plg), and fibrinogen (Fbg) were analyzed and compared among the three groups. RESULTS The FMC level decreased in the order of shortened, within, and prolonged groups, and the decrease was statistically significant among all three group pairs. The opposite tendency was observed for Fbg and fibrinolysis-related markers of α2-PI and Plg, and significant differences were recognized in all pair comparisons except for between within and prolonged groups in Plg. The mean values of the fibrinolysis markers D-dimer and PIC in all three groups were higher than the cut-off values, and the PIC value differed significantly between the within and prolonged groups. CONCLUSION The fibrinolysis reaction was detected in all three groups, but the status differed. CFWA has the potential to reflect the fibrinolysis status in one global assay.
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Affiliation(s)
- Takumi Tsuchida
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Mineji Hayakawa
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Osamu Kumano
- Sysmex Corporation, Kobe, Japan
- Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Takamatsu, Japan
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2
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Terras M, El Borgi W, Betbout W, Jaied R, Lakhal FB, Salem SF, Ghali O, Gouider E. Clot waveform analysis in acute promyelocytic leukemia. Blood Coagul Fibrinolysis 2024; 35:27-31. [PMID: 37994627 DOI: 10.1097/mbc.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The aim of this study was to evaluate the activated partial thromboplastin time (APTT) and prothrombin time (PT)-based clot waveform analysis (CWA) in patients diagnosed with acute promyelocytic leukemia (APL). APTT-based and PT-based CWA parameters of patients diagnosed with APL were analyzed and compared with healthy volunteers. Four APTT-CWA parameters were noted, maximum velocity corresponding to the first peak of the first derivative (max1), maximum acceleration corresponding to the first peak of the second derivative (max2) and the corresponding peak times of max1 and max2 (Tmax1, Tmax2). For the PT-CWA, two PT-CWA parameters were noted, maximum velocity (max1') and the corresponding timing (Tmax1'). The results were expressed in medians. Mann-Whitney U test was used to compare the CWA parameters. Correlations were examined using the Spearman correlation test. Tmax1 and Tmax2 were significantly prolonged in patients with APL in comparison with healthy volunteers. Although max1 and max2 were lower in APL patients compared with healthy volunteers, no significant difference was noted. There was a strong and significant correlation between the DIC score and the parameters max1, max2 and max1' and a very strong and significant correlation between fibrinogen levels and max1, max2 and max1'. When comparing DIC patients with hypofibrinogenemia and DIC without hypofibrinogenemia, a significant difference was noted in max1, max2, Tmax1 and Tmax2. The APTT and PT-based CWA analysis is a good tool to evaluate the bleeding tendency in APL, as it offers a novel approach for evaluating global hemostasis, predicting the bleeding risk and delivering improvements to APL patients management.
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Affiliation(s)
- Malek Terras
- Biological Hematology Department, Aziza Othmana Hospital, Tunis, Tunisia
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Mannan KA, Kumar N, Ahluwalia J, Hans C, Kler A, Prakash G, Jain R. The activated partial thromboplastin time-clot waveform analysis in hemophilia: Does it help in differentiation? Int J Lab Hematol 2023; 45:241-249. [PMID: 36495061 DOI: 10.1111/ijlh.14008] [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: 02/17/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The clot waveform analysis (CWA) provide valuable information beyond clotting time. The present study was planned to assess whether the activated partial thromboplastin time (aPTT)-CWA can differentiate between hemophilia A (HA), hemophilia B (HB), or hemophilia A with inhibitors (HAWI). METHODS The aPTT-CWA was generated by an optical detection system (ACL-TOP™ 500 coagulation analyzer) and the other tests were performed as per instructions from the manufacturer in the kit. RESULTS A total of 75 samples (47-HA, 16-HAWI, and 12-HB) with prolonged aPTT were recruited. On analyzing the quantitative aPTT-CWA data of HA (non-inhibitors) and HB samples, the width of acceleration 1 [+] peak was the differentiating finding. Among the significant parameters, the second derivative [+] peak was lower in both mild and moderate HA, equating to HB. The time for the height of 1/2 fibrin formation and width of velocity was significantly higher in mild, moderate and severe HA. The study did not show any significant differentiating finding while comparing HAWI and hemophilia A non-inhibitors (HANI). In the subgroups of HAWI and HANI with aPTT <70 s and 70-100 s, the second derivative [+] peak (2A) was higher and the time for the height of 1/2 fibrin formation (1C) was lesser in HAWI. CONCLUSION The aPTT-CWA parameters may be supportive for the differentiation of hemophilia including its severity and the existence of inhibitors.
