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Favaloro EJ, Mohammed S, Vong R, McVicker W, Chapman K, Swanepoel P, Kershaw G, Cai N, Just S, Connelly L, Prasad R, Brighton T, Pasalic L. Verification of the ACL Top 50 Family (350, 550, and 750) for Harmonization of Routine Coagulation Assays in a Large Network of 60 Laboratories. Am J Clin Pathol 2021; 156:661-678. [PMID: 33891005 DOI: 10.1093/ajcp/aqab004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To verify a single platform of hemostasis instrumentation, the ACL TOP 50 Family, comprising 350, 550, and 750 instruments, across a large network of 60 laboratories. METHODS Comparative evaluations of instrument classes (350 vs 550 and 750) were performed using a large battery of test samples for routine coagulation tests, comprising prothrombin time/international normalized ratio, activated partial thromboplastin time (APTT), thrombin time, fibrinogen and D-dimer, and using HemosIL reagents. Comparisons were also made against existing equipment (Diagnostica Stago Satellite, Compact, and STA-R Evolution) and existing reagents to satisfy national accreditation standards. Verification of manufacturer normal reference ranges (NRRs) and generation of an APTT heparin therapeutic range were undertaken. RESULTS The three instrument types were verified as a single instrument class, which will permit standardization of methods and NRRs across all instruments (n = 75) to be deployed in 60 laboratories. In particular, ACL TOP 350 test result data were similar to ACL TOP 550 and 750 and showed no to limited bias. All manufacturer NRRs were verified with occasional minor variance. CONCLUSIONS This ACL TOP 50 Family (350, 550, and 750) verification will enable harmonization of routine coagulation across all laboratories in the largest public pathology network in Australia.
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Affiliation(s)
- Emmanuel J Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, Australia
- Sydney Centres for Thrombosis and Haemostasis, Westmead, Australia
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia
| | - Soma Mohammed
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, Australia
| | - Ronny Vong
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, Australia
| | - Wendy McVicker
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, Australia
| | - Kent Chapman
- Haematology, NSW Health Pathology, John Hunter Hospital, Newcastle, Australia
| | - Priscilla Swanepoel
- Haematology, NSW Health Pathology, John Hunter Hospital, Newcastle, Australia
| | - Geoff Kershaw
- Haematology, NSW Health Pathology, Prince Alfred Hospital, Camperdown, Australia
| | - Nancy Cai
- Haematology, NSW Health Pathology, Prince Alfred Hospital, Camperdown, Australia
| | - Sarah Just
- Haematology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, Australia
| | - Lynne Connelly
- Haematology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, Australia
| | - Ritam Prasad
- Haematology, NSW Health Pathology, John Hunter Hospital, Newcastle, Australia
| | - Timothy Brighton
- Haematology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, Australia
| | - Leonardo Pasalic
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, Australia
- Sydney Centres for Thrombosis and Haemostasis, Westmead, Australia
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Favaloro EJ, McVicker W, Mohammed S, Hamdam S. Mathematical rounding as a post-analytical issue in pathology reporting: generation of bias in INR resulting. Pathology 2018; 50:459-461. [PMID: 29731140 DOI: 10.1016/j.pathol.2017.11.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/06/2017] [Accepted: 11/13/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia; Sydney Centres for Thrombosis and Haemostasis, Westmead, NSW, Australia.
| | - Wendy McVicker
- Department of Haematology, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Soma Mohammed
- Department of Haematology, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Sayed Hamdam
- NSW Health Pathology, Blacktown Hospital, Blacktown, NSW, Australia
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Favaloro EJ, McVicker W, Lay M, Ahuja M, Zhang Y, Hamdam S, Hocker N. Harmonizing the International Normalized Ratio (INR) : Standardization of Methods and Use of Novel Strategies to Reduce Interlaboratory Variation and Bias. Am J Clin Pathol 2016; 145:191-202. [PMID: 26800763 DOI: 10.1093/ajcp/aqv022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To reduce interlaboratory variation and bias in international normalized ratio (INR) results, as used to monitor patients receiving vitamin K antagonist therapy, including warfarin, in a large pathology network (n = 27 laboratories) by procedural standardization and harmonization. METHODS Network consensus to standardize to common instrument and reagent platforms was established, following development of hemostasis test specifications. Subsequent installations and implementation occurred after conclusion of a government tender process. Network-wide application of simple novel process of verification harmonization of local international sensitive index and mean normal prothrombin time initiated for each new lot of INR reagent that does not require ongoing use of reference thromboplastin or calibration/certified plasma sets. RESULTS We achieved reduction of different instrument manufacturers (from four to one), instrument types (10 to three), reagent types (four to one), and instrument/reagent combinations (12 to three), plus substantial reduction in INR variability and bias. CONCLUSIONS Results infer significant improvement in local patient management, with positive implications for other laboratories. For the United States in particular, lack of US Food and Drug Administration-cleared certified plasmas may compromise INR accuracy, and our novel approach may provide a workable alternative for laboratories and networks.
