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Yu J, Zhu G, Cui K, Yu D, Bayartaikishigtai D, Chen Z, Zhou Z. Comparison of the speed and quality of innovative and traditional pneumatic tube system transport outside of an emergency laboratory. Heliyon 2024; 10:e31511. [PMID: 38826741 PMCID: PMC11141344 DOI: 10.1016/j.heliyon.2024.e31511] [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: 01/21/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024] Open
Abstract
Background Ensuring the rapidity and accuracy of emergency laboratory test results is especially important to save the lives of patients with acute and critical conditions. To better meet the needs of clinicians and patients, detection efficiency can be improved by reducing extra-laboratory sample turnaround times (TATs) through the use of innovative pneumatic tube system (PTS) transport for sample transport. However, concerns remain regarding the potential compromise of sample quality during PTS transit relative to that occurring with manual transportation. This study was performed to evaluate the efficacy of an innovative PTS (Tempus600 PTS) relative to a traditional PTS in terms of sample transit time, sample quality, and the concordance of analytical results with those obtained from manually transported samples. Methods In total, 30 healthy volunteers aged >18 years were recruited for this study, conducted for five consecutive days. Venous blood samples were collected from six volunteers per day at fixed timepoints. From each volunteer, nine blood samples were collected into tubes with tripotassium ethylene diamine tetraacetic acid anticoagulant, tubes with 3.2 % sodium citrate, and serum tubes with separation gel (n = 3 each) and subjected to all tests conducted in the emergency laboratory in our hospital. 270 blood samples from 30 healthy volunteers were transported and analyzed, yielding 6300 test results. The blood samples were divided randomly into three groups (each containing one tube of each type) and transported to the emergency laboratory manually and with Tempus600 PTS and conventional Swisslog PTS, respectively. The extra-laboratory TATs, sample quality, and test results of the transported blood samples were compared. Results The sample quality and test results did not differ according to the delivery method. The TAT was much shorter with the Tempus600 than with the other two transport modes (58.40 ± 1.52 s vs. 1711.20 ± 77.56 s for manual delivery and 146.60 ± 1.82 s for the Swisslog PTS; P = 0.002). Conclusion Blood sample transport with the Tempus600 PTS significantly reduced the extra-laboratory TAT without compromising sample quality or test result accuracy, thereby improving the efficiency of sample analysis and the services provided to clinicians and patients.
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Affiliation(s)
| | | | - Kai Cui
- Diagnostic Laboratory Service, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dongze Yu
- Diagnostic Laboratory Service, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dabuxilite Bayartaikishigtai
- Diagnostic Laboratory Service, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zixin Chen
- Diagnostic Laboratory Service, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zhou Zhou
- Diagnostic Laboratory Service, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
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2
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Fan BE, Lippi G, Favaloro EJ. D-dimer Levels for the exclusion of pulmonary embolism: making sense of international guideline recommendations. J Thromb Haemost 2024; 22:604-608. [PMID: 38135252 DOI: 10.1016/j.jtha.2023.12.015] [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: 10/28/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Several international guidelines provide recommendations around the use of D-dimer testing for exclusion of pulmonary embolism, including the appropriate D-dimer threshold (or cutoff), but there is no consensus among them. We briefly discuss guideline variation, performance characteristics, and limitations of commercially available D-dimer assays in this setting, referencing the Clinical and Laboratory Standards Institute guidelines that recommend immunoassays with high sensitivity (≥97%) and negative predictive value (≥98%). While age-adjusted D-dimer and pretest-adjusted D-dimer are considered a safe strategy across predefined patient subgroups, clinicians need to recognize the different performance characteristics of D-dimer assays to enable safe clinical decisions for their patients. Importantly, D-dimer values must be correlated not only to clinical findings but also interpreted within the context of the accuracy and precision of the specific testing modality, adhering to manufacturer specifications that are approved by regulatory authorities.
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Affiliation(s)
- Bingwen Eugene Fan
- Department of Haematology, Tan Tock Seng Hospital, Singapore; Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore; Lee Kong Chian School of Medicine, Singapore; Yong Loo Lin School of Medicine, Singapore.
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research, Sydney Centres for Thrombosis and Haemostasis, New South Wales Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia; School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, Australia; School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia.
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3
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Chen S, Zang Y, Wang L, Zheng J, Deng H, Li M, Li Y, Qian B, Lu Y. Evaluation of a rail logistics transmission system for the transportation of blood components within a medical centre. Vox Sang 2023; 118:955-965. [PMID: 37673798 DOI: 10.1111/vox.13527] [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: 04/27/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Rail logistics transmission systems (RLTSs) are commonly used for the transportation of blood samples, pathological specimens and other medical materials in many hospitals, as they are rapid, secure, cost-effective and intelligent. However, few studies have evaluated blood component transportation from blood banks to the patient care areas of hospitals using RLTS. In this study, we evaluate the RLTS used for the transportation of blood components within a medical centre. MATERIALS AND METHODS The dispatch of blood components, including packed red blood cells (pRBCs), fresh frozen plasma (FFP), cryoprecipitate and platelet units, from a blood bank to critical care areas or general wards was done using RLTS. Parameters such as the delivery time, temperature, physical integrity and blood component quality were evaluated via analytical testing using specimens obtained before and after transportation by RLTS. RESULTS The turnaround time and temperature of all tested blood units via RLTS transportation were able to meet the clinical demands of blood component delivery (median time: 323 s [118-668 s]; temperature variation: 4.5-8.9°C for pRBCs and FFP and 21.5-23.5°C for cryoprecipitate and platelet units). Furthermore, parameters of pRBC quality, including the haemolysis index and potassium and lactate dehydrogenase levels in plasma, were not significantly different before and after transportation through RLTS. Similarly, RLTS transportation affected neither the basic coagulation test results in FFP and cryoprecipitate specimens nor platelet aggregation and activation markers in apheresis platelet specimens. CONCLUSION Hospital-wide delivery of blood components via RLTS seems to be safe, reliable and cost-effective and does not have any negative impact on blood quality. Therefore, the establishment of standard criteria, protocols and guidelines based on further studies is needed.