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Affiliation(s)
- Khalid Abdul Mannan
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Narender Kumar
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Chander Hans
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Anita Kler
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Gaurav Prakash
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Richa Jain
- Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Kamon T, Horie S, Inaba T, Ito N, Shiraki K, Ichikawa Y, Ezaki M, Shimpo H, Shimaoka M, Nishigaki A, Shindo A, Wada H. The Detection of Hypercoagulability in Patients with Acute Cerebral Infarction Using a Clot Waveform Analysis. Clin Appl Thromb Hemost 2023; 29:10760296231161591. [PMID: 36872898 PMCID: PMC9989368 DOI: 10.1177/10760296231161591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
A few studies concerning hypercoagulable states have sufficiently been reported in patients with acute cerebral infarction (ACI), as ACI is generally considered to be caused by platelet activation. Clot waveform analyses (CWA) for activated partial thromboplastin time (APTT) and small amount of tissue factor FIX activation assay (sTF/FIXa) were examined in 108 patients with ACI, 61 patients without ACI, and 20 healthy volunteers. CWA-APTT and CWA-sTF/FIXa showed that the peak heights were significantly higher in ACI patients without anticoagulant therapy than in healthy volunteers. Absorbance exceeding 78.1 mm on the 1st DPH in the CWA-sTF/FIXa showed the highest odds ratio for ACI. The peak heights were significantly lower in the CWA-sTF/FIXa of ACI patients receiving argatroban therapy than in those of ACI patients without anticoagulant therapy. CWA can suggest a hypercoagulable state in ACI patients and may be useful for monitoring the need for anticoagulant therapy.
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Affiliation(s)
- Toshitaka Kamon
- Department of Neurology, 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Shotaro Horie
- Department of Neurology, 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Tomoya Inaba
- Department of Neurology, 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Nobuo Ito
- Department of Neurology, 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Katsuya Shiraki
- Department of General and Laboratory Medicine, 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Yuhuko Ichikawa
- Department of Central Laboratory, 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Minoru Ezaki
- Department of Central Laboratory, 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Hideto Shimpo
- 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, 38072Mie University Graduate School of Medicine, Tsu, Japan
| | - Akisato Nishigaki
- Department of Neurology, 38072Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Shindo
- Department of Neurology, 38072Mie University Graduate School of Medicine, Tsu, Japan
| | - Hideo Wada
- Department of General and Laboratory Medicine, 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
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Ruberto MF, Marongiu F, Barcellona D. Performance and Interpretation of Clot Waveform Analysis. Methods Mol Biol 2023; 2663:163-173. [PMID: 37204709 DOI: 10.1007/978-1-0716-3175-1_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The prothrombin time (PT) and the activated partial thromboplastin time (aPTT) are two basic tests for routine purposes, which are widely used in the clinical screening of coagulopathies. PT and aPTT are useful tests for detecting both symptomatic (hemorrhagic) and asymptomatic defects, but they are unsuitable for studying hypercoagulable states. However, these tests are available for studying the dynamic process of clot formation by means of the detection of the clot waveform analysis (CWA), which has been introduced several years ago. CWA can provide useful information on both hypocoagulable and hypercoagulable states. Nowadays it is possible to detect the whole clot formation both in the PT and aPTT tubes starting from the initial step of fibrin polymerization by means of specific and dedicated algorithm implemented in a coagulometer. In particular, CWA provides information on the velocity (first derivative), acceleration (second derivative), and density (delta) of clot formation. CWA has been applied to several pathologic conditions such as coagulation factor deficiency (including congenital hemophilia from factor VIII, IX, or XI deficiency), acquired hemophilia, disseminated intravascular coagulation (DIC), sepsis, replacement therapy management, chronic spontaneous urticarial, and liver cirrhosis, in patients with high venous thromboembolic risk before LMWH prophylaxis, and in patients with different hemorrhagic patterns along with an electron microscopy evaluation of the clot density. We report here materials and methods used for detecting the additional clotting parameters available in both PT and aPTT.
