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Kumari S, Kumar S, Bharti N, Shekhar R. Impact of Pneumatic Transport System on Preanalytical Phase Affecting Clinical Biochemistry Results. J Lab Physicians 2022; 15:48-55. [PMID: 37064988 PMCID: PMC10104724 DOI: 10.1055/s-0042-1750077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Abstract
Introduction PTS (pneumatic transport system) is extensively being used in modern hospitals for rapid transportation of blood samples and other specimens. However, it has a potential impact on blood components, which should be investigated and nullified accordingly. This study was part of a correction program aimed at reducing hemolysis. It was done by comparing paired samples transported manually and by PTS.
Materials and Methods This study was initiated to monitor the impact of PTS on hemolysis of clinical biochemistry blood samples. It was performed in two phases—before and after the corrective action taken. Phase I: done after PTS installation but before the corrective action was taken. Duplicate samples from 100 healthy individuals were collected, one set transported by PTS and the other by human carriers. Both sets were assessed for 25 biochemistry analytes, hemolysis index (HI), and acceleration profiles using a data logger. Corrective measures were then taken, followed by phase II of the study. In phase II, the sample size and study design remained the same as phase I. All the test results of PTS and hand-carried samples were statistically analyzed for any significant difference.
Result In phase I, all the hemolysis-manifesting parameters, LDH (lactate dehydrogenase), potassium, AST (aspartate transaminase), and phosphorus, were raised in PTS samples as compared with the manual samples. Their differences were significant as the p-values were 0.001, 0.000, 0.025, and 0.047, respectively. The differences for LDH and potassium were clinically significant as well. HI (9%) and peak acceleration (15.7 g) were high in PTS samples.In phase II, no statistically significant difference between paired samples was found for all biochemistry parameters except for a few which were clinically nonsignificant. For PTS samples, HI was 2.5% and the peak acceleration was 11.2 g, whereas for manual samples, HI was 2%.
Conclusion Evidence of hemolysis was found in PTS samples as compared with handheld samples, which was resolved after several corrective actions were taken. Thereafter, PTS became reliable for sample delivery in a routine biochemistry laboratory. Hence, each hospital should scrutinize their PTS for its effects on sample integrity to get rid of PTS-induced preanalytical errors.
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Affiliation(s)
- Sweta Kumari
- Biochemistry Department, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India
| | - Santosh Kumar
- Biochemistry Department, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India
| | - Neha Bharti
- Biochemistry Department, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India
| | - Ravi Shekhar
- Biochemistry Department, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India
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Metze M, Platz M, Pfrepper C, Petros S. [Coagulation diagnostics in the clinical routine-Part 1 : Evaluation of the risk of bleeding before surgery, interventions and diagnostics in bleeding diathesis]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2022; 63:619-630. [PMID: 35925131 DOI: 10.1007/s00108-022-01331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
This article on coagulation diagnostics is published in two parts covering five common clinical scenarios for coagulation diagnostics. Part 1 deals with the diagnostics prior to invasive interventions and coagulation diagnostics to clarify a tendency to bleeding. The global parameters Quick and activated partial thromboplastin time are established for monitoring certain anticoagulants; however, they are not predictive with respect to the risk of bleeding prior to elective invasive interventions. In this context, disorders of primary hemostasis are frequent, which are insufficiently detected by the global parameters. Most clinical bleeding tendencies are due to acquired causes. These include anticoagulants and diseases which can be accompanied by tendency to bleeding. For coagulation tests preanalytical issues are essential in order to avoid false results. The interpretation should always be made in the context of the current physiological state.
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Affiliation(s)
- Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Martin Platz
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Christian Pfrepper
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Bereich Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Sirak Petros
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Bereich Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Interdisziplinäre Internistische Intensivmedizin, Universitätsklinikum Leipzig, Leipzig, Deutschland
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3
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Reichert L, Wallner S, Burkhardt R, Offner R, Ahrens N, Hähnel V. Triple apheresis platelet concentrate quality after pneumatic tube system, conveyor box, and courier transport: An observational study. Health Sci Rep 2022; 5:e596. [PMID: 35425867 PMCID: PMC8989271 DOI: 10.1002/hsr2.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lena Reichert
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Stefan Wallner
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Ralph Burkhardt
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Robert Offner
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Norbert Ahrens
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
- MVZ for Laboratory Medicine Raubling, amedes Labor Raubling Germany
| | - Viola Hähnel
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
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4
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Bourguignon A, Tasneem S, Hayward CP. Screening and diagnosis of inherited platelet disorders. Crit Rev Clin Lab Sci 2022; 59:405-444. [PMID: 35341454 DOI: 10.1080/10408363.2022.2049199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Inherited platelet disorders are important conditions that often manifest with bleeding. These disorders have heterogeneous underlying pathologies. Some are syndromic disorders with non-blood phenotypic features, and others are associated with an increased predisposition to developing myelodysplasia and leukemia. Platelet disorders can present with thrombocytopenia, defects in platelet function, or both. As the underlying pathogenesis of inherited thrombocytopenias and platelet function disorders are quite diverse, their evaluation requires a thorough clinical assessment and specialized diagnostic tests, that often challenge diagnostic laboratories. At present, many of the commonly encountered, non-syndromic platelet disorders do not have a defined molecular cause. Nonetheless, significant progress has been made over the past few decades to improve the diagnostic evaluation of inherited platelet disorders, from the assessment of the bleeding history to improved standardization of light transmission aggregometry, which remains a "gold standard" test of platelet function. Some platelet disorder test findings are highly predictive of a bleeding disorder and some show association to symptoms of prolonged bleeding, surgical bleeding, and wound healing problems. Multiple assays can be required to diagnose common and rare platelet disorders, each requiring control of preanalytical, analytical, and post-analytical variables. The laboratory investigations of platelet disorders include evaluations of platelet counts, size, and morphology by light microscopy; assessments for aggregation defects; tests for dense granule deficiency; analyses of granule constituents and their release; platelet protein analysis by immunofluorescent staining or flow cytometry; tests of platelet procoagulant function; evaluations of platelet ultrastructure; high-throughput sequencing and other molecular diagnostic tests. The focus of this article is to review current methods for the diagnostic assessment of platelet function, with a focus on contemporary, best diagnostic laboratory practices, and relationships between clinical and laboratory findings.
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Affiliation(s)
- Alex Bourguignon
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Subia Tasneem
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Catherine P Hayward
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
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5
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A Study on Design and Control of the Multi-Station Multi-Container Transportation System. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In considering the problem of saving spaces during the transportation of items from one station to another, for example, in warehouses, factories, hospitals, etc., an automatic transportation system (ATS) that could take advantage of the above ceiling spaces for the transportation of products is considered. Such a system guarantees that the activities occurring in the floor area will be maintained as usual. To achieve this requirement, the ceiling spaces of a building are used to construct an automatic multi-station multi-container (MSMC) transportation system. This system can transport items from one place to another in the whole system. This system is designed to utilize the spaces above the ceiling, and it has the advantage of saving floor space for transportation operations. This will increase the operational capability of the industries and also improve the productivity of the industry in which this system is implemented. The entire transportation system includes (1) the essential conveying system (which is a functional conveyor module with a specified number of containers); (2) the control block that can monitor and operate the system; and (3) the sensor block for detecting and identifying the containers. The content of this article focuses on the introduction of the mechanical system (1); the control system (2); and the operating principle of the whole system (3).