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Affiliation(s)
- Emmanuel J Favaloro
- From the Haematology Department, Institute of Clinical Pathology and Medical Research (ICPMR), Pathology West, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Wendy McVicker
- From the Haematology Department, Institute of Clinical Pathology and Medical Research (ICPMR), Pathology West, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Michelle Lay
- From the Haematology Department, Institute of Clinical Pathology and Medical Research (ICPMR), Pathology West, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Monica Ahuja
- From the Haematology Department, Institute of Clinical Pathology and Medical Research (ICPMR), Pathology West, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Yifang Zhang
- From the Haematology Department, Institute of Clinical Pathology and Medical Research (ICPMR), Pathology West, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Sayed Hamdam
- Pathology Department, Pathology West, NSW Health Pathology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Naomi Hocker
- Haematology Department, Pathology West, NSW Health Pathology, Wagga Wagga, NSW, Australia
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Joshi A, McVicker W, Segalla R, Favaloro E, Luu V, Vanniasinkam T. Determining the stability of complete blood count parameters in stored blood samples using the SYSMEX XE-5000 automated haematology analyser. Int J Lab Hematol 2015; 37:705-14. [DOI: 10.1111/ijlh.12389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/27/2015] [Indexed: 11/27/2022]
Affiliation(s)
- A. Joshi
- Institute of Clinical Pathology and Medical Research; Westmead Hospital; Sydney NSW Australia
| | - W. McVicker
- Institute of Clinical Pathology and Medical Research; Westmead Hospital; Sydney NSW Australia
| | - R. Segalla
- Institute of Clinical Pathology and Medical Research; Westmead Hospital; Sydney NSW Australia
| | - E. Favaloro
- Institute of Clinical Pathology and Medical Research; Westmead Hospital; Sydney NSW Australia
| | - V. Luu
- Institute of Clinical Pathology and Medical Research; Westmead Hospital; Sydney NSW Australia
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Favaloro EJ, McVicker W, Zhang Y, Hamdam S, Huynh M, Peris P, O'Neal M, Hocker N. Improving the inter-laboratory harmonization of the international normalized ratio (INR): utilizing the concept of transference to estimate and/or validate international sensitivity index (ISI) and mean normal prothrombin time (MNPT) values and/or to eliminate measurement bias. Clin Lab Sci 2012; 25:13-25. [PMID: 22458045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The Prothrombin Time (PT) assay is clinically the most often requested coagulation test, as used primarily for monitoring of Vitamin K antagonist therapy where results are typically expressed as an International Normalized Ratio (INR). The INR reflects the patient's PT adjusted for the specific test reagent and instrument combination used by applying two correction factors, namely the International Sensitivity Index (ISI) and the Mean Normal Prothrombin Time (MNPT), according to the formula: INR = (patient PT/MNPT)ISI. When the manufacturer provides an ISI, laboratories are encumbered to check or locally validate the assigned value. Where a manufacturer does not provide an ISI, the laboratory needs to define its own (local ISI) value. The MNPT typically has to be locally defined, based on the population being tested. The main current CLSI recommendation for defining ISI values comprises use of commercial reference ('certified') plasma calibration sets, but FDA cleared material is limited, and different results may arise using different products. The MNPT can be defined using a WHO/CLSI recommended procedure requiring 20 normal individuals or with some calibration sets. Overall, there is limited data to validate the performance of these processes in laboratory practice, and ongoing evidence from external quality assurance (proficiency testing) programs indicates continued failure in INR harmonization, suggesting that ISI and MNPT values used by laboratories (and presumably assessed using current recommended processes) continue to be inaccurate. OBJECTIVE To assess some novel approaches to the laboratory estimation and/or validation of ISI and MNPT values for use in the INR calculation, and including the process of 'transference', normally used to assess the comparability of analytical systems or to transfer reference intervals between comparable systems. RESULTS We have successfully adapted these comparative procedures, including 'transference', to permit ongoing estimation and/or validation of ISI and MNPT values for use in INR calculations for a range of instrumentation, which has led to improved harmonization of INR values obtained in our pathology network. These processes do not require the use of any normal individual plasmas or calibrator sets and greatly simplifies the INR process. Evidence for validation of the processes used is provided by ongoing satisfactory performance in external quality assurance (proficiency testing).
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Affiliation(s)
- Emmanuel J Favaloro
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead.
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Favaloro EJ, McVicker W, Zhang Y, Hamdam S, Huynh M, Peris P, O'Neal M, Hocker N. Improving the Inter-Laboratory Harmonization of the International Normalized Ratio (INR): Utilizing the Concept of Transference to Estimate and/or Validate International Sensitivity Index (ISI) and Mean Normal Prothrombin Time (MNPT) Values and/or to Eliminate Measurement Bias. ACTA ACUST UNITED AC 2012. [DOI: 10.29074/ascls.25.1.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Favaloro EJ, McVicker W, Hamdam S, Hocker N. Improving the harmonisation of the International Normalized Ratio (INR): time to think outside the box? Clin Chem Lab Med 2010; 48:1079-90. [DOI: 10.1515/cclm.2010.216] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Favaloro EJ, Hamdam S, McDonald J, McVicker W, Ule V. Time to think outside the box? Prothrombin time, international normalised ratio, international sensitivity index, mean normal prothrombin time and measurement of uncertainty a novel approach to standardisation. Pathology 2008; 40:277-87. [DOI: 10.1080/00313020801911454] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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