scholarly journals International Council for Standardization in Haematology (ICSH) recommendations for processing of blood samples for coagulation testing

2021 ◽  
Author(s):  
Steve Kitchen ◽  
Dorothy M. Adcock ◽  
Ray Dauer ◽  
Ann‐Helen Kristoffersen ◽  
Giuseppe Lippi ◽  
...  
Keyword(s):  
Blood Samples ◽  
International Council ◽  
Coagulation Testing

scholarly journals International Council for Standardisation in Haematology (ICSH) recommendations for collection of blood samples for coagulation testing

2021 ◽  
Author(s):  
Steve Kitchen ◽  
Dorothy M. Adcock ◽  
Ray Dauer ◽  
Ann‐Helen Kristoffersen ◽  
Giuseppe Lippi ◽  
...  
Keyword(s):  
Blood Samples ◽  
International Council ◽  
Coagulation Testing

Design and Development of a Unit-Use Cartridge for Coagulation Testing in Whole Blood

1999 ◽  
Author(s):  
Rhonda Cheadle ◽  
Andy Maczuszenko ◽  
Cindra Widrig Opalsky
Keyword(s):  
Blood Sample ◽  
Whole Blood ◽  
Clot Formation ◽  
Coagulation Cascade ◽  
Design And Development ◽  
Blood Samples ◽  
Coagulation Assays ◽  
Coagulation Testing ◽  
Functional Features ◽  
Whole Blood Samples

Abstract The following describes the development of a disposable cartridge for use at the patient bedside to perform traditional coagulation assays on fresh whole blood samples. The cartridge provides a means by which a blood sample can be metered and quantitatively mixed with reagents that activate the coagulation cascade. Clot formation is subsequently detected using a microfabricated sensor housed within the cartridge. The functional features of the cartridge and sensor are described.

Heparin and citrate additive carryover during blood collection

2019 ◽  
Vol 57 (12) ◽  
pp. 1888-1896 ◽  
Author(s):  
Martin H. Keppel ◽  
Simon Auer ◽  
Giuseppe Lippi ◽  
Alexander von Meyer ◽  
Michael Cornes ◽  
...  
Keyword(s):  
Clinical Chemistry ◽  
Relative Volume ◽  
Ionized Calcium ◽  
Blood Collection ◽  
Thrombin Time ◽  
Blood Samples ◽  
Published Evidence ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Clinically Significant

Abstract Background Published evidence on the risk of additive carryover during phlebotomy remains elusive. We aimed to assess potential carryover of citrated and heparinized blood and the relative volume needed to bias clinical chemistry and coagulation tests. Methods We simulated standardized phlebotomies to quantify the risk of carryover of citrate and heparin additives in distilled water, using sodium and lithium as surrogates. We also investigated the effects of contamination of heparinized blood samples with increasing volumes of citrated blood and pure citrate on measurements of sodium, potassium, chloride, magnesium, total and ionized calcium and phosphate. Likewise, we studied the effects of contamination of citrated blood samples with increasing volumes of heparinized blood on heparin (anti-Xa) activity, lithium, activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time (TT). We interpreted these results based on measurement deviations beyond analytical, biological and clinical significance. Results Standardized phlebotomy simulations revealed no significant differences in concentration of surrogate markers. Clinically significant alterations were observed after contamination of heparinized blood samples with volumes of citrated blood beyond 5–50 μL for ionized calcium and beyond 100–1000 μL for sodium, chloride and total calcium. Investigations of pure citrate carryover revealed similar results at somewhat lower volumes. Heparinized blood carryover showed clinically significant interference of coagulation testing at volumes beyond 5–100 μL. Conclusions Our results suggest that during a standardized phlebotomy, heparin or citrate contamination is highly unlikely. However, smaller volumes are sufficient to severely alter test results when deviating from phlebotomy guidelines.

scholarly journals LO37: Reducing hemolysis of coagulation blood samples in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S20-S20
Author(s):  
H. Weatherby ◽  
V. Woolner ◽  
L. Chartier ◽  
S. Casey ◽  
C. Ong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Best Practice ◽  
Average Rate ◽  
International Normalized Ratio ◽  
Chi Square ◽  
Statistical Process ◽  
Blood Samples ◽  
Process Measure ◽  
Coagulation Testing ◽  
Ed Visits