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Kosem A, Topcuoglu C, Sezer S, Demir E, Turhan T. The effects of transport by pneumatic tube system on urine analysis. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:361-364. [PMID: 34346281 DOI: 10.1080/00365513.2021.1923058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The pneumatic tube transport system (PTS) is used frequently for the transport of samples in hospitals. Effects of PTS on urine components are unknown. In our study, we aim to examine the influence of PTS on the quality of routine urine microscopic parameters. Urine samples were divided into two groups: group 1 were transported to the laboratory manually and group 2 were transported to the laboratory via the PTS. Each of 187 urine samples was studied with iQ200 automated urine devices for erythrocytes, leukocytes, epithelial cells, crystal, cast and yeast cells. No statistically significant differences were detected between group 1 and group 2 for urine parameters. For erythrocytes, leukocytes, and epithelial cells, the gamma was 0.982, 0.959, and 1.0, respectively. For crystal, cast and yeast cells, the kappa values were 0.952, 0.866, and 1.0, respectively. PTS has no effect on erythrocytes, leukocytes, epithelial cells, crystal, cast, and yeast cells in urine analysis. We concluded that PTS can be used in the transport of urine samples.
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Affiliation(s)
- Arzu Kosem
- Biochemistry Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Canan Topcuoglu
- Biochemistry Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Sevilay Sezer
- Biochemistry Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Evren Demir
- Biochemistry Laboratory, Ankara Etlik Lady Zübeyde Gynaecology Education and Research Hospital, Ankara, Turkey
| | - Turan Turhan
- Biochemistry Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
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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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Bolliger D, Lancé MD, Siegemund M. Point-of-Care Platelet Function Monitoring: Implications for Patients With Platelet Inhibitors in Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 35:1049-1059. [PMID: 32807601 DOI: 10.1053/j.jvca.2020.07.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022]
Abstract
Although most physicians are comfortable managing the limited anticoagulant effect of aspirin, the recent administration of potent P2Y12 receptor inhibitors in patients undergoing cardiac surgery remains a dilemma. Guidelines recommend discontinuation of potent P2Y12 inhibitors 5- to- 7 days before surgery to reduce the risk of postoperative hemorrhage. Such a strategy might not be feasible before urgent surgery, due to ongoing myocardial ischemia or in patients at high risk for thromboembolic events. Recently, different point-of-care devices to assess functional platelet quality have become available for clinical use. The aim of this narrative review was to evaluate the implications and potential benefits of platelet function monitoring in guiding perioperative management and therapeutic options in patients treated with antiplatelets, including aspirin or P2Y12 receptor inhibitors, undergoing cardiac surgery. No objective superiority of one point-of-care device over another was found in a large meta-analysis. Their accuracy and reliability are generally limited in the perioperative period. In particular, preoperative platelet function testing has been used to assess platelet contribution to bleeding after cardiac surgery. However, predictive values for postoperative hemorrhage and transfusion requirements are low, and there is a significant variability between and within these tests. Further, platelet function monitoring has been used to optimize the preoperative waiting period after cessation of dual antiplatelet therapy before urgent cardiac surgery. Furthermore, studies assessing their value in therapeutic decisions in bleeding patients after cardiac surgery are scarce. A general and liberal use of perioperative platelet function testing is not yet recommended.
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Affiliation(s)
- Daniel Bolliger
- Department for Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
| | - Marcus D Lancé
- Department of Anesthesiology, Intensive Care Unit and Perioperative Medicine, Weill-Cornell Medicine-Qatar, Hamad Medical Corporation, Doha, Qatar
| | - Martin Siegemund
- Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
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9
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Gils C, Broell F, Vinholt PJ, Nielsen C, Nybo M. Use of clinical data and acceleration profiles to validate pneumatic transportation systems. ACTA ACUST UNITED AC 2019; 58:560-568. [PMID: 31804954 DOI: 10.1515/cclm-2019-0881] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/03/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Modern pneumatic transportation systems (PTSs) are widely used in hospitals for rapid blood sample transportation. The use of PTS may affect sample integrity. Impact on sample integrity in relation to hemolysis and platelet assays was investigated and also, we wish to outline a process-based and outcome-based validation model for this preanalytical component.
Methods
The effect of PTS was evaluated by drawing duplicate blood samples from healthy volunteers, one sent by PTS and the other transported manually to the core laboratory. Markers of hemolysis (potassium, lactate dehydrogenase [LD] and hemolysis index [HI]) and platelet function and activation were assessed. Historic laboratory test results of hemolysis markers measured before and after implementation of PTS were compared. Furthermore, acceleration profiles during PTS and manual transportation were obtained from a mini g logger in a sample tube.
Results
Hand-carried samples experienced a maximum peak acceleration of 5 g, while peaks at almost 15 g were observed for PTS. No differences were detected in results of potassium, LD, platelet function and activation between PTS and manual transport. Using past laboratory data, differences in potassium and LD significantly differed before and after PTS installation for all three lines evaluated. However, these estimated differences were not clinically significant.
Conclusions
In this study, we found no evidence of PTS-induced hemolysis or impact on platelet function or activation assays. Further, we did not find any clinically significant changes indicating an acceleration-dependent impact on blood sample quality. Quality assurance of PTS can be performed by surveilling outcome markers such as HI, potassium and LD.