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Affiliation(s)
- Shaoheng Chen
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zang
- Department of Blood Transfusion, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Lili Wang
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zheng
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huimin Deng
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meiting Li
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaohua Li
- Department of Blood Transfusion, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Baohua Qian
- Department of Laboratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanshan Lu
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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4
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Shaw JR, Castellucci LA, Siegal D, Carrier M. DOAC-associated bleeding, hemostatic strategies, and thrombin generation assays - a review of the literature. J Thromb Haemost 2023; 21:433-452. [PMID: 36696204 DOI: 10.1016/j.jtha.2022.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/24/2022] [Accepted: 11/15/2022] [Indexed: 01/26/2023]
Abstract
Direct oral anticoagulants (DOACs) account for most oral anticoagulant use. DOAC-associated bleeding events are commonly encountered in clinical practice and are associated with substantial morbidity and mortality. Both specific reversal agents and nonspecific hemostatic therapies, such as prothrombin complex concentrates, are used in the management of DOAC-associated bleeding. Measuring hemostatic efficacy and demonstrating a clinical impact from these therapies among studies of bleeding patients is challenging. Thrombin generation assays provide information on the total hemostatic potential of plasma, and have emerged as a promising modality to both measure the impact of DOACs on coagulation and to evaluate the effects of hemostatic therapies among patients with DOAC-associated bleeding. The mechanisms by which nonspecific hemostatic agents impact coagulation and thrombin generation in the context of DOAC therapy are unclear. As a result, we undertook a review of the literature using a systematic search strategy with the goal of summarizing the effects of DOACs on thrombin generation and the effects of both specific reversal agents and nonspecific hemostatic therapies on DOAC-altered thrombin generation parameters. We sought to identify clinical studies focusing on whether altered thrombin generation is associated with clinical bleeding and whether correction of altered thrombin generation parameters predicts improvements in clinical hemostasis. Lastly, we sought to outline future directions for the application of thrombin generation assays toward anticoagulation therapies and the question of anticoagulation reversal.
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Affiliation(s)
- Joseph R Shaw
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Lana A Castellucci
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Deborah Siegal
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marc Carrier
- Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
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5
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Wauthier L, Favresse J, Hardy M, Douxfils J, Le Gal G, Roy P, van Es N, Ay C, ten Cate H, Lecompte T, Lippi G, Mullier F. D-dimer testing: A narrative review. Adv Clin Chem 2023. [DOI: 10.1016/bs.acc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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6
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D-dimer Testing in Pulmonary Embolism with a Focus on Potential Pitfalls: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12112770. [PMID: 36428830 PMCID: PMC9689068 DOI: 10.3390/diagnostics12112770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
D-dimer is a multifaceted biomarker of concomitant activation of coagulation and fibrinolysis, which is routinely used for ruling out pulmonary embolism (PE) and/or deep vein thrombosis (DVT) combined with a clinical pretest probability assessment. The intended use of the tests depends largely on the assay used, and local guidance should be applied. D-dimer testing may suffer from diagnostic errors occurring throughout the pre-analytical, analytical, and post-analytical phases of the testing process. This review aims to provide an overview of D-dimer testing and its value in diagnosing PE and discusses the variables that may impact the quality of its laboratory assessment.
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7
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Märtens CM, Schöpfel J, Bollmann S, Hannemann A, Zylla S, Dahl MB, Gauß F, Schedl J, Nauck M, Petersmann A. Evaluation of a pneumatic tube system carrier prototype with fixing mechanism allowing for automated unloading. Clin Chem Lab Med 2022; 60:1202-1210. [PMID: 35635785 DOI: 10.1515/cclm-2022-0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A carrier prototype by Aerocom® (Schwäbisch Gmünd, Germany) for pneumatic tube systems (PTS) is able to transport 9 blood tubes which are automatically fixed by closing the lid. In this study, we examined the influence of the transport on blood sample quality using the carrier prototype comparing to courier transport and a conventional carrier (AD160, Aerocom®). METHODS Triplicate blood samples sets (1 lithium heparin, 1 EDTA, 1 sodium citrate) of 35 probands were split among the transportation methods: 1. courier, 2. conventional carrier, and 3. carrier prototype. After transport 51 measurands from clinical chemistry, hematology and coagulation were measured and compared. RESULTS Overall, 49 of the investigated 51 measurands showed a good concordance among the three transport types, especially between the conventional carrier and the carrier prototype. Focusing on well-known hemolysis sensitive measurands, potassium showed no statistically significant differences. However, between courier and both carrier types lactate dehydrogenase (LDH) and free hemoglobin (fHb) showed statistically significant shifts, whereas the clinical impact of the identified differences was neglectable. The median concentration of fHb, for example, was 0.29 g/L (18 µmol/L), 0.31 g/L (19 µmol/L) and 0.32 g/L (20 µmol/L) for courier transport, conventional carrier and carrier prototype, respectively. These differences cannot be resolved analytically since the minimal difference (MD) for fHb is 0.052 g/L (3.23 µmol/L), at this concentration. CONCLUSIONS The carrier prototype by Aerocom® is suitable for transportation of diagnostic blood samples. The overall workflow is improved by decreasing hands-on-time on the ward and laboratory while minimizing the risk of incorrectly packed carriers.