Background: Hemolysis of blood samples is the leading cause of specimen rejection from hospital laboratories. It contributes to delays in patient care and disposition decisions. Coagulation tests (prothrombin time/international normalized ratio [PT/INR] and activated partial thromboplastin time [aPTT]) are especially problematic for hemolysis in our academic hospital, with at least one sample rejected daily from the emergency department (ED). Aim Statement: We aimed to decrease the monthly rate of hemolyzed coagulation blood samples sent from the ED from a rate of 2.9% (53/1,857) to the best practice benchmark of less than 2% by September 1st, 2019. Measures & Design: Our outcome measure was the rate of hemolyzed coagulation blood samples. Our process measure was the rate of coagulation blood tests sent per 100 ED visits. Our balancing measure was the number of incident reports by clinicians when expected coagulation testing did not occur. We used monthly data for our Statistical Process Control (SPC) charts, as well as Chi square and Mann-Whitney U tests for our before-and-after evaluation. Using the Model for Improvement to develop our project's framework, we used direct observation, broad stakeholder engagement, and process mapping to identify root causes. We enlisted nursing champions to develop our Plan-Do-Study-Act (PDSA) cycles/interventions: 1) educating nurses on hemolysis and coagulation testing; 2) redesigning the peripheral intravenous and blood work supply carts to encourage best practice; and 3) removing PT/INR and aPTT from automatic inclusion in our electronic chest pain bloodwork panel. Evaluation/Results: The average rate of hemolysis remained unchanged from baseline (2.9%, p = 0.83). The average rate of coagulation testing sent per 100 ED visits decreased from 41.5 to 28.8 (absolute decrease 12.7 per 100, p < 0.05), avoiding $4,277 in monthly laboratory costs. The SPC chart of our process measure showed special cause variation with greater than eight points below the centerline. Discussion/Impact: Our project reduced coagulation testing, without changing hemolysis rates. Buy-in from frontline nurses was integral to the project's early success, prior to implementing our electronic approach – a solution ranked higher on the hierarchy of intervention effectiveness – to help sustainability. This resource stewardship project will now be spread to a nearby institution by utilizing similar approaches.

To mix or not to mix venous blood samples collected in vacuum tubes?

2011 ◽  
Vol 49 (12) ◽  
Author(s):  
Anna Parenmark ◽  
Eva Landberg
Keyword(s):  
Lactate Dehydrogenase ◽  
Clinical Chemistry ◽  
Venous Blood ◽  
Activated Partial Thromboplastin Time ◽  
Plasma Lactate ◽  
Citrate Buffer ◽  
Blood Samples ◽  
Coagulation Testing ◽  
Vacuum Tubes ◽  
Mixed Samples

AbstractThere are recommendations to mix venous blood samples by inverting the tubes immediately after venipuncture. Though mixing allows efficient anticoagulation in plasma tubes and fast initiation of coagulation in serum tubes, the effect on laboratory analyses and risk of haemolysis has not been thoroughly evaluated.Venous blood samples were collected by venipuncture in vacuum tubes from 50 patients (10 or 20 patients in each group). Four types of tubes and 18 parameters used in routine clinical chemistry were evaluated. For each patient and tube, three types of mixing strategies were used: instant mixing, no mixing and 5 min of rest followed by mixing.Most analyses did not differ significantly in samples admitted to different mixing strategies. Plasma lactate dehydrogenase and haemolysis index showed a small but significant increase in samples omitted to instant mixing compared to samples without mixing. However, in one out of twenty non-mixed samples, activated partial thromboplastin time was seriously affected.These results indicate that mixing blood samples after venipuncture is not mandatory for all types of tubes. Instant mixing may introduce interference for those analyses susceptible to haemolysis. However, tubes with liquid-based citrate buffer for coagulation testing should be mixed to avoid clotting.

scholarly journals Use of an Automated Coagulation Analyzer to Perform Heparin Neutralization With Polybrene in Blood Samples for Routine Coagulation Testing: Practical, Rapid, and Inexpensive

2013 ◽  
Vol 137 (11) ◽  
pp. 1641-1647 ◽  
Author(s):  
Panutsaya Tientadakul ◽  
Chulalak Kongkan ◽  
Wimol Chinswangwatanakul
Keyword(s):  
Prothrombin Time ◽  
Blood Samples ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Clinically Significant ◽  
Aptt Reagent ◽  
Heparin Neutralization ◽  
Coagulation Analyzer ◽  
Suitable Sequence ◽  
Routine Coagulation

Context.—Heparin contamination in blood samples may cause false prolongation of activated partial thromboplastin time (aPTT) and prothrombin time results. Polybrene can neutralize heparin, but it affects coagulation by itself. Objectives.——To determine the optimal concentration of polybrene to neutralize heparin, to determine the suitable sequence of reagents for the neutralization method performed on the analyzer at the same time as prothrombin time and aPTT testing, and to detect the heparin contamination in blood samples for coagulation tests in our hospital using this method. Design.—Various concentrations of heparin were added to 10 normal and 76 abnormal plasma samples to study the efficacy of polybrene. Two programs of reagent sequencing for aPTT with polybrene performed on the analyzer were tested. Samples suspected of heparin contamination according to our criteria were selected for neutralization during a 3-month period. Results.——The optimal final concentration of polybrene was 25 μg/mL. Polybrene should be added after the aPTT reagent to minimize its interference effect. Even though results of prothrombin time and aPTT after neutralization did not equal those before the spike of heparin, the differences might not be clinically significant. Eighty-one of 4921 samples (1.6%) were selected for aPTT with the neutralization method, and the detection rate of heparin contamination was 84% (68 of 81), giving an overall incidence of 1.4% (68 of 4921). Conclusions.—This method is inexpensive and can be performed rapidly with prothrombin time and aPTT on the automated analyzer, which makes it easy to practice with no need for extra plasma volumes.

