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De Baerdemaeker K, Foxton E, Wood DM, Archer JRH, Layne K, Wolfe C, Dargan PI. Intravenous lipid emulsion interference in coagulation testing: an ex vivo analysis. Clin Toxicol (Phila) 2024:1-5. [PMID: 38958109 DOI: 10.1080/15563650.2024.2370324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 06/13/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Intravenous lipid emulsion is used in the rescue treatment of certain poisonings. A complication is interference with laboratory analyses. The aim of this study was to determine the impact of intravenous lipid emulsion on routine laboratory analysis of coagulation parameters ex vivo and determine if any of the analytical techniques remain reliable. METHODS Samples were obtained from 19 healthy volunteers and divided in triplicate. One sample served as a control, and the other two were diluted to simulate the treatment of an average adult with Intralipid® 20 per cent Fresenius Kabi 100 mL (dilution-1) or 500 mL (dilution-2). Coagulation tests performed were prothrombin time, activated prothrombin time, D-dimer concentration and fibrinogen. Coagulation testing was performed by three techniques. Test-1 was performed on a Sysmex CN6000 analyzer. Test-2 was performed with a manual mechanical endpoint method using the semi-automated Stago KC4 Delta. Test-3 involved high-speed centrifugation before repeat testing on the Sysmex CN6000 analyzer. RESULTS For test-1, only nine (47 per cent) samples in dilution-1 could be analyzed for coagulation tests, and no coagulation tests could be analyzed for dilution-2 because of lipaemia. For test-2 and test-3, all samples could be analyzed, and all results of both testing methods fell within the limits of the laboratory reference range. DISCUSSION Difficulties in laboratory analysis of patients having received intravenous lipid emulsion are due to multiple factors. Most automated coagulation analyzers use optical measurements, which can be unreliable in the presence of a high intravenous lipid concentration. By altering the lipaemia in the testing solution using high-speed centrifugation or by using manual mechanical endpoint detection, we were able to obtain reliable results. These findings are limited by the use of an ex vivo method and healthy volunteers. CONCLUSIONS This ex vivo model confirms that Intralipid® interferes with routine coagulation studies. It is important that clinicians are aware and inform their laboratories of its administration.
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Affiliation(s)
- Klara De Baerdemaeker
- Emergency Medicine, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Eleanor Foxton
- Haemostasis & Thrombosis Laboratory, Synovis, London, UK
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - John R H Archer
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kerry Layne
- Acute Medicine, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Caitlin Wolfe
- Atlantic Canada Poison Centre, Halifax, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Canada
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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Oliveira PL, Bonatto NCM, Bosculo MRM, Floriano BP, de Barros LD, Almeida BFMD. Effect of post-prandial lipemia on canine biochemical parameters. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s00580-020-03130-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Grunbaum AM, Gilfix BM, Hoffman RS, Lavergne V, Morris M, Miller-Nesbitt A, Gosselin S. Review of the effect of intravenous lipid emulsion on laboratory analyses. Clin Toxicol (Phila) 2015; 54:92-102. [DOI: 10.3109/15563650.2015.1115515] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ami M. Grunbaum
- Division of Medical Biochemistry, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Brian M. Gilfix
- Division of Medical Biochemistry, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Robert S. Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, USA
| | - Valéry Lavergne
- Department of Medical Biology, Sacré-Coeur Hospital, University of Montréal, Montréal, Québec, Canada
| | - Martin Morris
- Schulich Library of Science and Engineering, McGill University, Montréal, Québec, Canada
| | - Andrea Miller-Nesbitt
- Schulich Library of Science and Engineering, McGill University, Montréal, Québec, Canada
| | - Sophie Gosselin
- Department of Emergency Medicine, McGill University Health Centre & Department of Medicine, McGill University, Montreal, Québec, Canada
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Shang J, Chen Z, Wang M, Li Q, Feng W, Wu Y, Wu W, Graziano MP, Chintala M. Zucker Diabetic Fatty rats exhibit hypercoagulability and accelerated thrombus formation in the Arterio-Venous shunt model of thrombosis. Thromb Res 2014; 134:433-9. [PMID: 24796819 DOI: 10.1016/j.thromres.2014.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/06/2014] [Accepted: 04/08/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Diabetes is a significant risk factor for thrombosis. The present study aimed at assessing coagulability, platelet reactivity, and thrombogenicity of the diabetic female Zucker Diabetic Fatty (ZDF) rat model and its relevance in studying antithrombotic mechanisms. MATERIALS AND METHODS The basal coagulant state in ZDF rats was evaluated by clotting times, thromboelastography, and thrombin generation assay. A 14-day treatment with dapagliflozin in ZDF rats was pursued to investigate if glycemic control can improve coagulability. Thrombus formation in the Arterio-Venous (A-V) shunt model and the FeCl3-induced arterial thrombosis model was studied, with the antithrombotic effect of apixaban in the former model further investigated. RESULTS ZDF rats exhibited significantly shortened clotting times, enhanced thrombin generation, and decreased fibrinolysis at baseline. Effective glycemic control achieved with dapagliflozin did not improve any of these parameters. ZDF rats displayed accelerated thrombus formation and were amenable to apixaban treatment in the A-V shunt model albeit with less sensitivity than normal rats. ZDF rats exhibited less platelet aggregation in response to ADP, collagen and PAR-4, and attenuated thrombotic response in the FeCl3 model. CONCLUSIONS ZDF rats are at a chronic hypercoagulable and hypofibrinolytic state yet with compromised platelet reactivity. They display accelerated and attenuated thrombosis in the A-V shunt and FeCl3 model of thrombosis, respectively. Results shed new light on the pathophysiology of the ZDF rat model and illustrate its potential value in translational research on anticoagulant agents in diabetics. Caution needs to be exerted in utilizing this model in assessing antiplatelet mechanisms in diabetes-associated atherothrombosis.
