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Larsen JB, Hvas AM, Hojbjerg JA. Platelet Function Testing: Update and Future Directions. Semin Thromb Hemost 2023; 49:600-608. [PMID: 36384230 DOI: 10.1055/s-0042-1757898] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Platelets play a key role in maintaining normal hemostasis and are also recognized as partners in the development of arterial thrombosis. Today, platelet function testing is used for very different clinical purposes; first, for investigation of platelet dysfunction in acute bleeding and diagnosis of platelet disorders in patients with long-lasting bleeding tendency, and second, for testing the efficacy of antiplatelet therapy in patients with increased thromboembolic risk. Moreover, it has been discussed whether platelet function testing can be used for prediction of bleeding risk (e.g., prior to major surgery). Ever since light transmission aggregometry was introduced, laboratories around the world have worked on testing platelet function, and during the last decades a wide range of new methods has emerged. Besides the clinical utility of platelet function testing, the present review summarizes the test principles and advantages and disadvantages of the different methods, depending on the purpose for which it is to be used. A critical step in investigation of platelet function is the preanalytical factors that can substantially affect test results. Therefore, this review also provides an overview of preanalytical variables that range from patient-related factors such as smoking, coffee, and exercise prior to blood sampling to selection of anticoagulant, needle gauge, and time from blood sampling to analyses. Finally, this review outlines further perspectives on platelet function testing for clinical practice and for research purposes.
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Affiliation(s)
- Julie Brogaard Larsen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Johanne Andersen Hojbjerg
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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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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Hardy M, Lecompte T, Douxfils J, Lessire S, Dogné JM, Chatelain B, Testa S, Gouin-Thibault I, Gruel Y, Medcalf RL, ten Cate H, Lippi G, Mullier F. Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory. Thromb J 2020; 18:17. [PMID: 32922211 PMCID: PMC7474970 DOI: 10.1186/s12959-020-00230-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with extreme inflammatory response, disordered hemostasis and high thrombotic risk. A high incidence of thromboembolic events has been reported despite thromboprophylaxis, raising the question of a more effective anticoagulation. First-line hemostasis tests such as activated partial thromboplastin time, prothrombin time, fibrinogen and D-dimers are proposed for assessing thrombotic risk and monitoring hemostasis, but are vulnerable to many drawbacks affecting their reliability and clinical relevance. Specialized hemostasis-related tests (soluble fibrin complexes, tests assessing fibrinolytic capacity, viscoelastic tests, thrombin generation) may have an interest to assess the thrombotic risk associated with COVID-19. Another challenge for the hemostasis laboratory is the monitoring of heparin treatment, especially unfractionated heparin in the setting of an extreme inflammatory response. This review aimed at evaluating the role of hemostasis tests in the management of COVID-19 and discussing their main limitations.
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Affiliation(s)
- M. Hardy
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Hematology Laboratory, Yvoir, Belgium
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Anesthesiology Department, Yvoir, Belgium
| | - T. Lecompte
- Département de Médecine, Hôpitaux Universitaires de Genève, service d’angiologie et d’hémostase et Faculté de Médecine Geneva Platelet Group (GpG), Université de Genève, Geneva, Suisse Switzerland
| | - J. Douxfils
- Pharmacy Department, University of Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur, Belgium
- Qualiblood s.a, Namur, Belgium
| | - S. Lessire
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Anesthesiology Department, Yvoir, Belgium
| | - J. M. Dogné
- Pharmacy Department, University of Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur, Belgium
| | - B. Chatelain
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Hematology Laboratory, Yvoir, Belgium
| | - S. Testa
- Haemostasis and Thrombosis Center, Cremona Hospital, Cremona, Italy
| | - I. Gouin-Thibault
- Département d’Hématologie Biologique, INSERM, CIC 1414 (Centre d’Investigation Clinique de Rennes), Université de Rennes, CHU de Rennes, Rennes, France
| | - Y. Gruel
- Laboratoire d’Hématologie-Hémostase, CHRU de Tours, Hôpital Trousseau, Tours, France