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Affiliation(s)
- Cora M Märtens
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Juliane Schöpfel
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Bollmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Stephanie Zylla
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Mathilde Borg Dahl
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Friederike Gauß
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
| | - Josef Schedl
- Technical Department, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
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8
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Uldry AC, Maciel-Dominguez A, Jornod M, Buchs N, Braga-Lagache S, Brodard J, Jankovic J, Bonadies N, Heller M. Effect of Sample Transportation on the Proteome of Human Circulating Blood Extracellular Vesicles. Int J Mol Sci 2022; 23:ijms23094515. [PMID: 35562906 PMCID: PMC9099550 DOI: 10.3390/ijms23094515] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023] Open
Abstract
Circulating extracellular vesicles (cEV) are released by many kinds of cells and play an important role in cellular communication, signaling, inflammation modulation, coagulation, and tumor growth. cEV are of growing interest, not only as biomarkers, but also as potential treatment targets. However, very little is known about the effect of transporting biological samples from the clinical ward to the diagnostic laboratory, notably on the protein composition. Pneumatic tube systems (PTS) and human carriers (C) are both routinely used for transport, subjecting the samples to different ranges of mechanical forces. We therefore investigated qualitatively and quantitatively the effect of transport by C and PTS on the human cEV proteome and particle size distribution. We found that samples transported by PTS were subjected to intense, irregular, and multidirectional shocks, while those that were transported by C mostly underwent oscillations at a ground frequency of approximately 4 Hz. PTS resulted in the broadening of nanoparticle size distribution in platelet-free (PFP) but not in platelet-poor plasma (PPP). Cell-type specific cEV-associated protein abundances remained largely unaffected by the transport type. Since residual material of lymphocytes, monocytes, and platelets seemed to dominate cEV proteomes in PPP, it was concluded that PFP should be preferred for any further analyses. Differential expression showed that the impact of the transport method on cEV-associated protein composition was heterogeneous and likely donor-specific. Correlation analysis was nonetheless able to detect that vibration dose, shocks, and imparted energy were associated with different terms depending on the transport, namely in C with cytoskeleton-regulated cell organization activity, and in PTS with a release of extracellular vesicles, mainly from organelle origin, and specifically from mitochondrial structures. Feature selection algorithm identified proteins which, when considered together with the correlated protein-protein interaction network, could be viewed as surrogates of network clusters.
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Affiliation(s)
- Anne-Christine Uldry
- Proteomics and Mass Spectrometry Core Facility, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland; (A.-C.U.); (A.M.-D.); (M.J.); (N.B.); (S.B.-L.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
| | - Anabel Maciel-Dominguez
- Proteomics and Mass Spectrometry Core Facility, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland; (A.-C.U.); (A.M.-D.); (M.J.); (N.B.); (S.B.-L.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
| | - Maïwenn Jornod
- Proteomics and Mass Spectrometry Core Facility, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland; (A.-C.U.); (A.M.-D.); (M.J.); (N.B.); (S.B.-L.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
| | - Natasha Buchs
- Proteomics and Mass Spectrometry Core Facility, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland; (A.-C.U.); (A.M.-D.); (M.J.); (N.B.); (S.B.-L.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
| | - Sophie Braga-Lagache
- Proteomics and Mass Spectrometry Core Facility, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland; (A.-C.U.); (A.M.-D.); (M.J.); (N.B.); (S.B.-L.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
| | - Justine Brodard
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (J.B.); (J.J.)
| | - Jovana Jankovic
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (J.B.); (J.J.)
| | - Nicolas Bonadies
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (J.B.); (J.J.)