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Affiliation(s)
- Jin Shang
- Department of Cardiometabolic Disease, Merck Research Laboratories, Kenilworth, New Jersey.
| | - Zhu Chen
- Department of Cardiometabolic Disease, Merck Research Laboratories, Kenilworth, New Jersey.
| | - Min Wang
- Department of Cardiometabolic Disease, Merck Research Laboratories, Kenilworth, New Jersey
| | - Qiu Li
- Department of Cardiometabolic Disease, Merck Research Laboratories, Kenilworth, New Jersey
| | - Wen Feng
- Department of Cardiometabolic Disease, Merck Research Laboratories, Kenilworth, New Jersey
| | - Yangsong Wu
- Department of Cardiometabolic Disease, Merck Research Laboratories, Kenilworth, New Jersey
| | - Weizhen Wu
- Department of Cardiometabolic Disease, Merck Research Laboratories, Kenilworth, New Jersey
| | - Michael P Graziano
- Department of Cardiometabolic Disease, Merck Research Laboratories, Kenilworth, New Jersey
| | - Madhu Chintala
- Department of Cardiometabolic Disease, Merck Research Laboratories, Kenilworth, New Jersey
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Maunder CL, Costa M, Cue SM, Crawford EM, Papasouliotis K, Murphy KF. Measurement of prothrombin time and activated partial thromboplastin time in citrated whole blood samples from clinically ill dogs following storage. J Small Anim Pract 2012; 53:531-5. [DOI: 10.1111/j.1748-5827.2012.01255.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - S. M. Cue
- Diagnostic Laboratories; Langford Veterinary Services, Langford House; Langford; Bristol; BS40 5DU
| | - E. M. Crawford
- Diagnostic Laboratories; Langford Veterinary Services, Langford House; Langford; Bristol; BS40 5DU
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Geffré A, Grollier S, Hanot C, Vergez F, Trumel C, Braun JP. Canine Reference Intervals for Coagulation Markers Using the STA Satellite® and the STA-R Evolution® Analyzers. J Vet Diagn Invest 2010; 22:690-5. [DOI: 10.1177/104063871002200503] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the current study was to determine canine reference intervals for prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, and antithrombin (AT) according to international recommendations. The STA Satellite® coefficients of variation of within-laboratory imprecision were 3.9%, 1.3%, 6.9%, and 5.1% for PT, APTT, fibrinogen, and AT, respectively. At 4°C, citrated specimens were stable up to 8 hr for whole blood and 36 hr for plasma, except for APTT, which increased slightly (<1 sec). Nonparametric reference intervals determined in citrated plasma from 139 healthy fasting purebred dogs were 6.9–8.8 sec, 13.1–17.2 sec, 1.24–4.30 g/l, and 104–188% for PT, APTT, fibrinogen, and AT, respectively. Based on Passing–Bablok comparison between STA Satellite and STA-R Evolution® using 60 frozen specimens from a canine plasma bank, the corresponding reference intervals were transferred to the STA-R Evolution: 7.1–9.2 sec, 12.9–17.3 sec, 1.20–4.43 g/l, and 94–159% for PT, APTT, fibrinogen, and AT, respectively.