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Affiliation(s)
- Maria Filomena Ruberto
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Francesco Marongiu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Doris Barcellona
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- SHRO, Temple University, Philadelphia, PA, USA
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Kato K, Hatayama Y, Shimohiro H, Ichikawa H, Fukuda T. Differences in the Composition of Activated Partial Thromboplastin Time (APTT) Reagents Affect Clot Waveform Analysis. Yonago Acta Med 2022. [DOI: 10.33160/yam.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Konami Kato
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Yuki Hatayama
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Hisashi Shimohiro
- Department of Pathobiological Science and Technology, School of Health Sciences, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hitomi Ichikawa
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Tetsuya Fukuda
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
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7
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Kato K, Hatayama Y, Shimohiro H, Ichikawa H, Fukuda T. Differences in the Composition of Activated Partial Thromboplastin Time (APTT) Reagents Affect Clot Waveform Analysis. Yonago Acta Med 2022; 65:226-230. [DOI: 10.33160/yam.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Konami Kato
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Yuki Hatayama
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Hisashi Shimohiro
- Department of Pathobiological Science and Technology, School of Health Sciences, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hitomi Ichikawa
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Tetsuya Fukuda
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
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Clot Waveform Analysis Demonstrates Low Blood Coagulation Ability in Patients with Idiopathic Thrombocytopenic Purpura. J Clin Med 2021; 10:jcm10245987. [PMID: 34945283 PMCID: PMC8705019 DOI: 10.3390/jcm10245987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although platelets, which contain large amounts of phospholipids, play an important role in blood coagulation, there is still no routine assay to examine the effects of platelets in blood coagulation. METHODS Hemostatic abnormalities in patients with thrombocytopenia, including those with idiopathic thrombocytopenic purpura (ITP), were examined using clot wave analysis (CWA)-small-amount tissue-factor-induced FIX activation (sTF/FIXa) and thrombin time (TT). RESULTS Although there were no marked differences in the three parameters of activated partial thromboplastin time (APTT) between normal healthy volunteers and typical patients with ITP, the peak heights of the CWA-sTF/FIXa were markedly low in patients with ITP. The three peak times of the CWA-sTF/FIXa in patients with a platelet count of ≤8.0 × 1010/L were significantly longer than those in patients with a platelet count > 8.0 × 1010/L and the peak heights of the CWA-sTF/FIXa in patients with a platelet count of ≤8.0 × 1010/L were significantly lower than those in patients with >8.0 × 1010/L. The peak heights of the CWA-APTT in patients with ITP were significantly lower than in patients with other types of thrombocytopenia. The three peak heights of the CWA-sTF/FIXa in ITP patients were significantly lower than those in patients with other types of thrombocytopenia. The CWA-TT showed lower peak heights and longer peak times in patients with ITP in comparison to patients with other types of thrombocytopenia. CONCLUSIONS The CWA-sTF/FIXa and CWA-TT results showed that blood coagulation is enhanced by platelets and that the blood coagulation ability in ITP patients was low in comparison to healthy volunteers and patients with other types of thrombocytopenia.