| | - Manfred Heller
- Proteomics and Mass Spectrometry Core Facility, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland; (A.-C.U.); (A.M.-D.); (M.J.); (N.B.); (S.B.-L.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland;
- Correspondence: ; Tel.: +41-31-684-04-82
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9
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Gomez K, Anderson J, Baker P, Biss T, Jennings I, Lowe G, Platton S. Clinical and laboratory diagnosis of heritable platelet disorders in adults and children: a British Society for Haematology Guideline. Br J Haematol 2021; 195:46-72. [PMID: 34435350 DOI: 10.1111/bjh.17690] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Keith Gomez
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London
| | - Julia Anderson
- Haemophilia Thrombosis and Immunology Centre, Royal Infirmary, NHS Lothian, Edinburgh
| | - Peter Baker
- Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Tina Biss
- Haemophilia Comprehensive Care Centre, Royal Victoria Infirmary, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
| | - Ian Jennings
- UK NEQAS for Blood Coagulation, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Gillian Lowe
- Haemophilia Comprehensive Care Centre, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sean Platton
- Haemophilia Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK
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10
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Kitchen S, Adcock DM, Dauer R, Kristoffersen AH, Lippi G, Mackie I, Marlar RA, Nair S. International Council for Standardization in Haematology (ICSH) recommendations for processing of blood samples for coagulation testing. Int J Lab Hematol 2021; 43:1272-1283. [PMID: 34581008 DOI: 10.1111/ijlh.13702] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/27/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
This guidance document has been prepared on behalf of the International Council for Standardization in Haematology (ICSH). The aim of the document is to provide guidance and recommendations for the processing of citrated blood samples for coagulation tests in clinical laboratories in all regions of the world. The following areas are included in this document: Sample transport including use of pneumatic tubes systems; clots in citrated samples; centrifugation; primary tube storage and stability; interfering substances including haemolysis, icterus and lipaemia; secondary aliquots-transport, storage and processing; preanalytical variables for platelet function testing. The following areas are excluded from this document, but are included in an associated ICSH document addressing collection of samples for coagulation tests in clinical laboratories; ordering tests; sample collection tube and anticoagulant; preparation of the patient; sample collection device; venous stasis before sample collection; order of draw when different sample types are collected; sample labelling; blood-to-anticoagulant ratio (tube filling); influence of haematocrit. The recommendations are based on published data in peer-reviewed literature and expert opinion.
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Affiliation(s)
- Steve Kitchen
- Sheffield Haemophilia and Thrombosis Centre, Sheffield, UK
| | - Dorothy M Adcock
- Laboratory Corporation of America Holdings, Burlington, North Carolina, USA
| | - Ray Dauer
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ann-Helen Kristoffersen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Ian Mackie
- Research Department of Haematology, University College London, London, UK
| | - Richard A Marlar
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
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11
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Gosselin RC. Review of coagulation preanalytical variables with update on the effect of direct oral anticoagulants. Int J Lab Hematol 2021; 43 Suppl 1:109-116. [PMID: 34288452 DOI: 10.1111/ijlh.13585] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/02/2021] [Accepted: 04/28/2021] [Indexed: 12/18/2022]
Abstract
There are many preanalytical variables (PAV) that are known to affect coagulation testing. The more commonly acknowledged PAV addressed by the clinical laboratory tend to start with their influence on blood collection, but realistically coagulation PAV starts with the patient, where the laboratory has less influence or control. Patient selection and appropriate timing for blood collection may be integral for assuring proper diagnosis and management. Laboratory control and assurance for ideal phlebotomy practice would mitigate most PAVs related to blood collection to minimize suboptimal sample collection. Laboratory oversight of sample transportation, processing and storage will assure sample integrity until testing can be facilitated. The purpose of this document is to review common PAV that should be taken into consideration when ordering, performing and interpreting a coagulation test result, with additional attention to the effect of direct oral anticoagulants (DOACs).
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Affiliation(s)
- Robert C Gosselin
- Hemostasis & Thrombosis Center, Davis Health System, University of California, Sacramento, CA, USA
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12
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Lorenzen H, Frøstrup AB, Larsen AS, Fenger MS, Dahdouh S, Zoel-Ghina R, Nielsen LK. Pneumatic tube transport of blood samples affects global hemostasis and platelet function assays. Int J Lab Hematol 2021; 43:1207-1215. [PMID: 33538112 DOI: 10.1111/ijlh.13470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pneumatic tube systems (PTS) are frequently used for rapid and cost-effective transportation of blood samples to the clinical laboratory. The impact of PTS transport on platelet function measured by the Multiplate system and global hemostasis measured by the TEG 5000 was evaluated. METHODS Paired samples from healthy adult individuals were obtained at two study sites: Rigshospitalet (RH) and Nordsjaellands Hospital (NOH). One sample was transported by PTS and one manually (non-PTS). Platelet function was assessed by platelet aggregation (Multiplate) and global hemostasis was assessed by a variety of thrombelastography (TEG) assays. Multiplate (n = 39) and TEG (n = 32) analysis was performed at site RH, and Multiplate (n = 28) analysis was performed at site NOH. RESULTS A significant higher agonist-induced platelet aggregation was found for PTS samples compared to manual transport at site NOH (P < .02, all agonists). No significant difference was found at site RH (P > .05, all agonists). For Kaolin TEG, samples transported by PTS showed a significant lower R-time and higher Angle (P < .001). No significant differences in MA and LY30 was found (P > .05). ACT of RapidTEG was significantly reduced (P = .001) and MA of Functional Fibrinogen TEG was significantly increased (P < .001) after PTS transport. No significant impact of PTS was observed for TEG assays with heparinase (P > .05). CONCLUSIONS Depending on the type of PTS, transportation by PTS affected platelet aggregation measured by Multiplate. Furthermore, PTS alters TEG parameters possibly reflecting coagulation factors. Clinical laboratories should evaluate the effect of the local PTS on Multiplate and TEG results.