| | - R. L. Medcalf
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria Australia
| | - H. ten Cate
- Department of Internal Medicine, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - G. Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - F. Mullier
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Hematology Laboratory, Yvoir, Belgium
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Slavík L, Úlehlová J, Bradáčová P, Chasáková K, Hluší A, Palová M, Entrová A. The Modern Pneumatic Tube System Transports with Reduced Speed Does Not Affect Special Coagulation Tests. J Med Syst 2020; 44:142. [PMID: 32696269 DOI: 10.1007/s10916-020-01614-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/15/2020] [Indexed: 11/24/2022]
Abstract
Pneumatic tube transport systems (PTS) for delivery of patient samples to a hemostasis laboratory are often used to reduce turnaround time for vital analyses. PTS in our hospital has the ability to regulate the transport speed in the range of 3-6 m/s with acceleration control technology. We evaluated the effects of PTS transport for routine coagulation tests, platelet function tests and special global coagulation tests. Duplicate samples were collected from 29 patients and 40 healthy individuals. One sample was sent using PTS and the other was carried by personnel to the lab for determination of protrombin time, activated partial thromboplastin time, trombin time, fibrinogen, antitrombin and thrombin generation test. Platelet function was measured by means of a Apact 4004® analyzer using the inductors (ADP, Arachidonic acid and Epinephrine). Samples transported using PTS with normal transport speed 6 m/s does not affect basic coagulation tests (PT, aPTT, FIB, TT and AT), but TGT has significantly altered. The use of PTS with controlled acceleration regulated the increase in thrombin generation from 10% to 3%, which is not statistically signifiant. The use of PTS with controlled acceleration did not show a significant difference even with the highly sensitive method of platelet aggregation. We conclude that PTS with acceleration control with transport speed from 3 to 6 m/s does not affect to platelet activity as measured by LTA and also global coagulation test - TGT. The advantage of PTS transport is very rapid assessment laboratory testing. From the above validation study, it is clear that PTS should always be validated for specialized laboratory methods and appropriately adapted to specific transport conditions.
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Affiliation(s)
- Luděk Slavík
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic.
| | - Jana Úlehlová
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - Pavla Bradáčová
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - Kateřina Chasáková
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - Antonín Hluší
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - Miroslava Palová
- Department of Hemato-Oncology, Palacký University Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic
| | - Alice Entrová
- Department of Blood Transfusion, University Hospital Olomouc, Olomouc, Czech Republic
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Reduction of Preoperative Waiting Time before Urgent Surgery for Patients on P2Y 12 Inhibitors Using Multiple Electrode Aggregometry: A Retrospective Study. J Clin Med 2020; 9:jcm9020424. [PMID: 32033153 PMCID: PMC7074528 DOI: 10.3390/jcm9020424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/18/2022] Open
Abstract
P2Y12 inhibitor discontinuation is essential before most surgical interventions to limit bleeding complications. Based on pharmacodynamic data, fixed discontinuation durations have been recommended. However, as platelet function recovery is highly variable among patients, a more individualized approach based on platelet function testing (PFT) has been proposed. The aim of this retrospective single-centre study was to determine whether PFT using whole blood adenosine diphosphate–multiple electrode aggregometry (ADP–MEA) was associated with a safe reduction of preoperative waiting time. Preoperative ADP–MEA was performed for 29 patients on P2Y12 inhibitors. Among those, 17 patients underwent a coronary artery bypass graft. Twenty one were operated with an ADP–MEA ≥ 19 U (quantification of the area under the aggregation curve), and the waiting time was shorter by 1.6 days (median 1.8 days, IQR 0.5–2.9), by comparison with the current recommendations (five days for clopidogrel and ticagrelor, seven days for prasugrel). Platelet function recovery was indeed highly variable among individuals. With the 19 U threshold, high residual platelet inhibition was associated with perioperative platelet transfusion. These results suggest that preoperative PFT with ADP–MEA could help reduce waiting time before urgent surgery for patients on P2Y12 inhibitors.
