1
|
Kornya MR, Abrams-Ogg ACG, Blois SL, Wood RD. Determination of clopidogrel effect in cats using point-of-care Plateletworks ADP and shipped samples for PFA-200 analysis in a clinical practice setting. J Feline Med Surg 2024; 26:1098612X241241404. [PMID: 38682957 PMCID: PMC11103312 DOI: 10.1177/1098612x241241404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Clopidogrel is the recommended first-line antithrombotic in cats for a variety of conditions; however, it is ineffective in 15-20% of cats. The determination of clopidogrel effectiveness with platelet function assays has historically been limited to specialty centers; however, recent work has suggested that in-hospital or shipped analyses of samples may be feasible. The aim of the present study was to investigate the utility of an in-house analysis and shipping of blood samples collected in primary practices for the determination of clopidogrel effectiveness. METHODS Citrated blood samples were collected from cats receiving clopidogrel therapy by veterinarians in clinical practices across Canada, a median of 304.4 km from the reference laboratory (range 8-4425). Samples were analyzed in-house using Plateletworks ADP and shipped for remote analysis using PFA-200 P2Y and COL/ADP cartridges. RESULTS A total of 30 samples were collected from 25 cats. Of these, the percentage of samples analyzable for the presence or absence of the clopidogrel effect was 86% for Plateletworks ADP, 90% for PFA-200 P2Y and 87% for PFA-200 COL/ADP. There was no significant difference in the number of samples unable to be analyzed by each modality (P = 0.689) due to flow obstruction or other sample characteristics. The prevalence of absence of clopidogrel effectiveness on platelet function assays was 8% with the PFA-200 COL/ADP assay, 25% with the PFA-200 P2Y assay and 30% with the Plateletworks ADP assay. CONCLUSIONS AND RELEVANCE The results of this study confirm that samples of feline blood can be collected in clinical practices and shipped to a reference laboratory for PFA-200 analysis with a high rate of success, comparable to point-of-care analysis.
Collapse
Affiliation(s)
- Matthew R Kornya
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Anthony CG Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - R Darren Wood
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| |
Collapse
|
2
|
Zlamal J, Aliotta A, Alberio L, Chen V, Bakchoul T. Diagnostic value of antibody-induced procoagulant platelets in heparin-induced thrombocytopenia: communication from the ISTH SSC Subcommittee on Platelet Immunology. J Thromb Haemost 2024; 22:860-868. [PMID: 38065529 DOI: 10.1016/j.jtha.2023.11.019] [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: 07/27/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/30/2023]
Abstract
Heparin-induced thrombocytopenia (HIT) is an immune-mediated prothrombotic disorder characterized by a drop in platelet count and an increased risk of thromboembolic events. The accurate diagnosis of HIT involves clinical assessment and laboratory testing with well-characterized functional tests. Recent research has shown the potential of investigating procoagulant platelet formation induced by HIT antibodies. To successfully implement these assays in clinical laboratories, careful consideration of technical and preanalytical factors is crucial. In this communication from the SSC Platelet Immunology, we provide a consensus from experts on the use of flow cytometry in HIT diagnosis, highlighting the importance of standardized protocols.
Collapse
Affiliation(s)
- Jan Zlamal
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany; Centre for Clinical Transfusion Medicine, Tübingen, Germany
| | - Alessandro Aliotta
- Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Lorenzo Alberio
- Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Vivien Chen
- ANZAC Research Institute, Sydney Local Health District, Sydney, New South Wales, Australia; Department of Haematology, Concord Repatriation General Hospital and NSW Health Pathology, Sydney, New South Wales, Australia; Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Tamam Bakchoul
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany; Centre for Clinical Transfusion Medicine, Tübingen, Germany.