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Affiliation(s)
| | - Ann-Britt Frøstrup
- Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Immunology, Zealand University Hospital, Roskilde, Denmark
| | - Anja S Larsen
- Department of Clinical Immunology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Michelle S Fenger
- Faculty of Health, University College Copenhagen, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
| | - Sanne Dahdouh
- Faculty of Health, University College Copenhagen, Copenhagen, Denmark.,Department of Clinical Immunology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Randa Zoel-Ghina
- Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
| | - Leif K Nielsen
- Faculty of Health, University College Copenhagen, Copenhagen, Denmark
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13
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Wang H, Wang L, Liang H, Wei J, Wu Y, Wang X, Xu J. Falsely decreased FVIII activity following pneumatic tube transport. Int J Lab Hematol 2020; 43:305-310. [PMID: 33058454 DOI: 10.1111/ijlh.13363] [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: 07/20/2020] [Revised: 09/04/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The pneumatic tube system (PTS) is widely used for sample delivery. We aimed to investigate the impacts of PTS on hemostasis assays. METHODS Triplicate samples from 30 healthy volunteers were delivered to the core laboratory manually by human courier or via the 500 m long-distance PTS or via the 1000 m long-distance PTS. Comparisons of 19 hemostasis tests were conducted. RESULTS Although PT, INR, APTT, FII, FV, FVII FIX, FX, FXII, DD, α2-PI, and PC had statistical significance (all P < .05), all had low average bias remaining within clinical acceptable limits. PTS transportation only resulted in a statistically significant and clinically relevant decrease in FVIII activity. In the 500 m-PTS group, 66.7% (20/30) of samples for FVIII testing had a bias greater than 8.3%. Moreover, in the 1000 m-PTS group, 96.7% (29/30) of samples had a bias of over 8.3%, and the maximal bias achieved 42.1%. CONCLUSIONS Pneumatic tube system in our institution could be used to deliver blood samples for hemostasis tests evaluated in this study except FVIII activity assay.
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Affiliation(s)
- Hong Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,National Key Clinical Department of Laboratory Medicine, Nanjing, China
| | - Lin Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,National Key Clinical Department of Laboratory Medicine, Nanjing, China
| | - Hanyu Liang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,National Key Clinical Department of Laboratory Medicine, Nanjing, China
| | - Jia Wei
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yining Wu
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xueying Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Xu
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,National Key Clinical Department of Laboratory Medicine, Nanjing, China
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14
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Hardy M, Lecompte T, Douxfils J, Lessire S, Dogné JM, Chatelain B, Testa S, Gouin-Thibault I, Gruel Y, Medcalf RL, ten Cate H, Lippi G, Mullier F. Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory. Thromb J 2020; 18:17. [PMID: 32922211 PMCID: PMC7474970 DOI: 10.1186/s12959-020-00230-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with extreme inflammatory response, disordered hemostasis and high thrombotic risk. A high incidence of thromboembolic events has been reported despite thromboprophylaxis, raising the question of a more effective anticoagulation. First-line hemostasis tests such as activated partial thromboplastin time, prothrombin time, fibrinogen and D-dimers are proposed for assessing thrombotic risk and monitoring hemostasis, but are vulnerable to many drawbacks affecting their reliability and clinical relevance. Specialized hemostasis-related tests (soluble fibrin complexes, tests assessing fibrinolytic capacity, viscoelastic tests, thrombin generation) may have an interest to assess the thrombotic risk associated with COVID-19. Another challenge for the hemostasis laboratory is the monitoring of heparin treatment, especially unfractionated heparin in the setting of an extreme inflammatory response. This review aimed at evaluating the role of hemostasis tests in the management of COVID-19 and discussing their main limitations.
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Affiliation(s)
- M. Hardy
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Hematology Laboratory, Yvoir, Belgium
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Anesthesiology Department, Yvoir, Belgium
| | - T. Lecompte
- Département de Médecine, Hôpitaux Universitaires de Genève, service d’angiologie et d’hémostase et Faculté de Médecine Geneva Platelet Group (GpG), Université de Genève, Geneva, Suisse Switzerland
| | - J. Douxfils
- Pharmacy Department, University of Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur, Belgium
- Qualiblood s.a, Namur, Belgium
| | - S. Lessire
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Anesthesiology Department, Yvoir, Belgium
| | - J. M. Dogné
- Pharmacy Department, University of Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur, Belgium
| | - B. Chatelain
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Hematology Laboratory, Yvoir, Belgium
| | - S. Testa
- Haemostasis and Thrombosis Center, Cremona Hospital, Cremona, Italy
| | - I. Gouin-Thibault
- Département d’Hématologie Biologique, INSERM, CIC 1414 (Centre d’Investigation Clinique de Rennes), Université de Rennes, CHU de Rennes, Rennes, France
| | - Y. Gruel
- Laboratoire d’Hématologie-Hémostase, CHRU de Tours, Hôpital Trousseau, Tours, France
| | - R. L. Medcalf
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria Australia
| | - H. ten Cate
- Department of Internal Medicine, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - G. Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - F. Mullier
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Hematology Laboratory, Yvoir, Belgium
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15
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Lebreton A, Sinegre T, Lecompte T, Talon L, Abergel A, Lisman T. Thrombin Generation and Cirrhosis: State of the Art and Perspectives. Semin Thromb Hemost 2020; 46:693-703. [PMID: 32820480 DOI: 10.1055/s-0040-1715102] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epidemiological and laboratory studies performed in the last decades have changed our understanding of coagulopathy in cirrhosis, from a condition at increased risk of hemorrhagic events to one at higher thrombotic risk. However, it is not clear whether the decrease in factors that promote (except factor [F] VIII) versus inhibit coagulation in patients with cirrhosis results in a rebalanced state or in a hypercoagulable phenotype. This issue can be partially addressed using thrombin generation assays (TGA), which unlike routine clotting tests (prothrombin time or activated partial thromboplastin time) are sensitive to both procoagulant factors and coagulation inhibitors. However, many preanalytical issues and variable analytical methodologies used in TGAs complicate data analysis and interlaboratory comparisons. The introduction of TGAs in which activators of the protein C pathway (particularly soluble forms of thrombomodulin [TM]) are added has allowed detection of a reduced anticoagulant effect of TM or even a hypercoagulable phenotype as judged by endogenous thrombin potential. However, inter- and intra-assay variability may be greater with this TGA variant compared with "standard" TGAs. TGAs also allowed identifying main determinants of the hypercoagulability phenotype in the presence of TM: acquired antithrombin and protein C deficiencies, and elevated FVIII levels. The aim of this narrative review is to summarize the preanalytical and methodological variables of TGAs and also the findings of the main studies that have evaluated TGAs in patients with cirrhosis. The review also provides some propositions for future studies and outlines some perspectives on the potential implementation of this promising tool in clinical practice for the study of coagulation in patients with cirrhosis.