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Alterations in the parameters of classic, global, and innovative assays of hemostasis caused by sample transportation via pneumatic tube system. Thromb Res 2018; 170:156-164. [PMID: 30196193 DOI: 10.1016/j.thromres.2018.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/07/2018] [Accepted: 08/31/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pneumatic tube system (PTS) is an integral part of large medical facilities providing rapid interconnection between units within the hospital and often used to transport blood samples. The aim of our study was to compare a wide variety of hemostasis assays to identify assays sensitive to this transport method and diagnostic relevance of the alterations. METHODS Routine coagulation and platelet tests (APTT, PT, TT, fibrinogen, light transmission aggregometry (LTA) with ADP, collagen, ristomycin and epinephrine), whole blood flow cytometry platelet function test (levels of CD42b, CD61, CD62P, PAC1, annexin V binding and mepacrine release) and global coagulation tests (thromboelastography (TEG), thrombin generation (TGT), thrombodynamics (TD), thrombodynamics-4D (TD-4D)) were determined in PTS- and manually transported samples of 10 healthy volunteers. RESULTS There were no significant differences between the values of APTT, PT, TT or fibrinogen between the samples transported by PTS or manually. The results for LTA demonstrated increase in the collagen-induced aggregation (84 ± 7% versus 73 ± 5%), while the response to epinephrine was decreased (58 ± 20% versus 72 ± 7.4%). Flow cytometry-based platelet function test showed a pre-activation of platelets by PTS-transportation while all integral assays of coagulation tested in the present study (TEG, TGT, TD, TD-4D) demonstrated a hypercoagulation shift. CONCLUSIONS Transportation by PTS caused significant shifts in parameters of functional and integral assays that exceeded parameter variation values and sometimes even were comparable to normal ranges. The results obtained in this study indicate that using of PTS for such assays may cause sufficient alterations of results and can lead to patient's mistreatment.
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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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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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Correlation between laboratory coagulation testing and thromboelastometry is modified during management of trauma patients. J Trauma Acute Care Surg 2017; 81:319-27. [PMID: 27192467 DOI: 10.1097/ta.0000000000001109] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Thromboelastometry (ROTEM, Pentapharm GmbH, Munich, Germany) is increasingly being used to make a diagnosis of coagulopathy and to guide hemostatic therapy (HT). Although ROTEM parameters and standard laboratory test (SLT) correlated well before administration of HT, it is not known if this correlation persists after hemostatic resuscitation. METHODS A retrospective analysis of prospectively collected data from a trauma registry (2011-2014) was performed. All patients having a ROTEM analysis were included. ROTEM parameters (clotting time and clot amplitude at 5 minutes) were determined after activation with tissue factor (EXTEM) or platelet inhibition with cytochalasin D (FIBTEM). Spearman rank correlation coefficient was calculated for the correlation between SLT and thromboelastometry parameters, and thresholds were determined with receiver operating characteristic (ROC) curve analysis for the diagnosis of an international normalized ratio (INR) greater than 1.5, fibrinogen 1.5 g/L or less, and platelet count of less than 100.10/L. RESULTS Of the 358 patients included, 533 thromboelastometry results were obtained (335 at admission, 198 during care). Correlation between INR and EXTEM-clotting time was good at admission (r = 0.617) in the whole cohort but decreased in the subgroup of patients having an Injury Severity Score of less than 25 (r = 0.399) or a base excess of less than 6 mmol/L (r = 0.489). During care, correlation was impaired after the administration of fibrinogen concentrates in the whole cohort (r = 0.430), as well as in the subgroup of patients having an Injury Severity Score greater than 24 (r = 0.465). As well, for the diagnosis of increased INR, sensitivity and the area under the ROC curve decreased from 75% and 0.894 (no treatment) to 20% and 0.653 (fibrinogen concentrate). Areas under the ROC curve for the prediction of a fibrinogen or platelet decrease were not significantly altered regardless of the treatment group. CONCLUSIONS A decrease in the correlation between SLTs and ROTEM parameters was observed at admission or during care, which could be in relation with injury severity, base deficit, or the administration of blood products, particularly fibrinogen concentrate. Further work will be necessary to better understand which tool is the most suitable for guiding HT. LEVEL OF EVIDENCE Therapeutic study, level IV; diagnostic study, level IV.