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A Clot Waveform Analysis Showing a Hypercoagulable State in Patients with Malignant Neoplasms. J Clin Med 2021; 10:jcm10225352. [PMID: 34830633 PMCID: PMC8618625 DOI: 10.3390/jcm10225352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Abstract
(1) Objective: hypercoagulability in patients with malignant neoplasm were evaluated to examine the relationship with thrombosis. (2) Methods: clot waveform analysis (CWA)—activated partial thromboplastin time (APTT) and CWA—small amount of tissue factor induced FIX activation (sTF/FIXa) assays were performed in 92 patients with malignant neoplasm and the relationship between hypercoagulability and thrombosis was retrospectively examined. (3) Results: The study population included 92 patients with malignant neoplasms. Twenty-six (28.3%) had thrombotic diseases and 9 (9.8%) patients died within 28 days after the CWA. The peak time of the CWA-APTT could not show hypercoagulability in patients with malignant neoplasms. There were almost no significant differences in the peak times of the sTF/FIXa among patients with malignant neoplasms and healthy volunteers. In contrast, the peak heights of the CWA-sTF/FIXa in patients with various malignant neoplasms were significantly higher than those in healthy volunteers. Furthermore, among patients with malignant neoplasms, the peak heights of the sTF/FIXa in patients with thrombosis were significantly higher than those in patients without thrombosis. (4) Conclusions: although the routine APTT cannot evaluate the hypercoagulability, the peak heights of CWA-sTF/FIXa were significantly high in patients with malignant neoplasms, especially in those with thrombosis, suggesting that an elevated peak height of the CWA-sTF/FIXa may be a risk factor for thrombosis.
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Wada H, Ichikawa Y, Ezaki M, Matsumoto T, Yamashita Y, Shiraki K, Shimaoka M, Shimpo H. The Reevaluation of Thrombin Time Using a Clot Waveform Analysis. J Clin Med 2021; 10:jcm10214840. [PMID: 34768360 PMCID: PMC8585015 DOI: 10.3390/jcm10214840] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022] Open
Abstract
Object: Although thrombin burst has attracted attention as a physiological coagulation mechanism, clinical evidence from a routine assay for it is scarce. This mechanism was therefore evaluated by a clot waveform analysis (CWA) to assess the thrombin time (TT). Material and Methods: The TT with a low concentration of thrombin was evaluated using a CWA. We evaluated the CWA-TT of plasma deficient in various clotting factors, calibration plasma, platelet-poor plasma (PPP), and platelet-rich plasma (PRP) obtained from healthy volunteers, patients with thrombocytopenia, and patients with malignant disease. Results: Although the TT-CWA of calibration plasma was able to be evaluated with 0.01 IU/mL of thrombin, that of FVIII-deficient plasma could not be evaluated. The peak time of CWA-TT was significantly longer, and the peak height significantly lower, in various deficient plasma, especially in FVIII-deficient plasma compared to calibration plasma. The second peak of the first derivative (1st DP-2) was detected in PPP from healthy volunteers, and was shorter and higher in PRP than in PPP. The 1st DP-2 was not detected in PPP from patients with thrombocytopenia, and the 1st DP-2 in PRP was significantly lower in patients with thrombocytopenia and significantly higher in patients with malignant disease than in healthy volunteers. Conclusion: The CWA-TT became abnormal in plasma deficient in various clotting factors, and was significantly affected by platelets, suggesting that the CWA-TT may be a useful test for hemostatic abnormalities.
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Affiliation(s)
- Hideo Wada
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan;
- Correspondence: ; Tel.: +81-59-345-2321
| | - Yuhuko Ichikawa
- Department of Central Laboratory, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan; (Y.I.); (M.E.)
| | - Minoru Ezaki
- Department of Central Laboratory, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan; (Y.I.); (M.E.)
| | - Takeshi Matsumoto
- Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu 514-8507, Japan;
| | - Yoshiki Yamashita
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan;
| | - Katsuya Shiraki
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan;
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan;
| | - Hideto Shimpo
- Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan;
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Wada H, Matsumoto T, Ohishi K, Shiraki K, Shimaoka M. Update on the Clot Waveform Analysis. Clin Appl Thromb Hemost 2021; 26:1076029620912027. [PMID: 32862666 PMCID: PMC7466886 DOI: 10.1177/1076029620912027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The activated partial thromboplastin time (APTT)–clot waveform analysis (CWA) was previously reported to be associated with the early detection of disseminated intravascular coagulation and was also reported to be able to measure very low levels of coagulation factor VIII activity. The software program for the analysis for the APTT-CWA allows the associated first and second derivative curves (first and second DCs) to be displayed. The first and second DC reflect the velocity and acceleration, respectively. The height of the first DC reflects the “thrombin burst” and bleeding risk, while that of the second DC is useful for detecting any coagulation factor deficiency and abnormal enhancement of coagulation by phospholipids. Activated partial thromboplastin time-CWA aids in making a differential diagnosis which is difficult to do using only the routine APTT. The CWA is currently used for many applications in the clinical setting, including the monitoring of hemophilia patients and patients receiving anticoagulant therapy and the differential diagnosis of diseases.