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Affiliation(s)
- Aurélien Lebreton
- Service d'hématologie biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
| | - Thomas Sinegre
- Service d'hématologie biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
| | - Thomas Lecompte
- Hôpitaux Universitaires de Genève, Unité d'hémostase, Département de médecine, Genève; Université de Genève, faculté de Médecine - GpG, Switzerland
| | - Laurie Talon
- Service d'hématologie biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Armand Abergel
- Service d'Hépato-Gastro-Entérologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Ton Lisman
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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16
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Slavík L, Úlehlová J, Bradáčová P, Chasáková K, Hluší A, Palová M, Entrová A. The Modern Pneumatic Tube System Transports with Reduced Speed Does Not Affect Special Coagulation Tests. J Med Syst 2020; 44:142. [PMID: 32696269 DOI: 10.1007/s10916-020-01614-6] [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: 05/05/2020] [Accepted: 07/15/2020] [Indexed: 11/24/2022]
Abstract
Pneumatic tube transport systems (PTS) for delivery of patient samples to a hemostasis laboratory are often used to reduce turnaround time for vital analyses. PTS in our hospital has the ability to regulate the transport speed in the range of 3-6 m/s with acceleration control technology. We evaluated the effects of PTS transport for routine coagulation tests, platelet function tests and special global coagulation tests. Duplicate samples were collected from 29 patients and 40 healthy individuals. One sample was sent using PTS and the other was carried by personnel to the lab for determination of protrombin time, activated partial thromboplastin time, trombin time, fibrinogen, antitrombin and thrombin generation test. Platelet function was measured by means of a Apact 4004® analyzer using the inductors (ADP, Arachidonic acid and Epinephrine). Samples transported using PTS with normal transport speed 6 m/s does not affect basic coagulation tests (PT, aPTT, FIB, TT and AT), but TGT has significantly altered. The use of PTS with controlled acceleration regulated the increase in thrombin generation from 10% to 3%, which is not statistically signifiant. The use of PTS with controlled acceleration did not show a significant difference even with the highly sensitive method of platelet aggregation. We conclude that PTS with acceleration control with transport speed from 3 to 6 m/s does not affect to platelet activity as measured by LTA and also global coagulation test - TGT. The advantage of PTS transport is very rapid assessment laboratory testing. From the above validation study, it is clear that PTS should always be validated for specialized laboratory methods and appropriately adapted to specific transport conditions.
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Affiliation(s)
- Luděk Slavík
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic.
| | - Jana Úlehlová
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - Pavla Bradáčová
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - Kateřina Chasáková
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - Antonín Hluší
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - Miroslava Palová
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - Alice Entrová
- Department of Blood Transfusion, University Hospital Olomouc, Olomouc, Czech Republic
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17
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Favresse J, Lippi G, Roy PM, Chatelain B, Jacqmin H, Ten Cate H, Mullier F. D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications. Crit Rev Clin Lab Sci 2019; 55:548-577. [PMID: 30694079 DOI: 10.1080/10408363.2018.1529734] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
D-dimer is a soluble fibrin degradation product deriving from the plasmin-mediated degradation of cross-linked fibrin. D-dimer can hence be considered a biomarker of activation of coagulation and fibrinolysis, and it is routinely used for ruling out venous thromboembolism (VTE). D-dimer is increasingly used to assess the risk of VTE recurrence and to help define the optimal duration of anticoagulation treatment in patients with VTE, for diagnosing disseminated intravascular coagulation, and for screening medical patients at increased risk of VTE. This review is aimed at (1) revising the definition of D-dimer; (2) discussing preanalytical variables affecting the measurement of D-dimer; (3) reviewing and comparing assay performance and some postanalytical variables (e.g. different units and age-adjusted cutoffs); and (4) discussing the use of D-dimer measurement across different clinical settings.