scholarly journals Specific Point-of-Care Testing of Coagulation in Patients Treated with Dabigatran

2021 ◽  
Author(s):  
Florian Härtig ◽  
Ingvild Birschmann ◽  
Andreas Peter ◽  
Matthias Ebner ◽  
Charlotte Spencer ◽  
...  
Keyword(s):  
Point Of Care ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Rapid Assessment ◽  
Plasma Concentrations ◽  
High Sensitivity ◽  
Diagnostic Study ◽  
Blood Samples ◽  
Urgent Surgery ◽  
Coagulation Testing

Abstract Background and Purpose Accurate and rapid assessment of coagulation status is necessary to guide thrombolysis or reversal of anticoagulation in stroke patients, but commercially available point-of-care (POC) assays are not suited for coagulation testing in patients treated with direct oral anticoagulants (DOACs). We aimed to evaluate the direct thrombin monitoring (DTM) test card by Helena Laboratories (Texas, United States) for anti-IIa-specific POC coagulation testing, hypothesizing that its POC-ecarin clotting time (POC-ECT) accurately reflects dabigatran plasma concentrations. Methods A prospective single-center diagnostic study (ClinicalTrials.gov-identifier: NCT02825394) was conducted enrolling patients receiving a first dose of dabigatran and patients already on dabigatran treatment. Blood samples were collected before drug intake and 0.5, 1, 2, 8, and 12 hours after intake. POC-ECT was performed using whole blood (WB), citrated blood (CB), and citrated plasma (CP). Dabigatran plasma concentrations were determined by mass spectrometry. Results In total, 240 blood samples from 40 patients contained 0 to 275 ng/mL of dabigatran. POC-ECT with WB/CB/CP ranged from 20 to 186/184/316 seconds. Pearson's correlation coefficient showed a strong correlation between dabigatran concentrations and POC-ECT with WB/CB/CP (R2  = 0.78/0.90/0.92). Dabigatran concentrations >30 and >50 ng/mL (thresholds for thrombolysis, surgery, and reversal therapy according to clinical guidelines) were detected by POC-ECT with WB/CB/CP (>36/35/45 and >43/45/59 seconds) with 95/97/97 and 96/98/97% sensitivity, and 81/87/94 and 74/60/91% specificity. Conclusion This first study evaluating DOAC-specific POC coagulation testing revealed an excellent correlation of POC-ECT with actual dabigatran concentrations. Detecting clinically relevant dabigatran levels with high sensitivity/specificity, the DTM assay represents a suitable diagnostic tool in acute stroke, hemorrhage, and urgent surgery.

Stability of antioxidant vitamins in whole human blood during overnight storage at 4°C and frozen storage up to 6 months

2018 ◽  
Vol 88 (3-4) ◽  
pp. 151-157 ◽  
Author(s):  
Scott W. Leonard ◽  
Gerd Bobe ◽  
Maret G. Traber
Keyword(s):  
Ascorbic Acid ◽  
Whole Blood ◽  
Healthy Subjects ◽  
Frozen Storage ◽  
Blood Collection ◽  
Plasma Samples ◽  
Optimal Conditions ◽  
Plasma Ascorbic Acid ◽  
Blood Samples ◽  
Sample Handling

Abstract. To determine optimal conditions for blood collection during clinical trials, where sample handling logistics might preclude prompt separation of erythrocytes from plasma, healthy subjects (n=8, 6 M/2F) were recruited and non-fasting blood samples were collected into tubes containing different anticoagulants (ethylenediaminetetra-acetic acid (EDTA), Li-heparin or Na-heparin). We hypothesized that heparin, but not EDTA, would effectively protect plasma tocopherols, ascorbic acid, and vitamin E catabolites (α- and γ-CEHC) from oxidative damage. To test this hypothesis, one set of tubes was processed immediately and plasma samples were stored at −80°C, while the other set was stored at 4°C and processed the following morning (~30 hours) and analyzed, or the samples were analyzed after 6 months of storage. Plasma ascorbic acid, as measured using HPLC with electrochemical detection (LC-ECD) decreased by 75% with overnight storage using EDTA as an anticoagulant, but was unchanged when heparin was used. Neither time prior to processing, nor anticoagulant, had any significant effects upon plasma α- or γ-tocopherols or α- or γ-CEHC concentrations. α- and γ-tocopherol concentrations remained unchanged after 6 months of storage at −80°C, when measured using either LC-ECD or LC/mass spectrometry. Thus, refrigeration of whole blood at 4°C overnight does not change plasma α- or γ-tocopherol concentrations or their catabolites. Ascorbic acid is unstable in whole blood when EDTA is used as an anticoagulant, but when whole blood is collected with heparin, it can be stored overnight and subsequently processed.

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