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Affiliation(s)
- Hideo Wada
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan.,Associated Department with Mie Graduate School of Medicine, Tsu, Japan
| | - Takeshi Matsumoto
- Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu, Japan
| | - Kohshi Ohishi
- Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu, Japan
| | - Katsuya Shiraki
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan.,Associated Department with Mie Graduate School of Medicine, Tsu, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
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Hasegawa M, Tone S, Wada H, Naito Y, Matsumoto T, Yamashita Y, Shimaoka M, Sudo A. The Evaluation of Hemostatic Abnormalities Using a CWA-Small Amount Tissue Factor Induced FIX Activation Assay in Major Orthopedic Surgery Patients. Clin Appl Thromb Hemost 2021; 27:10760296211012094. [PMID: 34027710 PMCID: PMC8150457 DOI: 10.1177/10760296211012094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We analyzed the utility for a clot waveform analysis (CWA) of small tissue factor induced FIX activation (sTF/FIXa) assay in patients with major orthopedic surgery (including total hip arthroplasty [THA] and total knee arthroplasty [TKA]) receiving edoxaban for the prevention of venous thromboembolism (VTE). The sTF/FIXa assay using recombinant human TF in platelet-rich plasma (PRP) and platelet-poor plasma (PPP) was performed using a CWA in the above patients to monitor the efficacy of edoxaban administration. Of 147 patients (109 THA and 38 TKA), 21 exhibited deep vein thrombosis (DVT), and 15 had massive bleeding. Increased peak heights of the CWA-sTF/FIX were observed in almost patients after surgery and prolonged peak heights of the CWA-sTF/FIX were observed in almost patients treated with edoxaban. The peak heights and times of the CWA-sTF/FIX were significantly higher and shorter, respectively, in PRP than in PPP. There were no significant differences in parameters of the CWA-sTF/FIXa between the patients with and without DVT or between those with and without massive bleeding. The peak time of CWA-sTF/FIXa were significantly longer in TKA patients than in THA patients on day 1 after surgery. The second derivative peak height of the CWA-sTF/FIXa was significantly lower in TKA patients than in THA patients on day 4. The CWA-sTF/FIX reflected hemostatic abnormalities after surgery and the administration of edoxaban, and the results were better in PRP than PPP. Further studies separately analyzing the THA and TKA subgroups should be conducted.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hideo Wada
- Associated Department with Mie Graduate School of Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan.,Department of General Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takeshi Matsumoto
- Division of Blood Transfusion and Cell Therapy, Mie University Hospital, Tsu, Japan
| | - Yoshiki Yamashita
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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Clot waveform of APTT has abnormal patterns in subjects with COVID-19. Sci Rep 2021; 11:5190. [PMID: 33664450 PMCID: PMC7933409 DOI: 10.1038/s41598-021-84776-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
In Coronavirus disease 2019 (COVID-19) subjects, recent evidence suggests the presence of unique coagulation abnormalities. In this study, we performed clot waveform analyses to investigate whether specific modulations are observed in COVID-19 subjects. We analyzed the second derivative of the absorbance in routine APTT tests performed using an ACL-TOP system. We observed high frequencies of abnormal patterns in APTT second-derivative curves that could be classified into an early shoulder type, a late shoulder type, or a biphasic type, high maximum first-derivative and second-derivative peak levels, and a low minimum second-derivative peak level in COVID-19 subjects. These modulations were not observed in subjects with disseminated intravascular coagulation. These abnormal patterns are also observed in patients with lupus anticoagulant, hemophilia, or factor IX deficiency. The plasma fibrinogen levels might also be involved in the abnormal APTT waveforms, especially the high maximum first-derivative and second-derivative peak levels. The abnormal patterns in the APTT second-derivative curves appear with highest frequency at around 2 weeks after the onset of COVID-19 and were not associated with the severity of COVID-19. These results suggest the possible presence of a specific abnormal coagulopathy in COVID-19.