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Affiliation(s)
- Charlotte Gils
- Department of Clinical Biochemistry and Pharmacology , Odense University Hospital , Odense C , Denmark
- Clinical Institute , University of Southern Denmark , Odense , Denmark
| | | | - Pernille J. Vinholt
- Department of Clinical Biochemistry and Pharmacology , Odense University Hospital , Odense C , Denmark
- Clinical Institute , University of Southern Denmark , Odense , Denmark
| | - Christian Nielsen
- Department of Clinical Immunology , Odense University Hospital , Odense , Denmark
| | - Mads Nybo
- Clinical Institute , University of Southern Denmark , Odense , Denmark
- Department of Clinical Diagnostics , Hospital of South West Jutland , Esbjerg , Denmark
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Bolliger D, Tanaka KA. Platelet Count and Function—Can We Kill Two Birds With an Ultrasound Wave? J Cardiothorac Vasc Anesth 2019; 33:1599-1600. [DOI: 10.1053/j.jvca.2019.02.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 11/11/2022]
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Zilberman-Rudenko J, Zhao FZ, Reitsma SE, Mitrugno A, Pang J, Shatzel JJ, Rick B, Tyrrell C, Hasan W, McCarty OJT, Schreiber MA. Effect of Pneumatic Tubing System Transport on Platelet Apheresis Units. Cardiovasc Eng Technol 2018; 9:515-527. [PMID: 29785664 PMCID: PMC6168073 DOI: 10.1007/s13239-018-0361-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/08/2018] [Indexed: 01/23/2023]
Abstract
Platelet apheresis units are transfused into patients to mitigate or prevent bleeding. In a hospital, platelet apheresis units are transported from the transfusion service to the healthcare teams via two methods: a pneumatic tubing system (PTS) or ambulatory transport. Whether PTS transport affects the activity and utility of platelet apheresis units is unclear. We quantified the gravitational forces and transport time associated with PTS and ambulatory transport within our hospital. Washed platelets and supernatants were prepared from platelet apheresis units prior to transport as well as following ambulatory or PTS transport. For each group, we compared resting and agonist-induced platelet activity and platelet aggregate formation on collagen or von Willebrand factor (VWF) under shear, platelet VWF-receptor expression and VWF multimer levels. Subjection of platelet apheresis units to rapid acceleration/deceleration forces during PTS transport did not pre-activate platelets or their ability to activate in response to platelet agonists as compared to ambulatory transport. Platelets within platelet apheresis units transported via PTS retained their ability to adhere to surfaces of VWF and collagen under shear, although platelet aggregation on collagen and VWF was diminished as compared to ambulatory transport. VWF multimer levels and platelet GPIb receptor expression was unaffected by PTS transport as compared to ambulatory transport. Subjection of platelet apheresis units to PTS transport did not significantly affect the baseline or agonist-induced levels of platelet activation as compared to ambulatory transport. Our case study suggests that PTS transport may not significantly affect the hemostatic potential of platelets within platelet apheresis units.
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Affiliation(s)
- Jevgenia Zilberman-Rudenko
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA.
| | - Frank Z Zhao
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Stephanie E Reitsma
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA
| | - Annachiara Mitrugno
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA
| | - Jiaqing Pang
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA
| | - Joseph J Shatzel
- Division of Hematology & Medical Oncology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Beth Rick
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Christina Tyrrell
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Wohaib Hasan
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Owen J T McCarty
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA
| | - Martin A Schreiber
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
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Nybo M, Lund ME, Titlestad K, Maegaard CU. Blood Sample Transportation by Pneumatic Transportation Systems: A Systematic Literature Review. Clin Chem 2018; 64:782-790. [DOI: 10.1373/clinchem.2017.280479] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/05/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Pneumatic transportation systems (PTSs) are increasingly used for transportation of blood samples to the core laboratory. Many studies have investigated the impact of these systems on different types of analyses, but to elucidate whether PTSs in general are safe for transportation of blood samples, existing literature on the subject was systematically assessed.
METHODS
A systematic literature review was conducted following the preferred reporting items for systematic reviews and metaanalyses (PRISMA) Statement guidelines to gather studies investigating the impact of PTS on analyses in blood samples. Studies were extracted from PubMed and Embase. The search period ended November 2016.
RESULTS
A total of 39 studies were retrieved. Of these, only 12 studies were conducted on inpatients, mainly intensive care unit patients. Blood gases, hematology, and clinical chemistry were well investigated, whereas coagulation, rotational thromboelastometry, and platelet function in acutely ill patients were addressed by only 1 study each. Only a few parameters were affected in a clinically significant way (clotting time parameter in extrinsic system thromboelastometry, pO2 in blood gas, multiplate analysis, and the hemolysis index).
CONCLUSIONS
Owing to their high degree of heterogeneity, the retrieved studies were unable to supply evidence for the safety of using PTSs for blood sample transportation. In consequence, laboratories need to measure and document the actual acceleration forces in their existing PTS, instituting quality target thresholds for these measurements such as acceleration vector sums. Computer modeling might be applied to the evaluation of future PTS installations. With the increasing use of PTS, a harmonized, international recommendation on this topic is warranted.
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Affiliation(s)
- Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Merete E Lund
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
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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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15
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Enko D, Mangge H, Münch A, Niedrist T, Mahla E, Metzler H, Prüller F. Pneumatic tube system transport does not alter platelet function in optical and whole blood aggregometry, prothrombin time, activated partial thromboplastin time, platelet count and fibrinogen in patients on anti-platelet drug therapy. Biochem Med (Zagreb) 2017; 27:217-224. [PMID: 28392742 PMCID: PMC5382865 DOI: 10.11613/bm.2017.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/14/2017] [Indexed: 01/09/2023] Open
Abstract
Introduction The aim of this study was to assess pneumatic tube system (PTS) alteration on platelet function by the light transmission aggregometry (LTA) and whole blood aggregometry (WBA) method, and on the results of platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen. Materials and methods Venous blood was collected into six 4.5 mL VACUETTE® 9NC coagulation sodium citrate 3.8% tubes (Greiner Bio-One International GmbH, Kremsmünster, Austria) from 49 intensive care unit (ICU) patients on dual anti-platelet therapy and immediately hand carried to the central laboratory. Blood samples were divided into 2 Groups: Group 1 samples (N = 49) underwent PTS (4 m/s) transport from the central laboratory to the distant laboratory and back to the central laboratory, whereas Group 2 samples (N = 49) were excluded from PTS forces. In both groups, LTA and WBA stimulated with collagen, adenosine-5’-diphosphate (ADP), arachidonic acid (AA) and thrombin-receptor-activated-peptide 6 (TRAP-6) as well as platelet count, PT, APTT, and fibrinogen were performed. Results No statistically significant differences were observed between blood samples with (Group 1) and without (Group 2) PTS transport (P values from 0.064 – 0.968). The AA-induced LTA (bias: 68.57%) exceeded the bias acceptance limit of ≤ 25%. Conclusions Blood sample transportation with computer controlled PTS in our hospital had no statistically significant effects on platelet aggregation determined in patients with anti-platelet therapy. Although AA induced LTA showed a significant bias, the diagnostic accuracy was not influenced.