| |
Collapse
|
3
|
Kornya MR, Abrams-Ogg ACG, Blois SL, Wood RD. Validation of storage and shipping of feline blood samples for analysis on the Platelet Function Analyzer-200 for determining the effect of clopidogrel. Vet Clin Pathol 2023; 52:588-595. [PMID: 37488077 DOI: 10.1111/vcp.13265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/02/2023] [Accepted: 04/24/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The Platelet function analyzer-200 (PFA-200) can determine the effect of clopidogrel in cats, but analysis traditionally must be performed at point-of-care (POC). The ability to ship samples of blood to a laboratory would allow widespread access. OBJECTIVES We aimed to validate the shipping of blood samples for PFA-200 analysis in cats to determine the effect of clopidogrel. METHODS Twenty healthy cats and 10 cats receiving clopidogrel were recruited. Blood was collected from cats and aliquoted into two samples, one was analyzed at POC within 2 hours using the PFA-200, and the other was packaged and transported to a location 4 km away, stored, and transported back to the lab for analysis the following day. RESULTS Median closure times (CTs) with the collagen/adenosine diphosphate (COL/ADP) cartridge in healthy cats were 51.5 seconds (POC) and 78.8 seconds (shipped), which were significantly different (P < 0.001), and for cats on clopidogrel, median CTs were 147.5 seconds (POC) and 190 seconds (shipped), which were not significantly different (P = 0.131). Median CTs with the P2Y cartridge in healthy cats were 50.5 seconds (POC) and 64.9 seconds (shipped), which were significantly different (P = 0.03), and in cats receiving clopidogrel, median CTs were 300 seconds (POC) and 300 seconds (shipped) which were not significantly different (P = 1.000). Reference intervals for CTs differed for COL/ADP at POC (19.8-89.7 seconds) and shipped (50.9-161.6 seconds) and for P2Y at POC (35.5-118.8 seconds) and shipped (35.1-108.9 seconds). Receiver operating characteristics showed similar areas under the curve (AUCROCs) regarding the effect of clopidogrel for COL/ADP at POC (0.994 seconds) and shipped (0.932) and for P2Y at POC (0.904 seconds) and shipped (0.975 seconds). When classifying for the presence of clopidogrel effects, Cohen's Kappa was 0.62 for COL/ADP and 1.00 for P2Y. CONCLUSIONS Shipping blood samples for PFA analysis are feasible with similar performance to POC analyses for determining the effect of clopidogrel in cats.
Collapse
Affiliation(s)
- Matthew R Kornya
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony C G Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - R Darren Wood
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
4
|
Wang S, Liu Q, Cheng L, Wang L, Xu F, Yao C. Targeting biophysical cues to address platelet storage lesions. Acta Biomater 2022; 151:118-133. [PMID: 36028196 DOI: 10.1016/j.actbio.2022.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/06/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Platelets play vital roles in vascular repair, especially in primary hemostasis, and have been widely used in transfusion to prevent bleeding or manage active bleeding. Recently, platelets have been used in tissue repair (e.g., bone, skin, and dental alveolar tissue) and cell engineering as drug delivery carriers. However, the biomedical applications of platelets have been associated with platelet storage lesions (PSLs), resulting in poor clinical outcomes with reduced recovery, survival, and hemostatic function after transfusion. Accumulating evidence has shown that biophysical cues play important roles in platelet lesions, such as granule secretion caused by shear stress, adhesion affected by substrate stiffness, and apoptosis caused by low temperature. This review summarizes four major biophysical cues (i.e., shear stress, substrate stiffness, hydrostatic pressure, and thermal microenvironment) involved in the platelet preparation and storage processes, and discusses how they may synergistically induce PSLs such as platelet shape change, activation, apoptosis and clearance. We also review emerging methods for studying these biophysical cues in vitro and existing strategies targeting biophysical cues for mitigating PSLs. We conclude with a perspective on the future direction of biophysics-based strategies for inhibiting PSLs. STATEMENT OF SIGNIFICANCE: Platelet storage lesions (PSLs) involve a series of structural and functional changes. It has long been accepted that PSLs are initiated by biochemical cues. Our manuscript is the first to propose four major biophysical cues (shear stress, substrate stiffness, hydrostatic pressure, and thermal microenvironment) that platelets experience in each operation step during platelet preparation and storage processes in vitro, which may synergistically contribute to PSLs. We first clarify these biophysical cues and how they induce PSLs. Strategies targeting each biophysical cue to improve PSLs are also summarized. Our review is designed to draw the attention from a broad range of audience, including clinical doctors, biologists, physical scientists, engineers and materials scientists, and immunologist, who study on platelets physiology and pathology.