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Wada H, Shiraki K, Matsumoto T, Ohishi K, Shimpo H, Shimaoka M. Effects of platelet and phospholipids on clot formation activated by a small amount of tissue factor. Thromb Res 2020; 193:146-153. [PMID: 32559572 DOI: 10.1016/j.thromres.2020.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Physiological coagulation is considered to activate coagulation factor IX (FIX) by a small amount of tissue factor (TF) and activated coagulation factor VII (FVIIa) with the presence of platelets. A Clot waveform analysis (CWA) may be useful for evaluating physiological coagulation. MATERIAL AND METHODS A CWA using a small amount of TF (CWA/sTF) was performed in platelet-rich plasma (PRP), platelet-poor plasma (PPP), several phospholipids (PLs) and patients with lupus anticoagulant (LA), idiopathic thrombocytopenic purpura (ITP) or inhibitor for FVIII. RESULTS The CWA/sTF without PLs showed a shorter peak time and higher peak height in PRP than in PPP. The effect of PRP on the CWA/sTF depended on the platelet count, and PLs showed a similar effect on the CWA/sTF results in PPP. The peak time of the CWA/sTF in PRP was prolonged in patient with ITP. The CWA/sTF in PRP showed a prolonged peak time and decreased peak height of the second derivative in patient with LA. Both a shortened peak time and elevated peak height were observed in the CWA/sTF of patient with inhibitor after treatment with activated recombinant human FVII. CONCLUSION A CWA can be conducted using a small amount of TF and platelets or PL without contact activation and may be able to detect not only hemostatic abnormalities but also changes in platelet counts.
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Affiliation(s)
- Hideo Wada
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan; Associated Department with Mie Graduate School of Medicine, Tsu, Japan.
| | - Katsuya Shiraki
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan; Associated Department with Mie Graduate School of Medicine, Tsu, Japan
| | - Takeshi Matsumoto
- Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu, Japan
| | - Kohshi Ohishi
- Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu, Japan
| | - Hideto Shimpo
- Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of medicine, Tsu, Japan
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McGinnis E, Wong SKW, Smith TW. Evaluation of activated partial thromboplastin time coagulation waveform analysis for identification of patients with acquired factor VIII inhibitors. Int J Lab Hematol 2020; 42:411-417. [PMID: 32297466 DOI: 10.1111/ijlh.13211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Activated partial thromboplastin time (PTT) coagulation waveforms produced by optical detection system coagulation analyzers provide additional potentially useful and routinely underutilized information for the evaluation of a patient's coagulation system. We aimed to identify features of PTT coagulation waveforms, available for all PTT assays performed in our hospital laboratories, that may prove useful in directing early investigations in patients with unexplained prolonged PTT. METHODS We retrospectively reviewed 211 PTT coagulation waveforms from patient testing and categorized them based on the underlying hemostatic abnormality: normal, therapeutic anticoagulation, lupus anticoagulant, congenital factor deficiency, or acquired factor VIII inhibitor. We compared quantitative waveform parameters and the frequency of qualitatively abnormal double-peaked first derivative waveform curves between these groups. RESULTS Partial thromboplastin time and derivative curve maxima and minima differed significantly between acquired factor VIII inhibitors and other diagnostic categories, and the second derivative curve minimum demonstrated the highest area under the receiver operator characteristic curve for identification of acquired factor VIII inhibitors (0.860; maximum accuracy: 79.5% for 2Dmin> -39.3 mAbs/s2 [sensitivity 90.5%; specificity 77.2%]). The presence of an abnormal double-peaked first derivative curve had a sensitivity of 83.3% and specificity of 81.6% for identification of acquired factor VIII inhibitors in cases with PTT >50 seconds. CONCLUSION Partial thromboplastin time coagulation waveform analysis can aid in identification of patients with acquired factor VIII inhibitors and may be of clinical utility in directing early laboratory investigations to identify patients at risk of severe bleeding without prompt intervention.