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Affiliation(s)
- Anne Geffré
- Département des Sciences Cliniques (Geffré, Grollier, Hanot, Trumel, Braun), Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Sophie Grollier
- Département des Sciences Cliniques (Geffré, Grollier, Hanot, Trumel, Braun), Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Camille Hanot
- Département des Sciences Cliniques (Geffré, Grollier, Hanot, Trumel, Braun), Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - François Vergez
- Groupe hospitalier de Rangueil-Larrey, Laboratoire d'Hématologie, Toulouse, France (Vergez)
| | - Catherine Trumel
- Département des Sciences Cliniques (Geffré, Grollier, Hanot, Trumel, Braun), Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Jean-Pierre Braun
- Département des Sciences Cliniques (Geffré, Grollier, Hanot, Trumel, Braun), Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
- UMR 181 Physiopathologie et Toxicologie Expérimentales, ENVT, INRA (Braun), Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
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Bauer N, Eralp O, Moritz A. Reference Intervals and Method Optimization for Variables Reflecting Hypocoagulatory and Hypercoagulatory States in Dogs using the STA Compact® Automated Analyzer. J Vet Diagn Invest 2009; 21:803-14. [DOI: 10.1177/104063870902100606] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Reference intervals for coagulation parameters have been rarely determined in dogs for the STA Compact® automated coagulation analyzer, so it is the aim of the current study to validate assays and establish reference ranges for its use in canine specimens. Coagulation parameters were assessed in 56 healthy dogs with a median age of 2 years and evenly distributed sex. The 95% reference intervals were as follows: 1-stage prothrombin time = 5.7–8.0 sec; activated partial thromboplastin time (APTT) = 10.0–14.3 sec; thrombin time (TT) = 11.9–18.3 sec; fibrinogen = 1.3–3.1 g/1; antithrombin (AT) = 107.9–128.0%; D-dimer = 0.023–0.65 μg/ml; anti-factor Xa = 0.04–0.26 IU/1; and activated protein C (APC) ratio = 2.0–3.0. Protein C and S activity was markedly below (<-20%) and factor VIII was 2- to 11-fold above the human calibration standard, so a standard curve had to be prepared from canine pooled plasma. Reference intervals for protein C, protein S, and factor VIII were 75.5–118.9%, 74.4–160.5%, and 70.9–136.4%, respectively, compared with a canine standard curve. Streptokinase-activated plasminogen assay was not suitable for dogs. There was no significant impact of sex on hemostasis test results. Factor VIII activity, AT, protein C, protein S, and APC ratio were overestimated in hemolytic plasma, whereas fibrinogen, TT, and APTT were underestimated. Lipemia resulted only in false-high D-dimers. This study provided useful reference intervals for dogs, but some human tests (i.e., protein C, protein S, factor VIII, and plasminogen) required modification.
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Affiliation(s)
- Natali Bauer
- Departments of Veterinary Clinical Sciences, Clinical Pathophysiology,
and Clinical Pathology, Justus-Liebig University, Giessen, Germany
| | - Oya Eralp
- Departments of Veterinary Clinical Sciences, Clinical Pathophysiology,
and Clinical Pathology, Justus-Liebig University, Giessen, Germany
| | - Andreas Moritz
- Departments of Veterinary Clinical Sciences, Clinical Pathophysiology,
and Clinical Pathology, Justus-Liebig University, Giessen, Germany
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Casella S, Giannetto C, Fazio F, Giudice E, Piccione G. Assessment of Prothrombin Time, Activated Partial Thromboplastin Time, and Fibrinogen Concentration on Equine Plasma Samples following Different Storage Conditions. J Vet Diagn Invest 2009; 21:674-8. [DOI: 10.1177/104063870902100512] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to assess the effect of different storage conditions on prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen concentration in clinical samples from healthy horses. A total of 100 healthy horses of varying breeds and gender, ranging in age from 4 to 18 years, with a mean body weight of 480 + 70 kg, were used. Blood was collected by jugular venipuncture, and a hemochrome-cytometric examination was conducted on all samples. All blood samples were centrifuged and divided into 4 different aliquots to assess clotting parameters by means of a coagulometer. The first aliquots were analyzed 1 hr after collection, the second aliquots were refrigerated at 8°C for 6 hr, the third aliquots were frozen at −20°C for 24 hr, and the fourth aliquots were frozen at −20°C for 48 hr. Significant differences ( P < 0.05) were determined by one-way analysis of variance with repeated measures, and statistical analysis showed a significant effect of the experimental conditions on all parameters studied. In particular, the results demonstrated that coagulation tests can be done within 6 hr when samples are stored at 8°C because the short-term refrigeration does not change the result of analyses; storage at −20°C is acceptable only after 24 hr for PT, aPTT, and fibrinogen measurements because after 48 hr, freezing alters the values of clotting parameters. Therefore, the results of this investigation indicate that clotting parameters remain stable only up to 24 hr in horses without adversely affecting hemostasis test results.