Collapse
Affiliation(s)
- Shichun Wang
- Department of Blood Transfusion, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Qi Liu
- Department of Blood Transfusion, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Lihan Cheng
- Department of Blood Transfusion, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Lu Wang
- Department of Blood Transfusion, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Feng Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, PR China; Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, 710049, PR China.
| | - Chunyan Yao
- Department of Blood Transfusion, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China; State Key Laboratory of Trauma, Burn and Combined Injury, Third Military Medical University, Chongqing 400038, PR China.
| |
Collapse
|
5
|
McMahon SR, Chava S, Taatjes-Sommer HS, Meagher S, Brummel-Ziedins KE, Schneider DJ. Variation in platelet expression of FcγRIIa after myocardial infarction. J Thromb Thrombolysis 2019; 48:88-94. [PMID: 30968301 DOI: 10.1007/s11239-019-01852-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
FcγRIIa amplifies platelet activation and greater platelet expression of FcγRIIa identifies patients at greater risk of subsequent cardiovascular events. Thus, platelet expression of FcγRIIa may be useful to guide therapy. Because platelet function tests are impacted by preparative procedures and substantial intra-individual variability, we examined the impact of these factors on platelet expression of FcγRIIa in blood from healthy subjects and in patients after myocardial infarction (MI). Platelet expression of FcγRIIa was quantified with the use of flow cytometry. Blood was taken from healthy subjects and 114 patients after a MI in whom platelet expression of FcγRIIa was quantified before discharge and at 6 ± 1 months. Neither anticoagulants nor the antiplatelet agent cangrelor changed platelet expression of FcγRIIa. Intra-individual variation in platelet FcγRIIa expression was 8.5% ± 5% over the course of 1 month in healthy subjects. Platelet FcγRIIa expression was within 20% of the baseline value after 6 months in 71% of patients after MI. In summary, because FcγRIIa is a protein on the surface of platelets, assay conditions and antiplatelet agents do not change expression. Intra-individual variability in platelet expression of FcγRIIa is modest. Accordingly, platelet expression of FcγRIIa is a marker of increased platelet reactivity that can be reliably and repeatedly measured.Clinical Trial Registration: NCT02505217.
Collapse
Affiliation(s)
- Sean R McMahon
- Departments of Medicine and Biochemistry, The University of Vermont, Burlington, VT, USA
- Cardiovascular Research Institute, The University of Vermont, 308 S. Park Drive, Colchester, Burlington, VT, 05446, USA
| | - Sreedivya Chava
- Departments of Medicine and Biochemistry, The University of Vermont, Burlington, VT, USA
- Cardiovascular Research Institute, The University of Vermont, 308 S. Park Drive, Colchester, Burlington, VT, 05446, USA
| | - Heidi S Taatjes-Sommer
- Departments of Medicine and Biochemistry, The University of Vermont, Burlington, VT, USA
- Cardiovascular Research Institute, The University of Vermont, 308 S. Park Drive, Colchester, Burlington, VT, 05446, USA
| | - Sean Meagher
- Departments of Medicine and Biochemistry, The University of Vermont, Burlington, VT, USA
- Cardiovascular Research Institute, The University of Vermont, 308 S. Park Drive, Colchester, Burlington, VT, 05446, USA
| | - Kathleen E Brummel-Ziedins
- Departments of Medicine and Biochemistry, The University of Vermont, Burlington, VT, USA
- Cardiovascular Research Institute, The University of Vermont, 308 S. Park Drive, Colchester, Burlington, VT, 05446, USA
| | - David J Schneider
- Departments of Medicine and Biochemistry, The University of Vermont, Burlington, VT, USA.
- Cardiovascular Research Institute, The University of Vermont, 308 S. Park Drive, Colchester, Burlington, VT, 05446, USA.