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Affiliation(s)
- Dietmar Enko
- Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Steyr, Austria; Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Andreas Münch
- Department of Anesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria
| | - Tobias Niedrist
- Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Elisabeth Mahla
- Department of Anesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria; Research Unit "Perioperative Platelet Function", Medical University of Graz, Graz, Austria
| | - Helfried Metzler
- Department of Anesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Laboratory Diagnostics, Medical University Graz, Graz, Austria; Research Unit "Perioperative Platelet Function", Medical University of Graz, Graz, Austria
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16
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Chapman K, Favaloro EJ. Time dependent reduction in platelet aggregation using the multiplate analyser and hirudin blood due to platelet clumping. Platelets 2017; 29:305-308. [DOI: 10.1080/09537104.2017.1384540] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kent Chapman
- Department of Haematology, NSW Health Pathology, John Hunter Hospital, New Lambton Hts, Newcastle, NSW, Australia
| | - Emmanuel J. Favaloro
- Diagnostic Haemostasis Laboratory, Department of Haematology, Institute of Clinical Pathology and Medical research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, Sydney, NSW, Australia
- Sydney Centres for Thrombosis and Haemostasis, Westmead, Sydney, NSW, Australia
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Pupek A, Matthewson B, Whitman E, Fullarton R, Chen Y. Comparison of pneumatic tube system with manual transport for routine chemistry, hematology, coagulation and blood gas tests. Clin Chem Lab Med 2017; 55:1537-1544. [PMID: 28432841 DOI: 10.1515/cclm-2016-1157] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/06/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The pneumatic tube system (PTS) is commonly used in modern clinical laboratories to provide quick specimen delivery. However, its impact on sample integrity and laboratory testing results are still debatable. In addition, each PTS installation and configuration is unique to its institution. We sought to validate our Swisslog PTS by comparing routine chemistry, hematology, coagulation and blood gas test results and sample integrity indices between duplicate samples transported either manually or by PTS. METHODS Duplicate samples were delivered to the core laboratory manually by human courier or via the Swisslog PTS. Head-to-head comparisons of 48 routine chemistry, hematology, coagulation and blood gas laboratory tests, and three sample integrity indices were conducted on 41 healthy volunteers and 61 adult patients. RESULTS The PTS showed no impact on sample hemolysis, lipemia, or icterus indices (all p<0.05). Although alkaline phosphatase, total bilirubin and hemoglobin reached statistical significance (p=0.009, 0.027 and 0.012, respectively), all had very low average bias which ranged from 0.01% to 2%. Potassium, total hemoglobin and percent deoxyhemoglobin were statistically significant for the neonatal capillary tube study (p=0.011, 0.033 and 0.041, respectively) but no biases greater than ±4% were identified for these parameters. All observed differences of these 48 laboratory tests were not clinically significant. CONCLUSIONS The modern PTS investigated in this study is acceptable for reliable sample delivery for routine chemistry, hematology, coagulation and blood gas (in syringe and capillary tube) laboratory tests.
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Affiliation(s)
- Alex Pupek
- .Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network Fredericton, NB, Canada; and Dalhousie Medical Program in New Brunswick, Saint John, NB, Canada
| | - Beverly Matthewson
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, Canada
| | - Erin Whitman
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, Canada
| | - Rachel Fullarton
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, Canada
| | - Yu Chen
- Chief of Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada E3B 5N5; Associate Professor, Department of Pathology, Dalhousie University, Halifax, NS, Canada.
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18
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Le Quellec S, Paris M, Nougier C, Sobas F, Rugeri L, Girard S, Bordet JC, Négrier C, Dargaud Y. Pre-analytical effects of pneumatic tube system transport on routine haematology and coagulation tests, global coagulation assays and platelet function assays. Thromb Res 2017; 153:7-13. [DOI: 10.1016/j.thromres.2016.12.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/05/2016] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
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19
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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.
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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
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20
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Espinosa A, Ruckert A, Navarro J, Videm V, Sletta BV. Are TEG®results in healthy blood donors affected by the transport of blood samples in a pneumatic tube system? Int J Lab Hematol 2016; 38:e73-6. [DOI: 10.1111/ijlh.12494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Espinosa
- Department of Immunology and Transfusion Medicine; St. Olavs University Hospital; Trondheim Norway
| | - A. Ruckert
- Department of Immunology and Transfusion Medicine; St. Olavs University Hospital; Trondheim Norway
| | - J. Navarro
- Plant Radar Systems, Vestas; Oslo Norway
| | - V. Videm
- Department of Laboratory Medicine, Children's and Women's Health; Norwegian University of Science and technology; Trondheim Norway
| | - B. V. Sletta
- Department of Immunology and Transfusion Medicine; St. Olavs University Hospital; Trondheim Norway
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Koroglu M, Erkurt MA, Kuku I, Kaya E, Berber I, Nizam I, Yagar Y, Kayis SA. Assessing Safety of Pneumatic Tube System (PTS) for Patients with Very Low Hematologic Parameters. Med Sci Monit 2016; 22:1329-33. [PMID: 27097101 PMCID: PMC4841356 DOI: 10.12659/msm.898164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Preventive interventions save lives during the process of chemotherapy for hematologic malignancies, when a hematology laboratory can ensure accurate results. The use of a pneumatic tube system (PTS) is associated with measurement errors and unnecessary transfusions. The aim of this study was to evaluate pre-analytical errors associated with transportation method (PTS versus hand-delivered) and to investigate whether there are unnecessary transfusion events in pancytopenia leukemia patients with very low hematological parameters. Material/Methods A total of 140 paired blood collections were performed for hemogram and biochemistry assays. Paired EDTA and serum gel blood samples were collected from 58 cases with acute leukemia on different days. For each pair, one sample was hand-delivered by a courier (Group 1) while the other sample was transported through a PTS (Group 2). Results The hand-delivered method showed that some platelet transfusions were unnecessary for different thrombocyte cut-off values. Calculated unnecessary platelet (PLT) transfusion ratios when using PTS (PLT <30×103/μL, 16.3%; PLT <25×103/μL, 16.4%; PLT <20×103/μL, 80.3%; PLT <15×103/μL, 48.6%; and PLT <10×103/μL, 150.0%) were found to be statistically significant (p=0.002, p=0.046, p<0.000, p=0.028, and p<0.000, respectively). In contrast, for RBC transfusion ratios, although the ratios were high in Group 2, we found no significant difference between the two groups; (HGB <8.0 g/dL, 23.3%; HGB <9.0 g/dL, 25.0%, HGB<10.0 g/dL, 19.3%) and (p=0.002, p=0.085, p<0.160, and p=0.235, respectively). Conclusions Although our results cannot be universally applied, physicians should be careful, skeptical, and suspicious of transfusion decisions in hematology clinics and consider potential analytical and pre-analytical errors in cases of severe cytopenia when using PTS.