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Affiliation(s)
- Eric McGinnis
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Steven K W Wong
- Division of Hematopathology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Tyler W Smith
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Division of Hematopathology, Vancouver General Hospital, Vancouver, BC, Canada
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Shimomura D, Matsumoto T, Sugimoto K, Takata T, Kouno A, Shimada M, Matsuo S, Kamioka M. The First-Derivative Curve of the Coagulation Waveform Reveals the Cause of aPTT Prolongation. Clin Appl Thromb Hemost 2020; 26:1076029620978810. [PMID: 33372824 PMCID: PMC7783875 DOI: 10.1177/1076029620978810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Clot waveform analysis based on activated partial thromboplastin time (aPTT) is
reported to be a useful assay. We attempted to find beneficial parameters with
the first-derivative curve. We examined 106 plasma samples with prolonged aPTT
and analyzed the first-derivative curve statistically by dividing it into 6
groups (Lupus anticoagulant, Heparin, Direct oral anticoagulants, Factor VIII
inhibitor, Hepatic dysfunctions and Factor deficiency). We obtained 7
coordinates for parameter measurement by analyzing the first-derivative curve
and set 20 parameters including the velocity axis, the time axis, and area
parameters. The distribution was checked by extracting each parameter that
showed the most significant difference in the 6 groups. As a result, it was
revealed that we could classify aPTT prolongation by using a combination of 3
parameters, the initial-to-peak gradient, the ratio initial-to-intermediate
velocity/intermediate-to-peak velocity, and the initial-to-peak area size. We
constructed a flowchart combining these 3 parameters and were able to
discriminate 75% of the specimens. These parameters derived from the
first-derivative curve of clot waveform analysis are useful tools to
discriminate aPTT prolongation.
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Affiliation(s)
- Daiki Shimomura
- Department of Laboratory Medicine, Tenri Hospital, Tenri City, Nara, Japan
| | - Tomoko Matsumoto
- Department of Clinical Laboratory Science, Tenri Health Care University, Tenri City, Nara, Japan
| | - Kana Sugimoto
- Department of Clinical Laboratory Science, Tenri Health Care University, Tenri City, Nara, Japan
| | - Tokio Takata
- Department of Laboratory Medicine, Tenri Hospital, Tenri City, Nara, Japan
| | - Aya Kouno
- Department of Laboratory Medicine, Tenri Hospital, Tenri City, Nara, Japan
| | - Masashi Shimada
- Department of Laboratory Medicine, Tenri Hospital, Tenri City, Nara, Japan
| | - Shuji Matsuo
- Department of Laboratory Medicine, Tenri Hospital, Tenri City, Nara, Japan
| | - Mikio Kamioka
- Department of Laboratory Medicine, Tenri Hospital, Tenri City, Nara, Japan
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17
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Suzuki K, Wada H, Matsumoto T, Ikejiri M, Ohishi K, Yamashita Y, Imai H, Iba T, Katayama N. Usefulness of the APTT waveform for the diagnosis of DIC and prediction of the outcome or bleeding risk. Thromb J 2019; 17:12. [PMID: 31297038 PMCID: PMC6598339 DOI: 10.1186/s12959-019-0201-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
Background The usefulness of the activated partial thromboplastin time (APTT) waveform has been reported in hemophilia, acquired hemophilia and monitoring for anticoagulants. Material and methods The APTT waveform was examined in patients suspected of having disseminated intravascular coagulation (DIC) to analyze its usefulness for the diagnosis of DIC or the prediction of the outcome or bleeding risk. Results DIC with fibrinogen < 2 g/L was frequently associated with infectious diseases (43.3%). The heights of the first derivative peak (1stDP) and second DP (2ndDP) were extremely low in DIC, especially DIC with hypofibrinogenemia, but high in infectious patients without DIC. The peak time and width of the 1stDP and 2ndDP were prolonged in patients with DIC. The heights of the 1stDP and 2ndDP were markedly low in patients with a poor outcome or those with hemoglobin < 8.0 g/dl. Discussion and conclusion As bleeding type DIC was observed in infectious DIC, DIC without hypofibrinogenemia might switch to DIC with hypofibrinogenemia by the progression of DIC. The height of the 1stDP and 2ndDP is useful for the diagnosis of DIC and prediction of the bleeding risk or outcome.