| |
Collapse
|
6
|
Katzman BM, Wockenfus AM, Scott RJ, Bryant SC, Jaffe AS, Karon BS. Estimating short- and long-term reference change values and index of individuality for tests of platelet function. Clin Biochem 2019; 74:54-59. [PMID: 31669512 DOI: 10.1016/j.clinbiochem.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND In order to manage risks of bleeding and thrombosis after some surgical procedures, platelet function is often measured repeatedly over days or weeks using laboratory tests of platelet function. To interpret test results in the perioperative period, it is necessary to understand analytical, biological and between-person variation. METHODS We collected three separate blood specimens from 16 healthy volunteers on the first study day, and one additional specimen from each volunteer 1, 2, and 3 months later. Arachidonic acid-induced and adenosine diphosphate (ADP)-induced platelet function were measured in duplicate by whole blood impedance aggregometry using Multiplate (ASPI/ADP tests) and VerifyNow (Aspirin Reaction Units [ARU] and P2Y12 Reaction Units [PRU]). The analytical variation (CVA), within-subject variation (CVI), between-subject variation (CVG), index of individuality (II), and reference change values (RCV) were calculated. RESULTS VerifyNow ARU demonstrated the smallest short-term and long-term variability (CVA, CVI, and CVG ~1%), resulting in short- and long-term RCV values <5%. II was also higher (1.92) for VerifyNow ARU than other platelet function tests. Multiplate ASPI and ADP tests had the highest RCV both short-(19.0% and 25.2%, respectively) and long-term (32.1% and 39.6%, respectively) due to increased CVA (>5%) and CVI (3.9-13.1%). VerifyNow PRU had a lower RCV than Multiplate ADP; but was the only test with II <0.6. CONCLUSIONS VerifyNow ARU results can be interpreted relative to a fixed cut-off or population-based reference interval; or relative to small changes in an individual's previous values. VerifyNow PRU and Multiplate ASPI and ADP tests should only be interpreted based upon relative change; and can only distinguish relatively large (>23%) changes over several weeks.
Collapse
Affiliation(s)
- Brooke M Katzman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Amy M Wockenfus
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Renee J Scott
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Sandra C Bryant
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Department of Cardiology, Mayo Clinic, Rochester, MN, United States
| | - Brad S Karon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
| |
Collapse
|
7
|
Kim J, Cho CH, Jung BK, Nam J, Seo HS, Shin S, Lim CS. Comparative evaluation of Plateletworks, Multiplate analyzer and Platelet function analyzer-200 in cardiology patients. Clin Hemorheol Microcirc 2019; 70:257-265. [PMID: 29710682 DOI: 10.3233/ch-170331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective of this study was to comparatively evaluate three commercial whole-blood platelet function analyzer systems: Platelet Function Analyzer-200 (PFA; Siemens Canada, Mississauga, Ontario, Canada), Multiplate analyzer (MP; Roche Diagnostics International Ltd., Rotkreuz, Switzerland), and Plateletworks Combo-25 kit (PLW; Helena Laboratories, Beaumont, TX, USA). Venipuncture was performed on 160 patients who visited a department of cardiology. Pairwise agreement among the three platelet function assays was assessed using Cohen's kappa coefficient and percent agreement within the reference limit. Kappa values with the same agonists were poor between PFA-collagen (COL; agonist)/adenosine diphosphate (ADP) and MP-ADP (-0.147), PFA-COL/ADP and PLW-ADP (0.089), MP-ADP and PLW-ADP (0.039), PFA-COL/ADP and MP-COL (-0.039), and between PFA-COL/ADP and PLW-COL (-0.067). Nonetheless, kappa values for the same assay principle with a different agonist were slightly higher between PFA-COL/ADP and PFA-COL/EPI (0.352), MP-ADP and MP-COL (0.235), and between PLW-ADP and PLW-COL (0.247). The range of percent agreement values was 38.7% to 73.8%. Therefore, various measurements of platelet function by more than one method were needed to obtain a reliable interpretation of platelet function considering low kappa coefficient and modest percent agreement rates among 3 different platelet function tests.