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Affiliation(s)
- Mustafa Koroglu
- Department of Hematology, Karabuk University, Faculty of Medicine, Karabuk, Turkey
| | - Mehmet Ali Erkurt
- Department of Hematology, Inonu University, Faculty of Medicine, Malatya, Turkey
| | - Irfan Kuku
- Department of Hematology, Inonu University, Faculty of Medicine, Malatya, Turkey
| | - Emin Kaya
- Department of Hematology, Inonu University, Faculty of Medicine, Malatya, Turkey
| | - Ilhami Berber
- Department of Hematology, Inonu University, Faculty of Medicine, Malatya, Turkey
| | - Ilknur Nizam
- Department of Hematology, Inonu University, Faculty of Medicine, Malatya, Turkey
| | - Yavuz Yagar
- Department of Hematology, Inonu University, Faculty of Medicine, Malatya, Turkey
| | - Seyit Ali Kayis
- Department of Biostatistics, Karabuk University, Faculty of Medicine, Karabuk, Turkey
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22
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Agarwal S, Johnson RI, Kirmani BH. Pre- and Post-Bypass Platelet Function Testing With Multiple Electrode Aggregometry and TEG Platelet Mapping in Cardiac Surgery. J Cardiothorac Vasc Anesth 2015; 29:1272-6. [DOI: 10.1053/j.jvca.2015.01.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Indexed: 01/30/2023]
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23
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Bolliger D, Filipovic M, Matt P, Tanaka KA, Gregor M, Zenklusen U, Seeberger MD, Lurati Buse G. Reduced aspirin responsiveness as assessed by impedance aggregometry is not associated with adverse outcome after cardiac surgery in a small low-risk cohort. Platelets 2015; 27:254-61. [PMID: 26367099 DOI: 10.3109/09537104.2015.1083969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Reduced aspirin responsiveness (i.e. persistent high platelet reactivity in platelet function testing) might be associated with increased risk of myocardial ischemia and cardiac mortality in patients with coronary disease. However, the impact in patients undergoing coronary artery bypass grafting (CABG) is unclear. The aim of this prospective cohort study was to evaluate the predictive value of reduced aspirin responsiveness on cardiac and thromboembolic events in patients undergoing elective isolated CABG surgery with aspirin intake until at least two days before surgery. We included 304 patients in this prospective single-center cohort study. Impedance platelet aggregometry (Multiplate®) was performed directly before and on the first day after surgery. Reduced aspirin responsiveness was defined as area under the curve in ASPItest (AUCASPI) ≥300 U. The primary outcome was a composite of all-cause mortality and/or major adverse cardiac or thromboembolic events within 1 year. Reduced aspirin responsiveness was found in 13 and 24% of patients pre and postoperatively, respectively. There was no difference in the outcomes between patients with normal and reduced aspirin responsiveness in the preoperative measurement (log-rank test, p = 0.540). Multivariate analysis including logistic EuroSCORE I and postoperative troponin T levels did not show any association of reduced aspirin responsiveness with adverse outcome (hazard ratio, 0.576; (95% CI 0.128-2.585; p = 0.471). Similarly, postoperative reduced aspirin responsiveness was not associated with adverse events. To conclude, reduced aspirin responsiveness as evaluated by Multiplate® platelet function analyzer was not associated with increased incidence of major adverse cardiac and thromboembolic events and mortality after CABG surgery.
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Affiliation(s)
- Daniel Bolliger
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland
| | - Miodrag Filipovic
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland .,b Institute of Anesthesiology, Cantonal Hospital , St. Gallen , Switzerland
| | - Peter Matt
- c Division of Cardiac Surgery , University Hospital Basel , Basel , Switzerland
| | - Kenichi A Tanaka
- d Department of Anesthesiology, Cardiothoracic Anesthesia Division , University of Maryland , Baltimore , MD , USA , and
| | - Michael Gregor
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland
| | - Urs Zenklusen
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland .,c Division of Cardiac Surgery , University Hospital Basel , Basel , Switzerland
| | - Manfred D Seeberger
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland .,e Institute for Anesthesiology and Intensive Care, Hirslanden Klinik , Zurich , Switzerland
| | - Giovanna Lurati Buse
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland
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24
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Bolliger D, Mauermann E, Tanaka KA. Thresholds for Perioperative Administration of Hemostatic Blood Components and Coagulation Factor Concentrates: An Unmet Medical Need. J Cardiothorac Vasc Anesth 2015; 29:768-76. [DOI: 10.1053/j.jvca.2015.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Indexed: 12/19/2022]
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25
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Kicken C, Van Poucke S, Marcus AE, Lancé MD, Henskens Y. Response of platelet concentrates to pressure and temperature changes without impairment of the in vitro function. Thromb Res 2015; 135:679-83. [DOI: 10.1016/j.thromres.2015.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/09/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
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26
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Tóth J, Lenkey Á, V. Oláh A, Köteles J, Kissné Sziráki V, Kerényi A, Kappelmayer J. Pneumatic tube system for transport of laboratory samples: preanalytical aspects. Orv Hetil 2014; 155:1113-20. [DOI: 10.1556/oh.2014.29895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: A considerable proportion of laboratory errors occurs in the preanalytical phase. Aim: The aims of the authors were to study preanalytical errors in routine and emergency laboratory diagnostics in a regional clinical laboratory and evaluate the effect of the pneumatic tube system on turnaround time and laboratory results. Method: The ratio of preanalytical errors and reasons of test rejection were analysed. In addition, the effects of pneumatic tube and manual transport on the occurrence of hemolysis and platelet activation were compared. Results: Using the pneumatic tube transport system, preanalytical error was below 1%. The main causes of test rejection were haemolysis in case of serum samples, and clot formation and citrate excess in anticoagulated samples. The pneumatic tube transport resulted in significantly faster sample transport, more equalized sample arrival and processing, hence the turnaround time became shorter both for routine and emergency tests. Conclusions: Autovalidation and proper control of preanalytical errors are essential for rapid and reliable laboratory service supported by the pneumatic tube system for sample transport. Orv. Hetil., 2014, 155(28), 1113–1120.
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Affiliation(s)
- Judit Tóth
- Debreceni Egyetem Klinikai Központ, Általános Orvostudományi Kar Laboratóriumi Medicina Intézet Debrecen Nagyerdei krt. 98. 4032
| | - Ágota Lenkey
- Debreceni Egyetem Klinikai Központ, Általános Orvostudományi Kar Laboratóriumi Medicina Intézet Debrecen Nagyerdei krt. 98. 4032
| | - Anna V. Oláh
- Debreceni Egyetem Klinikai Központ, Általános Orvostudományi Kar Laboratóriumi Medicina Intézet Debrecen Nagyerdei krt. 98. 4032
| | - Julianna Köteles
- Debreceni Egyetem Klinikai Központ, Általános Orvostudományi Kar Laboratóriumi Medicina Intézet Debrecen Nagyerdei krt. 98. 4032
| | - Valéria Kissné Sziráki
- Debreceni Egyetem Klinikai Központ, Általános Orvostudományi Kar Laboratóriumi Medicina Intézet Debrecen Nagyerdei krt. 98. 4032
| | - Adrienne Kerényi
- Debreceni Egyetem Klinikai Központ, Általános Orvostudományi Kar Laboratóriumi Medicina Intézet Debrecen Nagyerdei krt. 98. 4032
| | - János Kappelmayer
- Debreceni Egyetem Klinikai Központ, Általános Orvostudományi Kar Laboratóriumi Medicina Intézet Debrecen Nagyerdei krt. 98. 4032
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Chemonges S, Shekar K, Tung JP, Dunster KR, Diab S, Platts D, Watts RP, Gregory SD, Foley S, Simonova G, McDonald C, Hayes R, Bellpart J, Timms D, Chew M, Fung YL, Toon M, Maybauer MO, Fraser JF. Optimal management of the critically ill: anaesthesia, monitoring, data capture, and point-of-care technological practices in ovine models of critical care. BIOMED RESEARCH INTERNATIONAL 2014; 2014:468309. [PMID: 24783206 PMCID: PMC3982457 DOI: 10.1155/2014/468309] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/21/2014] [Accepted: 02/10/2014] [Indexed: 12/18/2022]
Abstract
Animal models of critical illness are vital in biomedical research. They provide possibilities for the investigation of pathophysiological processes that may not otherwise be possible in humans. In order to be clinically applicable, the model should simulate the critical care situation realistically, including anaesthesia, monitoring, sampling, utilising appropriate personnel skill mix, and therapeutic interventions. There are limited data documenting the constitution of ideal technologically advanced large animal critical care practices and all the processes of the animal model. In this paper, we describe the procedure of animal preparation, anaesthesia induction and maintenance, physiologic monitoring, data capture, point-of-care technology, and animal aftercare that has been successfully used to study several novel ovine models of critical illness. The relevant investigations are on respiratory failure due to smoke inhalation, transfusion related acute lung injury, endotoxin-induced proteogenomic alterations, haemorrhagic shock, septic shock, brain death, cerebral microcirculation, and artificial heart studies. We have demonstrated the functionality of monitoring practices during anaesthesia required to provide a platform for undertaking systematic investigations in complex ovine models of critical illness.