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Affiliation(s)
- Stefania Casella
- Dipartimento di Scienze Sperimentali e Biotecnologie Applicate, Sezione di Fisiologia Applicata ed Etologia Comparata
| | - Claudia Giannetto
- Dipartimento di Scienze Sperimentali e Biotecnologie Applicate, Sezione di Fisiologia Applicata ed Etologia Comparata
| | - Francesco Fazio
- Dipartimento di Scienze Sperimentali e Biotecnologie Applicate, Sezione di Fisiologia Applicata ed Etologia Comparata
| | - Elisabetta Giudice
- Dipartimento di Sanità Pubblica Veterinaria, Facoltà di Medicina Veterinaria, Università degli Studi di Messina, Polo Universitario dell'Annunziata Messina, Italy
| | - Giuseppe Piccione
- Dipartimento di Scienze Sperimentali e Biotecnologie Applicate, Sezione di Fisiologia Applicata ed Etologia Comparata
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Rizzo F, Papasouliotis K, Crawford E, Dodkin S, Cue S. Measurement of prothrombin time (PT) and activated partial thromboplastin time (APTT) on canine citrated plasma samples following different storage conditions. Res Vet Sci 2008; 85:166-70. [DOI: 10.1016/j.rvsc.2007.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 09/28/2007] [Accepted: 10/01/2007] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE To compare gravimetric and colorimetric methods of quantifying surgical blood loss, and to determine if there is a correlation between preoperative hemostatic tests (buccal mucosa bleeding time [BMBT] and intraoperative blood loss). STUDY DESIGN Prospective clinical study. ANIMALS Dogs (n=15) admitted for cutaneous tumor excision, orthopedic procedure, or exploratory laparotomy. METHODS Intraoperative blood loss was quantified by measuring irrigation fluid and weighing surgical sponges used for blood and fluid collection during surgery. Results of gravimetric measurements were then correlated to blood loss quantified using spectrophotometric analysis of hemoglobin (Hb) content. Hemostatic variables including BMBT were measured before surgery and compared with the calculated amount of blood loss. RESULTS Blood loss quantified by gravimetric measurement showed a significant correlation with colorimetric determination of Hb content in surgical sponges and collected irrigation fluid (r=0.93, P<.0001). BMBT correlated weakly but significantly with intraoperative blood loss (r=0.56, P<.05). CONCLUSIONS Quantifying intraoperative blood loss using spectrophotometric Hb analysis accurately assessed the amount of blood loss; however, it is a time-consuming procedure, primarily applicable as a research tool. Gravimetric evaluation of intraoperative blood loss was found to be an accurate method, which can be recommended for use in a clinical setting. CLINICAL RELEVANCE Estimation of blood loss using a gravimetric method is accurate and applicable in the clinical setting and provides surgeons with a simple and objective tool to evaluate intraoperative blood loss.
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Affiliation(s)
- Marcel H Lee
- Small Animal Veterinary Teaching Hospital, Department of Small Animal Clinical Sciences, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark.
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Martínez-Subiela S, Tecles F, Montes A, Gutiérrez C, Cerón JJ. Effects of haemolysis, lipaemia, bilirubinaemia and fibrinogen on protein electropherogram of canine samples analysed by capillary zone electrophoresis. Vet J 2002; 164:261-8. [PMID: 12505401 DOI: 10.1053/tvjl.2001.0672] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The possible interference of haemolysis, lipaemia, bilirubinaemia and fibrinogen on capillary zone electrophoresis of canine samples were studied. Solutions of haemoglobin, lipid and bilirubin were prepared and mixed with serum aliquots to make up samples containing different concentrations of the putative interferent substance. In addition, samples of serum and plasma were assayed to assess the influence of fibrinogen. Haemolysis and lipids produced a change in electropherogram morphology giving an interference peak located in the beta-2 region when haemoglobin was increased, and in the alpha-2 region when lipids were increased. A rise in concentration of these interferents caused an increase in the beta and alpha-2 fractions respectively, and a decrease in the other fractions. Bilirubin did not alter morphology but gave an increase in the albumin and alpha-1 and a decrease in the alpha-2 and beta-2 fractions. No differences were found between serum and plasma samples, and fibrinogen did not produce any additional peak.
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Affiliation(s)
- S Martínez-Subiela
- Animal Pathology Department, Veterinary School, University of Murcia, Spain
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