Collapse
Affiliation(s)
- Jeeyong Kim
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Chi Hyun Cho
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Bo Kyeung Jung
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jeonghun Nam
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hong Seog Seo
- Department of Internal Medicine, Division of Cardiology, College of Medicine, Korea University, Seoul, Korea
| | - Sehyun Shin
- School of Mechanical Engineering, Korea University, Seoul, Korea
| | - Chae Seung Lim
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| |
Collapse
|
8
|
Ialongo C, Bernardini S. Preanalytical investigations of phlebotomy: methodological aspects, pitfalls and recommendations. Biochem Med (Zagreb) 2017; 27:177-191. [PMID: 28392739 PMCID: PMC5382842 DOI: 10.11613/bm.2017.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/25/2016] [Indexed: 11/12/2022] Open
Abstract
Phlebotomy is often addressed as a crucial process in the pre-analytical phase, in which a large part of laboratory errors take place, but to date there is not yet a consolidated methodological paradigm. Seeking literature, we found 36 suitable investigations issued between 1996 and 2016 (April) dealing with the investigation of pre-analytical factors related to phlebotomy. We found that the largest part of studies had a cohort of healthy volunteers (22/36) or outpatients (11/36), with the former group showing a significantly smaller median sample size (N = 20, IQR: 17.5-30 and N = 88, IQR: 54.5-220.5 respectively, P < 0.001). Moreover, the largest part investigated one pre-analytical factor (26/36) and regarded more than one laboratory test (29/36), and authors preferably used paired Student’s t-test (17/36) or Wilcoxon’s test (11/36), but calibration (i.e. sample size calculation for a detectable effect) was addressed only in one manuscript. The Bland-Altman plot was often the preferred method used to estimate bias (12/36), as well as the Passing-Bablok regression for agreement (8/36). However, often papers did assess neither bias (12/36) nor agreement (24/36). Clinical significance of bias was preferably assessed comparing to a database value (16/36), and it resulted uncorrelated with the size of the effect produced by the factor (P = 0.142). However, the median effect size (ES) resulted significantly larger if the associated factor was clinically significant instead of non-significant (ES = 1.140, IQR: 0.815-1.700 and ES = 0.349, IQR: 0.228-0.531 respectively, P < 0.001). On these evidences, we discussed some recommendations for improving methodological consistency, delivering reliable results, as well as ensuring accessibility to practical evidences.
Collapse
Affiliation(s)
- Cristiano Ialongo
- Department of Human Physiology and Pharmacology, University of Rome Sapienza, Rome, Italy; Laboratory Medicine Department, "Tor Vergata" University Hospital, Rome, Italy
| | - Sergio Bernardini
- Laboratory Medicine Department, "Tor Vergata" University Hospital, Rome, Italy; Experimental Medicine and Surgery Department, "Tor Vergata" University, Rome, Italy
| |
Collapse
|
9
|
Nikolac N, Krleza JL, Simundic AM. Preanalytical external quality assessment of the Croatian Society of Medical Biochemistry and Laboratory Medicine and CROQALM: finding undetected weak spots. Biochem Med (Zagreb) 2017; 27:131-143. [PMID: 28392736 PMCID: PMC5382847 DOI: 10.11613/bm.2017.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/14/2017] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION The aim of this paper is to present results of first two years of preanalytical external quality assessment (EQA) in Croatia. MATERIALS AND METHODS This paper summarizes results from 6 rounds of preanalytical EQA during 2014-2016 in 161-175 Croatian laboratories (number ranged between cycles). EQA was designed as an online survey of the compliance with National recommendations for phlebotomy (NRP). Forty-seven questions in 5 categories are analyzed (materials and equipment, patient identification, patient preparation, sampling and storage). Additionally, preanalytical cases are presented. Overall performance scores (Question score (Qscore) for compliance with NRP and Case score (Cscore) for preanalytical cases) are calculated for each question/case as a proportion of laboratories with satisfactory procedure (x 100). Qscores and Cscores ≥ 70 were classified as acceptable (maximal score = 100). RESULTS In investigation of compliance with NRP, acceptable Qscores were obtained for 34/47 questions. The lowest scores were observed for the availability of sterile disposable tourniquets (Qscore = 15) and safe-sharp needles (Qscore = 34), obtaining patients address as an identifier (Qscore = 21), using glycolysis inhibitor tubes for glucose concentration measurement (Qscore = 21) and verification of manufacturers declarations on temperature and time of storage (Qscore = 31). There was no statistically significant difference in overall Qscore according to different categories of phlebotomy procedures (P = 0.284). The results of preanalytical cases showed acceptable Cscore values for all cases (89-96). CONCLUSION First two years of preanalytical EQA showed good compliance with the NRP and excellent expertise in resolving complex preanalytical issues. Major critical spots are lack of availability of safe-sharp needles, disposable tourniquets and glucose inhibitor tubes.