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Affiliation(s)
- Saul Chemonges
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Medical Engineering Research Facility (MERF), Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - Kiran Shekar
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Bond University, Gold Coast, QLD 4226, Australia
| | - John-Paul Tung
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD 4059, Australia
| | - Kimble R Dunster
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Science and Engineering Faculty, Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - Sara Diab
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - David Platts
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Ryan P Watts
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Department of Emergency Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Shaun D Gregory
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Chermside, Brisbane, QLD 4032, Australia
| | - Samuel Foley
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Gabriela Simonova
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Charles McDonald
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Rylan Hayes
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Judith Bellpart
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Daniel Timms
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Chermside, Brisbane, QLD 4032, Australia
| | - Michelle Chew
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia
| | - Yoke L Fung
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Michael Toon
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia
| | - Marc O Maybauer
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - John F Fraser
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Chermside, Brisbane, QLD 4032, Australia
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28
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The effects of pneumatic tube transport on fresh and stored platelets in additive solution. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12:85-90. [PMID: 24333086 DOI: 10.2450/2013.0097-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 08/27/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Limited scientific work has been conducted on potential in vitro effects of transport on pneumatic tube systems on blood components, in particular platelets. MATERIALS AND METHODS To evaluate the possible effects of the Swisslog TranspoNet system on the cellular, metabolic, phenotypic and secreting properties of fresh and stored platelets, we set up a four-arm paired study comparing transported and non-transported platelets. Platelets were aliquoted, prepared with the OrbiSac system and suspended in 70% SSP+ (n=8). All in vitro parameters were monitored over a 7-day storage period. RESULTS Throughout storage, no differences were observed in glucose consumption, lactate production, pH, pCO2, ATP, hypotonic shock response reactivity, CD62P, PAC-1, platelet endothelial cell adhesion molecule-1 or CD42b. The release of sCD40L increased (p<0.01) in all units but without any significant differences between groups. CONCLUSION The storage stability of all platelets conveyed by the Swisslog TranspoNet system was not impaired throughout 7 days of storage. The Swisslog TranspoNet system does not, therefore, seem to be a risk for increased metabolic activity, activation or release reactions from the platelets. This lack of effect of the pneumatic tube transport system did not seem to be affected by the age of the platelets or repeated transport.
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Bolliger D, Tanaka KA. Roles of thrombelastography and thromboelastometry for patient blood management in cardiac surgery. Transfus Med Rev 2013; 27:213-20. [PMID: 24075802 DOI: 10.1016/j.tmrv.2013.08.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 12/28/2022]
Abstract
The value of thrombelastography (TEG) and thromboelastometry (ROTEM) to improve perioperative hemostasis is under debate. We aimed to assess the effects of TEG- or ROTEM-guided therapy in patients undergoing cardiac surgery on the use of allogeneic blood products. We analyzed 12 trials including 6835 patients, 749 of them included in 7 randomized controlled trials (RCTs). We collected data on the amount of transfused allogeneic blood products and on the proportion of patients who received allogeneic blood products or coagulation factor concentrates. Including all trials, the odds ratios (ORs) for transfusion of red blood cell (RBC) concentrates, fresh-frozen plasma (FFP), and platelets were 0.62 (95% confidence interval [CI], 0.56-0.69; P<.001), 0.28 (95% CI, 0.24-0.33; P<.001), and 0.55 (95% CI, 0.49-0.62; P<.001), respectively. However, more than 50% of the patients in this analysis were derived from one retrospective study. Including RCTs only, the ORs for transfusion of RBC, FFP, and platelets were 0.54 (95% CI, 0.38-0.77; P<.001), 0.36 (95% CI, 0.25-0.53; P<.001), and 0.57 (95% CI, 0.39-0.81; P=.002), respectively. The use of coagulation factor concentrates was reported in 6 studies, 2 of them were RCTs. The ORs for the infusion of fibrinogen and prothrombin complex concentrate were 1.56 (95% CI, 1.29-1.87; P<.001) and 1.74 (95% CI, 1.40-2.18; P<.001), respectively. However, frequencies and amounts were similar in the intervention and control group in the 2 RCTs. It is presumed that TEG- or ROTEM-guided hemostatic management reduces the proportion of patients undergoing cardiac surgery transfused with RBC, FFP, and platelets. This presumption is strongly supported by similar ORs found in the analysis including RCTs only. Patient blood management based on the transfusion triggers by TEG or ROTEM appears to be more restrictive than the one based on conventional laboratory testing. However, evidence for improved clinical outcome is limited at this time.
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Affiliation(s)
- Daniel Bolliger
- Department of Anesthesia and Intensive Care Medicine, University Hospital, Basel, Switzerland.
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Lima-Oliveira G, Lippi G, Salvagno GL, Dima F, Brocco G, Picheth G, Guidi GC. Management of preanalytical phase for routine hematological testing: is the pneumatic tube system a source of laboratory variability or an important facility tool? Int J Lab Hematol 2013; 36:e37-40. [DOI: 10.1111/ijlh.12143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G. Lima-Oliveira
- Laboratory of Clinical Biochemistry; Department of Life and Reproduction Sciences; University of Verona; Verona Italy
- Post-Graduate Program of Pharmaceutical Sciences; Department of Medical Pathology; Federal University of Parana; Curitiba Parana Brazil
| | - G. Lippi
- O U. Laboratory of Clinical Chemistry and Hematology; Department of Pathology and Laboratory Medicine; Academic Hospital of Parma; Parma Italy
| | - G. L. Salvagno
- Laboratory of Clinical Biochemistry; Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | - F. Dima
- Laboratory of Clinical Biochemistry; Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | - G. Brocco
- Laboratory of Clinical Biochemistry; Department of Life and Reproduction Sciences; University of Verona; Verona Italy
| | - G. Picheth
- O U. Laboratory of Clinical Chemistry and Hematology; Department of Pathology and Laboratory Medicine; Academic Hospital of Parma; Parma Italy
| | - G. C. Guidi
- Laboratory of Clinical Biochemistry; Department of Life and Reproduction Sciences; University of Verona; Verona Italy
- Post-Graduate Program of Pharmaceutical Sciences; Department of Medical Pathology; Federal University of Parana; Curitiba Parana Brazil
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Thalén S, Forsling I, Eintrei J, Söderblom L, Antovic JP. Pneumatic tube transport affects platelet function measured by multiplate electrode aggregometry. Thromb Res 2013; 132:77-80. [PMID: 23706534 DOI: 10.1016/j.thromres.2013.04.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 04/14/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022]
Abstract
Multiple electrode aggregometry (MEA) is used to measure platelet function. Pneumatic tube transport systems (PTS) for delivery of patient samples to a central laboratory are often used to reduce turnaround time for vital analyses. We evaluated the effects of PTS transport on platelet function as measured by MEA. Duplicate samples were collected from 58 individuals. One sample was sent using PTS and the other was carried by personnel to the lab. Platelet function was measured by means of a Multiplate® analyzer using the ADP test, ASPI test, COL test, RISTO test and TRAP test. Samples transported using PTS showed a reduction of AUC-values of up to a 100% of the average as compared to samples carried by personnel and a majority showed reductions of AUC-values greater than 20% of the average. Bias±95% limits of agreement for the ADP test were 26±56% of the average. Bias±95% limits of agreement for the ASPI test were 16±58% of the average. Bias±95% limits of agreement for the COL test were 20±54% of the average. Bias±95% limits of agreement for the RISTO were 14±79% of the average. Bias±95% limits of agreement for the TRAP test were 19±45% of the average. We conclude that PTS transport affect platelet activity as measured by MEA. We advise against clinical decisions regarding platelet function on the basis of samples sent by PTS in our hospital settings.