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Affiliation(s)
- Julien Favresse
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Giuseppe Lippi
- b Section of Clinical Biochemistry , University Hospital of Verona , Verona , Italy
| | - Pierre-Marie Roy
- c Département de Médecine d'Urgence, CHU d'Angers, Institut MITOVASC , Université d'Angers , Angers , France
| | - Bernard Chatelain
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Hugues Jacqmin
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Hugo Ten Cate
- d Department of Internal Medicine, Cardiovascular Institute , Maastricht University Medical Center , Maastricht , the Netherlands
| | - François Mullier
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
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18
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Wei J, Wu YN, Ling Y, Chen XT, Zhu Q, Xu J. False decrease of high-sensitivity cardiac troponin T assay in pneumatic tube system samples. Clin Chim Acta 2019; 495:507-511. [DOI: 10.1016/j.cca.2019.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/28/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
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19
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Shi H, Shi B, Lu J, Wu L, Sun G. Application value of thromboelastography in perioperative clinical blood transfusion and its effect on the outcome of patient. Exp Ther Med 2019; 17:3483-3488. [PMID: 30988727 PMCID: PMC6447791 DOI: 10.3892/etm.2019.7333] [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: 10/15/2018] [Accepted: 02/20/2019] [Indexed: 11/21/2022] Open
Abstract
Application value of thromboelastography (TEG) in perioperative clinical blood transfusion and its effect on the outcome of patient were investigated. Seventy-four patients, admitted to The Surgical Department of the First Hospital of Zibo from March 2015 to March 2018, were selected for this study. Among them, 34 patients took only the traditional coagulation function testing method as the blood transfusion guide during the perioperative period and they were regarded as the control group. The other 40 patients used TEG as the blood transfusion guide during the perioperative period, and they were regarded as the TEG group. The coagulation function indicators in 2 h before the operation and in 24 h after the operation, the transfusion amount and blood loss during the operation, the condition of the blood transfusion during the perioperative period, the occurrence rate of the postoperative rebleeding, the length of hospital stay and mortality of the patients in the two groups were compared. The coagulation function indicators of the patients in the two groups in 2 h before the operation and in 24 h after the operation showed that there was no significant difference between the two groups (P>0.050). However, APTT and Pt of the patients in the two groups both increased when compared with those before the treatment (P<0.050) and Hb, Hct, Plt and Fib all decreased (P<0.050). The suspended erythrocytes, Plt, fibrinogen and plasma in the TEG group were both significantly lower than those in the control group (P<0.001). Compared with the traditional coagulation function test, TEG was more accurate for estimating the coagulation function of patient and was more suitable for estimating the condition of blood transfusion of patient in the perioperative period; also, it could shorten the recovery period of patient and it is worthwhile to promote it in the clinic.
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Affiliation(s)
- Haiyan Shi
- Department of Blood Transfusion, The First Hospital of Zibo, Zibo, Shandong 255000, P.R. China
| | - Bo Shi
- Department of Neurology, The First Hospital of Zibo, Zibo, Shandong 255000, P.R. China
| | - Jun Lu
- Department of Blood Transfusion, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, P.R. China
| | - Lingling Wu
- Department of Blood Transfusion, Quanzhou First Hospital Affiliated to Medical University of Fujian, Quanzhou, Fujian 362000, P.R. China
| | - Guang Sun
- Department of Intensive Care Unit, Central Hospital of Zibo, Zibo, Shandong 255000, P.R. China
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20
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Alterations in the parameters of classic, global, and innovative assays of hemostasis caused by sample transportation via pneumatic tube system. Thromb Res 2018; 170:156-164. [PMID: 30196193 DOI: 10.1016/j.thromres.2018.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/07/2018] [Accepted: 08/31/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pneumatic tube system (PTS) is an integral part of large medical facilities providing rapid interconnection between units within the hospital and often used to transport blood samples. The aim of our study was to compare a wide variety of hemostasis assays to identify assays sensitive to this transport method and diagnostic relevance of the alterations. METHODS Routine coagulation and platelet tests (APTT, PT, TT, fibrinogen, light transmission aggregometry (LTA) with ADP, collagen, ristomycin and epinephrine), whole blood flow cytometry platelet function test (levels of CD42b, CD61, CD62P, PAC1, annexin V binding and mepacrine release) and global coagulation tests (thromboelastography (TEG), thrombin generation (TGT), thrombodynamics (TD), thrombodynamics-4D (TD-4D)) were determined in PTS- and manually transported samples of 10 healthy volunteers. RESULTS There were no significant differences between the values of APTT, PT, TT or fibrinogen between the samples transported by PTS or manually. The results for LTA demonstrated increase in the collagen-induced aggregation (84 ± 7% versus 73 ± 5%), while the response to epinephrine was decreased (58 ± 20% versus 72 ± 7.4%). Flow cytometry-based platelet function test showed a pre-activation of platelets by PTS-transportation while all integral assays of coagulation tested in the present study (TEG, TGT, TD, TD-4D) demonstrated a hypercoagulation shift. CONCLUSIONS Transportation by PTS caused significant shifts in parameters of functional and integral assays that exceeded parameter variation values and sometimes even were comparable to normal ranges. The results obtained in this study indicate that using of PTS for such assays may cause sufficient alterations of results and can lead to patient's mistreatment.