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Affiliation(s)
- Kei Suzuki
- 1Emergency Critical Care Center, Mie University Graduate School of Medicine, Tsu, Mie Japan
| | - Hideo Wada
- 2Departments of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Mie 514-8507 Japan
| | - Takeshi Matsumoto
- 3Division of Blood Transfusion Medicine and Cell Therapy, Mie University Graduate School of Medicine, Tsu, Mie Japan
| | - Makoto Ikejiri
- 4Central laboratory, Mie University Graduate School of Medicine, Tsu, Mie Japan
| | - Kohshi Ohishi
- 3Division of Blood Transfusion Medicine and Cell Therapy, Mie University Graduate School of Medicine, Tsu, Mie Japan
| | - Yoshiki Yamashita
- 5Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Mie Japan
| | - Hiroshi Imai
- 1Emergency Critical Care Center, Mie University Graduate School of Medicine, Tsu, Mie Japan
| | - Toshiaki Iba
- 6Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoyuki Katayama
- 5Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Mie Japan
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Matsumoto T, Wada H, Ohishi K, Yamashita Y, Ikejiri M, Katayama N. Comments to: An Evaluation of Hemostatic Abnormalities in Patients With Hemophilia by APTT Waveform, Peak Heights of APTT Waveform Are Useful for Diagnosing Hemophilia or Inhibitor. Clin Appl Thromb Hemost 2019; 25:1076029618824419. [PMID: 30808219 PMCID: PMC6714993 DOI: 10.1177/1076029618824419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Takeshi Matsumoto
- 1 Blood Transfusion Service and Cell Therapy, Mie University Hospital, Tsu, Japan
| | - Hideo Wada
- 2 Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Kohshi Ohishi
- 2 Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | | | - Makoto Ikejiri
- 4 Central Laboratory, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Katayama H, Matsumoto T, Wada H, Fujimoto N, Toyoda J, Abe Y, Ohishi K, Yamashita Y, Ikejiri M, Habe K, Katayama N. An Evaluation of Hemostatic Abnormalities in Patients With Hemophilia According to the Activated Partial Thromboplastin Time Waveform. Clin Appl Thromb Hemost 2018; 24:1170-1176. [PMID: 29439640 PMCID: PMC6714760 DOI: 10.1177/1076029618757344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The usefulness of the waveform of activated partial thromboplastin time (APTT) in various diseases has been evaluated in recent years. The APTT waveform was examined in patients with hemophilia and patients positive for lupus anticoagulant (LA). The correlation with the FVIII activity was highest for the height of acceleration peak. The peak time of acceleration, velocity, and ½ fibrin formation, and the width of acceleration and velocity were significantly long and the height of acceleration was significantly low in patients with hemophilia. The height of velocity was significantly low in patients with hemophilia with inhibitor. There were no significant differences in the APTT waveform between patients with hemophilia and patients with LA, but the peak of acceleration and ½ fibrin formation were significantly longer and the height of acceleration and velocity were significantly lower in patients with hemophilia with inhibitor than in the patients with LA. Wave changes in the APTT were observed in all 22 patients positive for LA, while a biphasic waveform was observed in patients with hemophilia with FVIII activity <10.0%. The APTT waveform is useful for the analysis of hemostatic abnormalities in patients with hemophilia.
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Affiliation(s)
- Haruna Katayama
- 1 Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.,2 Department of Ketsueki-Gyouko, Ogikubo hospital, Suginami, Tokyo, Japan
| | - Takeshi Matsumoto
- 3 Division of Blood Transfusion Medicine and Cell Therapy, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hideo Wada
- 4 Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Naoki Fujimoto
- 4 Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Junki Toyoda
- 3 Division of Blood Transfusion Medicine and Cell Therapy, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yasunori Abe
- 5 Central Laboratory, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kohshi Ohishi
- 3 Division of Blood Transfusion Medicine and Cell Therapy, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yoshiki Yamashita
- 1 Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Makoto Ikejiri
- 5 Central Laboratory, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Koji Habe
- 6 Department of Dermatology, Mie University Graduate School of medicine, Tsu, Mie, Japan
| | - Naoyuki Katayama
- 1 Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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