Collapse
Affiliation(s)
- Nora Nikolac
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb, Croatia; Working group for preanalytical phase, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Jasna Lenicek Krleza
- Department of laboratory diagnostics, Children's hospital Zagreb, Croatia; CROQALM, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Ana-Maria Simundic
- Working group for preanalytical phase, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia; Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
| |
Collapse
|
10
|
Abstract
Light transmittance aggregometry is the historical reference method for platelet function testing and continues to be used extensively. Whole blood impedance lumiaggregometry represents an updated methodology that provides for simplified specimen management, an assay milieu that replicates in vivo platelet activation conditions, improved reproducibility, and near-patient testing. While the impedance-based whole blood aggregometer with luminescence channel is becoming the standard for platelet function testing using this methodology, at least three near-patient whole blood instruments are available, each employing its unique technology. We provide descriptions of whole blood lumiaggregometry and three near-patient systems. We include the principle of operation, materials, and stepwise example protocols and speculate on the importance of concordance among the platforms.
Collapse
Affiliation(s)
- George A Fritsma
- The Fritsma Factor, Your Interactive Hemostasis Resource, 153 Redwood Drive, Trussville, AL, 35173, USA.
| | | |
Collapse
|
11
|
Magnette A, Chatelain M, Chatelain B, Ten Cate H, Mullier F. Pre-analytical issues in the haemostasis laboratory: guidance for the clinical laboratories. Thromb J 2016; 14:49. [PMID: 27999475 PMCID: PMC5154122 DOI: 10.1186/s12959-016-0123-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/01/2016] [Indexed: 11/10/2022] Open
Abstract
Ensuring quality has become a daily requirement in laboratories. In haemostasis, even more than in other disciplines of biology, quality is determined by a pre-analytical step that encompasses all procedures, starting with the formulation of the medical question, and includes patient preparation, sample collection, handling, transportation, processing, and storage until time of analysis. This step, based on a variety of manual activities, is the most vulnerable part of the total testing process and is a major component of the reliability and validity of results in haemostasis and constitutes the most important source of erroneous or un-interpretable results. Pre-analytical errors may occur throughout the testing process and arise from unsuitable, inappropriate or wrongly handled procedures. Problems may arise during the collection of blood specimens such as misidentification of the sample, use of inadequate devices or needles, incorrect order of draw, prolonged tourniquet placing, unsuccessful attempts to locate the vein, incorrect use of additive tubes, collection of unsuitable samples for quality or quantity, inappropriate mixing of a sample, etc. Some factors can alter the result of a sample constituent after collection during transportation, preparation and storage. Laboratory errors can often have serious adverse consequences. Lack of standardized procedures for sample collection accounts for most of the errors encountered within the total testing process. They can also have clinical consequences as well as a significant impact on patient care, especially those related to specialized tests as these are often considered as "diagnostic". Controlling pre-analytical variables is critical since this has a direct influence on the quality of results and on their clinical reliability. The accurate standardization of the pre-analytical phase is of pivotal importance for achieving reliable results of coagulation tests and should reduce the side effects of the influence factors. This review is a summary of the most important recommendations regarding the importance of pre-analytical factors for coagulation testing and should be a tool to increase awareness about the importance of pre-analytical factors for coagulation testing.
Collapse
Affiliation(s)
- A Magnette
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Haematology Laboratory, B-5530 Yvoir, Belgium
| | - M Chatelain
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Haematology Laboratory, B-5530 Yvoir, Belgium
| | - B Chatelain
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Haematology Laboratory, B-5530 Yvoir, Belgium
| | - H Ten Cate
- Maastricht University Medical Centre and Cardiovascular Research Institute (CARIM), Department of Internal Medicine, Maastricht, The Netherlands
| | - F Mullier
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Haematology Laboratory, B-5530 Yvoir, Belgium
| |
Collapse
|
12
|