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21
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Dargaud Y, Negrier C, Rusen L, Windyga J, Georgiev P, Bichler J, Solomon C, Knaub S, Lissitchkov T, Klamroth R. Individual thrombin generation and spontaneous bleeding rate during personalized prophylaxis with Nuwiq®(human-cl rhFVIII) in previously treated patients with severe haemophilia A. Haemophilia 2018; 24:619-627. [DOI: 10.1111/hae.13493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Dargaud
- Hopital Cardiologique Louis Pradel; University of Lyon; Lyon France
| | - C. Negrier
- Hopital Cardiologique Louis Pradel; University of Lyon; Lyon France
| | | | - J. Windyga
- Department of Disorders of Haemostasis and Internal Medicine; Institute of Haematology and Transfusion Medicine; Warsaw Poland
| | - P. Georgiev
- Clinic of Haematology; University Multiprofile Hospital for Active Treatment “Sveti Georgi” and Medical University; Plovdiv Bulgaria
| | | | - C. Solomon
- Octapharma AG; Lachen Switzerland
- Department of Anesthesiology; Perioperative Care and General Intensive Care; Salzburg University Hospital; Paracelsus Medical University; Salzburg Austria
| | - S. Knaub
- Octapharma AG; Lachen Switzerland
| | - T. Lissitchkov
- Department of Clinical Haematology in Haemorrhagic Diathesis and Anaemia; Specialized Hospital for Active Treatment “Joan Pavel”; Sofia Bulgaria
| | - R. Klamroth
- Vivantes Klinikum im Friedrichshain; Berlin Germany
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22
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Nissen PH, Wulff DE, Tørring N, Hvas AM. The impact of pneumatic tube transport on whole blood coagulation and platelet function assays. Platelets 2018; 29:421-424. [DOI: 10.1080/09537104.2018.1430361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Peter H. Nissen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte E. Wulff
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Tørring
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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23
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Roullet S, de Maistre E, Ickx B, Blais N, Susen S, Faraoni D, Garrigue D, Bonhomme F, Godier A, Lasne D. Position of the French Working Group on Perioperative Haemostasis (GIHP) on viscoelastic tests: What role for which indication in bleeding situations? Anaesth Crit Care Pain Med 2018; 38:539-548. [PMID: 29355793 DOI: 10.1016/j.accpm.2017.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Viscoelastic tests (VETs), thromboelastography (TEG®) and thromboelastometry (ROTEM®) are global tests of coagulation performed on whole blood. They evaluate the mechanical strength of a clot as it builds and develops after coagulation itself. The time required to obtain haemostasis results remains a major problem for clinicians dealing with bleeding, although some teams have developed a rapid laboratory response strategy. Indeed, the value of rapid point-of-care diagnostic devices such as VETs has increased over the years. However, VETs are not standardised and there are few recommendations from the learned societies regarding their use. In 2014, the recommendations of the International Society of Thrombosis and Haemostasis (ISTH) only concerned haemophilia. The French Working Group on Perioperative haemostasis (GIHP) therefore proposes to summarise knowledge on the clinical use of these techniques in the setting of emergency and perioperative medicine. METHODS A review of the literature. PRINCIPAL FINDINGS The role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In other situations, their role remains to be defined: hepatic transplantation, postpartum haemorrhage, and non-cardiac surgery. They must be part of the global management of haemostasis based on algorithms defined in each centre and for each population of patients. Their position at the bedside or in the laboratory is a matter of discussion between clinicians and biologists. CONCLUSION VETs must be included in algorithms. In consultation with the biology laboratory, these devices should be situated according to the way each centre functions.
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Affiliation(s)
- Stéphanie Roullet
- Inserm U 12-11, service anesthésie-réanimation 1, université de Bordeaux, CHU de Bordeaux, 33000 Bordeaux, France.
| | | | - Brigitte Ickx
- Université Libre de Bruxelles, Erasme University Hospital, Department of Anesthesiology, Brussels, Belgium
| | - Normand Blais
- Hématologie et oncologie médicale, CHUM, Montréal, Canada
| | - Sophie Susen
- Institut d'hématologie et transfusion, CHRU de Lille, 59037 Lille, France
| | - David Faraoni
- Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Fanny Bonhomme
- Service d'anesthésiologie, hôpital universitaire de Genève, Geneva, Switzerland
| | - Anne Godier
- Service d'anesthésie-réanimation, Fondation Rothschild, 75019 Paris, France
| | - Dominique Lasne
- Laboratoire d'hématologie, hôpital Necker, 75015 Paris, France
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24
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Lebreton A, Casini A, Bulla O, Fontana P. Impact of pneumatic tube system transport for the monitoring of heparin therapy. Thromb Res 2017; 158:35-37. [PMID: 28802975 DOI: 10.1016/j.thromres.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/07/2017] [Accepted: 08/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Aurélien Lebreton
- Division of Angiology and Haemostasis and Haemostasis Laboratory, University Hospitals of Geneva, Geneva, Switzerland
| | - Alessandro Casini
- Division of Angiology and Haemostasis and Haemostasis Laboratory, University Hospitals of Geneva, Geneva, Switzerland
| | - Oana Bulla
- Division of Angiology and Haemostasis and Haemostasis Laboratory, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Fontana
- Division of Angiology and Haemostasis and Haemostasis Laboratory, University Hospitals of Geneva, Geneva, Switzerland.
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