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Affiliation(s)
- Simon Thalén
- Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden.
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Karlsson M, Roman-Emanuel C, Thimour-Bergström L, Hakimi CS, Jeppsson A. Sampling conditions influence multiple electrode platelet aggregometry in cardiac surgery patients. SCAND CARDIOVASC J 2012; 47:98-103. [PMID: 23098207 DOI: 10.3109/14017431.2012.743672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To investigate the importance of blood sampling conditions for multiple electrode platelet aggregometry (MEA) in cardiac surgery patients. DESIGN Eighty-one patients undergoing first time CABG surgery were included in three prospective, observational studies. MEA was used to analyze platelet aggregability after addition of adenosine-diphosphate (ADP) or thrombin activating peptide 6 (TRAP). In substudy 1, hirudin and citrate tubes were compared. In substudy 2, samples from peripheral vein, central venous catheter, and radial artery were compared and in substudy 3, the effect of surgery was investigated by analyzing pre- and postoperative samples. RESULTS Platelet aggregability values were 30% higher in hirudin tubes than in citrate tubes. There was a significant correlation between hirudin and citrate tubes in TRAP-induced aggregability (r = 0.84, p < 0.001) but not in ADP-induced aggregability (r = 0.25, p = 0.13). The blood sampling site did not influence platelet aggregability. Surgery reduced ADP-induced aggregability by 31% (p < 0.001) and TRAP-induced aggregability by 30% (p < 0.001) with large intraindividual variations. CONCLUSIONS MEA results in cardiac surgery patients should not be compared between samples collected in test tubes with different anticoagulants. The choice of blood sampling site does not affect the results. The operation in itself reduces markedly mean platelet aggregability.
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Affiliation(s)
- Martin Karlsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Martin J, Schuster T, Moessmer G, Kochs E, Wagner K. Alterations in rotation thromboelastometry (ROTEM ® ) parameters: point-of-care testing vs analysis after pneumatic tube system transport. Br J Anaesth 2012; 109:540-5. [DOI: 10.1093/bja/aes213] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Evliyaoğlu O, Toprak G, Tekin A, Başarali MK, Kilinç C, Colpan L. Effect of pneumatic tube delivery system rate and distance on hemolysis of blood specimens. J Clin Lab Anal 2012; 26:66-9. [PMID: 22467320 DOI: 10.1002/jcla.21484] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We evaluated the effects of pneumatic tube system (PTS) transport rates and distances on routine hematology and coagulation analysis. PTS effects on centrifuged blood samples were also examined. METHOD The study was completed at Dicle University Hospital, which has the longest pneumatic tube system in Turkey. Blood samples were collected at three different locations within the hospital and an emergency department, and delivered to the central laboratory by the PTS or a human carrier. Samples were transported at different rates and over varying distances. Each specimen's potassium (K) and lactic dehydrogenase (LDH) levels, in both the serum and plasma, were tracked to monitor hemolysis. Measurements of LDH and K were obtained using heparin or citrate. RESULT A positive correlation was observed between distance and hemolysis in serum samples transported at 4.2 m/sec, and at 3.1 m/sec for more than 2200 m (r = 0.774 and r = 0.766, respectively). Distance and hemolysis were also correlated in non-centrifuged samples (r = 0.871). The alterations in plasma LDH and K levels at different rates and PTS lengths were not statistically significant. CONCLUSION The rate of hemolysis in PTS transported samples, dependent on PTS length and rate, may seriously affect routine tests of non-centrifuged samples.
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Affiliation(s)
- Osman Evliyaoğlu
- Department of Medical Biochemistry, Dicle University, Diyarbakır, Turkey.
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Lancé MD, Kuiper GJ, Sloep M, Spronk HM, van Oerle R, ten Cate H, Marcus MA, Henskens YM. The effects of pneumatic tube system transport on ROTEM analysis and contact activation assessed by thrombin generation test. Thromb Res 2012; 130:e147-50. [DOI: 10.1016/j.thromres.2012.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/30/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
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Glas M, Mauer D, Kassas H, Volk T, Kreuer S. Sample transport by pneumatic tube system alters results of multiple electrode aggregometry but not rotational thromboelastometry. Platelets 2012; 24:454-61. [PMID: 22931353 DOI: 10.3109/09537104.2012.718383] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pneumatic tube systems (PTS) present a convenient way for blood sample transport in medical facilities. Associated preanalytical interference in various tests is largely unknown. Implementing point-of-care coagulation management at our institution, we investigated multiple electrode aggregometry (MEA) and rotational thromboelastometry (ROTEM) after PTS transportation. Whole blood samples from patients undergoing general or trauma surgery were analysed by MEA after collection (baseline, '0 × PTS') and sent on a predefined PTS track (n = 12). MEA was repeated after samples travelled the track 4 ('4 × PTS'), 8 ('8 × PTS') and 12 times ('12 × PTS') and compared with stationary controls analysed at the same time. Samples for ROTEM (n = 6) were analysed after collection and travelling the track 12 times. An acceleration detector recorded g-forces on the PTS track. At '0 × PTS' no significant differences in MEA results were detected. Values were significantly lower for transported samples compared with controls ('4 × PTS' to '12 × PTS', p < 0.001). Furthermore, MEA results of PTS samples were significantly decreased for '4 × PTS' to '12 × PTS' compared to baseline (p < 0.001). Except for the clotting time in EXTEM PTS transport did not significantly alter results for investigated ROTEM parameters, compared with baseline and stationary controls. Acceleration detector readout revealed alternating g-forces between -6.3 and +5.9 during transport. PTS transport caused invalid results in MEA while only one ROTEM parameter was found to be affected in this study. Variable acceleration during transport provides a potential reason for platelet activation. The authors recommend sample transport by hand or the device to be placed patient-side when MEA is performed.