Litvinenko A, Moskalensky A, Karmadonova N, Nekrasov V, Strokotov D, Konokhova A, Yurkin M, Pokushalov E, Chernyshev A, Maltsev V. Fluorescence-free flow cytometry for measurement of shape index distribution of resting, partially activated, and fully activated platelets. Cytometry A 2016; 89:1010-1016. [DOI: 10.1002/cyto.a.23003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/01/2016] [Accepted: 10/05/2016] [Indexed: 11/11/2022]
Affiliation(s)
- A.L. Litvinenko
- Voevodsky Institute of Chemical Kinetics and Combustion; Novosibirsk Russian Federation
- Novosibirsk State University; Novosibirsk Russian Federation
| | - A.E. Moskalensky
- Voevodsky Institute of Chemical Kinetics and Combustion; Novosibirsk Russian Federation
- Novosibirsk State University; Novosibirsk Russian Federation
| | - N.A. Karmadonova
- State Research Institute of Circulation Pathology; Novosibirsk Russian Federation
| | - V.M. Nekrasov
- Voevodsky Institute of Chemical Kinetics and Combustion; Novosibirsk Russian Federation
- Novosibirsk State University; Novosibirsk Russian Federation
| | - D.I. Strokotov
- Voevodsky Institute of Chemical Kinetics and Combustion; Novosibirsk Russian Federation
- Novosibirsk State Medical University; Novosibirsk Russian Federation
| | - A.I. Konokhova
- Voevodsky Institute of Chemical Kinetics and Combustion; Novosibirsk Russian Federation
| | - M.A. Yurkin
- Voevodsky Institute of Chemical Kinetics and Combustion; Novosibirsk Russian Federation
- Novosibirsk State University; Novosibirsk Russian Federation
| | - E.A. Pokushalov
- State Research Institute of Circulation Pathology; Novosibirsk Russian Federation
| | - A.V. Chernyshev
- Voevodsky Institute of Chemical Kinetics and Combustion; Novosibirsk Russian Federation
- Novosibirsk State University; Novosibirsk Russian Federation
| | - V.P. Maltsev
- Voevodsky Institute of Chemical Kinetics and Combustion; Novosibirsk Russian Federation
- Novosibirsk State University; Novosibirsk Russian Federation
- Novosibirsk State Medical University; Novosibirsk Russian Federation
| |
Collapse
|
13
|
Ho KK, Abrams-Ogg ACG, Wood RD, O'Sullivan ML, Kirby GM, Blois SL. Assessment of platelet function in healthy sedated cats using three whole blood platelet function tests. J Vet Diagn Invest 2015; 27:352-60. [PMID: 25943127 DOI: 10.1177/1040638715584994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objectives of this study were to establish feline references intervals for 3 commercial whole blood platelet function test analyzer systems: Multiplate analyzer (MP; Roche Diagnostics International Ltd., Rotkreuz, Switzerland), Platelet Function Analyzer-100 (PF: Siemens Canada, Mississauga, Ontario, Canada), and Plateletworks Combo-25 kit (PW; Helena Laboratories, Beaumont, TX). Venipuncture was performed on 55 healthy sedated cats, and platelet aggregation in response to adenosine diphosphate (ADP), collagen (COL), and arachidonic acid (AA; MP only) was assessed using citrated blood. For the MP analyzer, median (95% confidence intervals [CIs]) area under curve (Units) for ADP, COL, and AA agonists were 87 (11-176), 81 (32-129), and 91 (59-129), respectively. For the PF analyzer, median (95% CIs) closure time, using COL-ADP cartridges, was 69 (46-89) sec. For the PW assay, median (95% CIs) percent aggregations for ADP and COL agonists were 71 (18-92) and 49 (9-96), respectively, using impedance hematology analyzer platelet counts, and 94 (25-98) and 68 (14-119), respectively, using flow cytometry hematology analyzer platelet counts. There were low correlations between the PF analyzer (COL-ADP cartridge) and MP analyzer (COL agonist; ρ = 0.11), and between the PF analyzer (COL-ADP cartridge) and PW assay (COL agonist using impedance platelet counts; ρ = 0.14). The PW assay percent aggregations using impedance and flow cytometric platelet counts were correlated for both ADP (ρ = 0.64) and COL (ρ = 0.64) agonists. Platelet function testing using these tests are feasible in cats, but 95% CIs are wide, so single results may be difficult to interpret. Platelet counting by impedance or flow cytometry may be used for the PW assay but are not interchangeable.
Collapse
Affiliation(s)
- Kimberly K Ho
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony C G Abrams-Ogg
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - R Darren Wood
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - M Lynne O'Sullivan
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Gordon M Kirby
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shauna L Blois
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
14
|
Karon BS, Tolan NV, Koch CD, Wockenfus AM, Miller RS, Lingineni RK, Pruthi RK, Chen D, Jaffe AS. Precision and Reliability of 5 Platelet Function Tests in Healthy Volunteers and Donors on Daily Antiplatelet Agent Therapy. Clin Chem 2014; 60:1524-31. [DOI: 10.1373/clinchem.2014.226332] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Anticoagulation protocols used during mechanical circulatory support call for titration of antiplatelet agents. We compared the precision and reliability of 5 platelet function tests in healthy volunteers and donors on daily antiplatelet therapy to distinguish their efficacy for titrating antiplatelet therapy.