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Affiliation(s)
- Michael Glas
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital , Kirrberger Strasse, D-66421 Homburg (Saar) , Germany.
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The effect of pneumatic tube system on complete blood count parameters and thrombocyte donation in healthy donors. Transfus Apher Sci 2012; 47:81-3. [DOI: 10.1016/j.transci.2012.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bolliger D, Dell-Kuster S, Seeberger MD, Tanaka KA, Gregor M, Zenklusen U, Tsakiris DA, Filipovic M. Impact of loss of high-molecular-weight von Willebrand factor multimers on blood loss after aortic valve replacement. Br J Anaesth 2012; 108:754-62. [PMID: 22311365 DOI: 10.1093/bja/aer512] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Severe aortic stenosis is associated with loss of the largest von Willebrand factor (vWF) multimers, which could affect primary haemostasis. We hypothesized that the altered multimer structure with the loss of the largest multimers increases postoperative bleeding in patients undergoing aortic valve replacement. METHODS We prospectively included 60 subjects with severe aortic stenosis. Before and after aortic valve replacement, vWF antigen, activity, and multimer structure were determined and platelet function was measured by impedance aggregometry. Blood loss from mediastinal drainage and the use of blood and haemostatic products were evaluated perioperatively. RESULTS Before operation, the altered multimer structure was present in 48 subjects (80%). Baseline characteristics and laboratory data were similar in all subjects. The median blood loss after 6 h was 250 (105-400) and 145 (85-240) ml in the groups with the altered and normal multimer structures, respectively (P=0.182). After 24 h, the cumulative loss was 495 (270-650) and 375 (310-600) ml in the groups with the altered and normal multimer structures, respectively (P=0.713). Multivariable analysis revealed no significant influence of multimer structure and platelet function on bleeding volumes after 6 and 24 h. After 24 h, there was no obvious difference in vWF antigen, activity, and multimer structure in subjects with and without the altered multimer structure before operation or in subjects with and without perioperative plasma transfusion. CONCLUSIONS The altered vWF multimer structure before operation was not associated with increased bleeding after aortic valve replacement. Our findings might be explained by perioperative release of vWF and rapid recovery of the largest vWF multimers.
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Affiliation(s)
- D Bolliger
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
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Lancé MD, Marcus MAE, van Oerle R, Theunissen HMS, Henskens YMC. Platelet concentrate transport in pneumatic tube systems - does it work? Vox Sang 2012; 103:79-82. [DOI: 10.1111/j.1423-0410.2011.01580.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kaiser AFC, Neubauer H, Franken CC, Krüger JC, Mügge A, Meves SH. Which is the best anticoagulant for whole blood aggregometry platelet function testing? Comparison of six anticoagulants and diverse storage conditions. Platelets 2011; 23:359-67. [DOI: 10.3109/09537104.2011.624211] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Felder RA. Preanalytical Errors Introduced by Sample-Transportation Systems: A Means to Assess Them. Clin Chem 2011; 57:1349-50. [DOI: 10.1373/clinchem.2011.172452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robin A Felder
- University of Virginia Health System, Charlottesville, VA
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Gremmel T, Calatzis A, Steiner S, Kaider A, Seidinger D, Koppensteiner R, Kopp CW, Panzer S. Is TRAP-6 suitable as a positive control for platelet reactivity when assessing response to clopidogrel? Platelets 2011; 21:515-21. [PMID: 20624009 DOI: 10.3109/09537104.2010.493587] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adenosine 5′-diphosphate (ADP) inducible aggregation is used to assess platelet response to thienopyridines. Thrombin receptor-activating peptide-6 (TRAP-6) inducible aggregation may serve as a positive control because it acts via the thrombin receptor protease-activating receptor-1, which is not blocked by thienopyridines. We therefore investigated if TRAP-6 is suitable as a positive control when assessing residual platelet reactivity to ADP. Platelet response to clopidogrel was assessed in 200 patients on dual antiplatelet therapy using ADP inducible platelet aggregation by light transmission aggregometry (LTA), multiple electrode aggregometry (MEA), and the shear-dependent Impact-R. Test specificities were monitored by TRAP-6 inducible platelet aggregation. The aggregation-independent vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay served for comparisons. ADP inducible aggregation was correlated to that by TRAP-6 (r = 0.33 to 0.72; p < 0.001 for all assays). A linear correlation was seen within MEA (r = 0.72). LTA TRAP-6 correlated weakly with the VASP assay (r = 0.19; p = 0.01), while there were no correlations of TRAP-6 responses by MEA or the Impact-R with the VASP assay (r = 0.03 and −0.09; p > 0.05). In all three assays, differences between ADP and TRAP-6 inducible aggregation varied considerably. Within MEA, TRAP-6 inducible aggregation was almost always stronger than ADP inducible aggregation, while within LTA and the Impact-R, weak responses to ADP were associated with both, weak and strong responses to TRAP-6. In conclusion, the application of TRAP-6 as a positive control for platelet reactivity has major limitations and results need to be cautiously interpreted on an individual basis.
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Affiliation(s)
- Thomas Gremmel
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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The preanalytical influence of two different mechanical transport systems on laboratory analysis. Clin Chem Lab Med 2011; 49:1379-1382. [DOI: 10.1515/cclm.2011.198] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Boeer K, Reinhöfer M, Lösche W. Validation of a procedure to assess ASA-response in patients with decreased, initial TRAP induced aggregation. Platelets 2010; 21:314-9. [PMID: 20438395 DOI: 10.3109/09537101003763442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Whole blood aggregometry on the is a simple, fast and standardized method and it is widely used to assess platelet function under antiplatelet therapy. Reference ranges and a cut-off value as a measure of ASA response were established by measuring arachidonic acid induced aggregation (ASPI-test) in healthy volunteers and cardiac patients after and used to classify patients as ASA responders or non-responders. However, assessing the platelet function is highly affected by pre-analytical and analytical conditions and often reduced aggregation by TRAP induced aggregation (TRAP-test) is seen, rendering the samples difficult for interpretation of the ASPI-test and the responder status to ASA. We hypothesised that in this simplified model any preanalytical factor has the same effect on TRAP-testing as on ASPI-testing and that by calculating the ratio between a defined, normal TRAP-test result and the TRAP-test result measured for the individual patient this ratio could be applied to the measured ASPI-test thereby reaching a more valid discrimination between ASA responders and -non-responders. TRAP- and ASPI-test were performed in blood from ASA-treated volunteers and controls on Multiplate before an after pneumatic tube delivery as a model to stimulate shear stress induced platelet activation and aggregation. The calculated, normalised ASPI test result after tube delivery did not differ significantly from the initial ASPI test result although tube delivery had a significant impact on the measured ASPI test result. If applied to patients samples a definite judgement on the ASA response status of patients with reduced "general platelet activatability" could be given. Normalisation of the ASPI-test result using the TRAP-test result may provide a method to judge on the ASA response status in patients with decreased initial "general platelet activatability".
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Affiliation(s)
- K Boeer
- FSU Jena, Institute for Clinical Chemistry and Laboratory Diagnostics, Germany.
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