METHODS
We assessed arachidonic acid–induced platelet function by light transmission aggregometry (LTA), Multiplate impedance aggregometry, VerifyNow, and platelet mapping by thromboelastography (TEG PM). We assessed ADP-induced platelet function by the same methods and flow cytometry. Forty healthy volunteers and 10–13 volunteers on daily aspirin and/or clopidogrel therapy were evaluated. We compared tests for intraassay precision, interassay precision (samples from 2 separate blood draws), and reliability coefficient.
RESULTS
For arachidonic acid–induced platelet aggregation in healthy volunteers, intra- and interassay CVs were ≤10% for all methods. Intra- and interassay precision among donors on daily aspirin was ≤30% for all methods except LTA (38% interassay CV) and TEG PM (95% intraassay and 104% interassay CV). For ADP-induced platelet function, intra- and interassay precision was ≤10% and ≤30% for all methods. Only Multiplate demonstrated moderate or greater (R > 0.40) reliability coefficients for arachidonic acid–induced platelet function among all subjects. All methods of ADP-induced platelet function, except TEG PM, demonstrated substantial or greater (R > 0.60) reliability among all subjects.
CONCLUSIONS
TEG PM is least suited to monitor effects of antiplatelet agents. Multiplate impedance aggregometry was the only method to demonstrate an acceptable reliability coefficient among healthy volunteers and donors on both aspirin and clopidogrel therapy.
Collapse
Affiliation(s)
- Brad S Karon
- Department of Laboratory Medicine and Pathology and
| | - Nicole V Tolan
- Current address: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | | | | | - Ravi K Lingineni
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Dong Chen
- Department of Laboratory Medicine and Pathology and
| | | |
Collapse
|
15
|
Diagouraga B, Grichine A, Fertin A, Wang J, Khochbin S, Sadoul K. Motor-driven marginal band coiling promotes cell shape change during platelet activation. ACTA ACUST UNITED AC 2014; 204:177-85. [PMID: 24421335 PMCID: PMC3897189 DOI: 10.1083/jcb.201306085] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
During platelet activation, motor protein-induced coiling of the microtubule-based marginal band leads to the cells’ characteristic spherical shape, whereas actomyosin-mediated compression of the coil results in new microtubule polymerization in a smaller ring. Platelets float in the blood as discoid particles. Their shape is maintained by microtubules organized in a ring structure, the so-called marginal band (MB), in the periphery of resting platelets. Platelets are activated after vessel injury and undergo a major shape change known as disc to sphere transition. It has been suggested that actomyosin tension induces the contraction of the MB to a smaller ring. In this paper, we show that antagonistic microtubule motors keep the MB in its resting state. During platelet activation, dynein slides microtubules apart, leading to MB extension rather than contraction. The MB then starts to coil, thereby inducing the spherical shape of activating platelets. Newly polymerizing microtubules within the coiled MB will then take a new path to form the smaller microtubule ring, in concerted action with actomyosin tension. These results present a new view of the platelet activation mechanism and reveal principal mechanistic features underlying cellular shape changes.
Collapse
Affiliation(s)
- Boubou Diagouraga
- Institut Albert Bonniot, Institut National de la Santé et de la Recherche Médicale U823; and 2 Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications, Grenoble, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5525; Université Joseph Fourier-Grenoble 1, F-38041 Grenoble, France
| | | | | | | | | | | |
Collapse
|
16
|
Andreasen JB, Pistor-Riebold TU, Knudsen IH, Ravn HB, Hvas AM. Evaluation of different sized blood sampling tubes for thromboelastometry, platelet function, and platelet count. Clin Chem Lab Med 2014; 52:701-6. [DOI: 10.1515/cclm-2013-0836] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/06/2013] [Indexed: 11/15/2022]
|
17
|
Point of Care Testing in Cardiac Surgery: Diagnostic Modalities to Assess Coagulation and Platelet Function. Drug Dev Res 2013. [DOI: 10.1002/ddr.21099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|