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12
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Comparison of citrated and fresh whole blood for viscoelastic coagulation testing during elective neurosurgery. Thromb Res 2017; 156:73-79. [PMID: 28601642 DOI: 10.1016/j.thromres.2017.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/11/2017] [Accepted: 05/29/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous viscoelastic haemostatic tests studies have often indicated a hypercoagulative test signal with citrated blood, which could influence clinical decision makings. PURPOSE The aim of this study was to compare fresh and citrated whole blood using two non-automated viscoelastic ROTEM and Sonoclot tests. Our hypothesis was that citrated blood would demonstrate a hypercoagulative response in this setting, not tested before. METHODS Perioperative viscoelastic coagulation changes were evaluated with a ROTEM and Sonoclot in 38 patients undergoing elective brain tumor surgery. The citrated samples were recalcified with CaCl2. Wilcoxon nonparametric-paired tests and Bland-Altman plots were performed to compare the fresh and citrated blood analyses. RESULTS The citrated blood showed a hypercoagulative response in ROTEM NATEM-clot formation time and α-angle, Sonoclot-clot rate and platelet function, as compared to fresh blood (p<0.0001). CONCLUSIONS Fresh whole blood may theoretically reflect in vivo haemostasis more closely than citrated analyses, which indicated a hypercoagulative response as compared to the fresh whole blood analyses Bland-Altman plots also indicated that ROTEM reference ranges in patients undergoing brain surgery should be redefined. Future studies must establish the correlation between viscoelastic test results using fresh or citrate anticoagulated blood and clinical outcomes, such as bleeding, transfusion or reoperation for postoperative haematoma.
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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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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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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]
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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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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]
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Abstract
<b><i>Hintergrund: </i></b>Bei erworbenen oder chronisch bestehenden Störungen der Gerinnung ist in der perioperativen Phase eine gezielte Therapie von herausragender Bedeutung. Der kostenintensive Einsatz von Blut- und Gerinnungspräparaten und die Beeinflussung des Patientenoutcomes werden hinsichtlich des G-DRG(German Diagnosis Related Groups)-Systems und der Anwendung von Point-of-Care-Geräten bewertet. <b><i>Methode: </i></b>Anhand einer Literaturübersicht und eigener Daten wird der aktuelle Sachstand analysiert und diskutiert. <b><i>Ergebnisse: </i></b>Die perioperative Behandlung von Störungen der Gerinnung ist komplex. Neben der klassischen Labordiagnostik unterstützen und beschleunigen Point-of-Care-Geräte die Therapieentscheidungen. Die Anwendung eines Algorithmus-basierten Applikationsregimes von Blut- und Gerinnungspräparaten optimiert die Verbrauchsmengen und verbessert das Patientenoutcome. Demgegenüber können durch das G-DRG-System bedingte finanzielle Effekte aufgrund von kosten- und erlösseitigen Änderungen für das Krankenhaus negativ ausfallen. Fallpauschalen und Zusatzentgelte decken vor allem bei komplexen Behandlungsfällen wie der Lebertransplantation nicht die tatsächlichen Aufwendungen. Systemisch finanzielle Anreize zur Therapieentscheidung, die unabhängig von einer medizinischen Indikation sein können, sind vorherrschend. <b><i>Schlussfolgerungen: </i></b>Die Therapie von Gerinnungsstörungen stellt Ärzte, die Krankenhausverwaltungen und das G-DRG-System vor besondere Herausforderungen. Nicht selten besteht eine paradoxe Situation zwischen dem Streben nach einer bestmöglichen Patientenversorgung und einer adäquaten Leistungsvergütung des Krankenhauses. Finanzielle Anreize durch Pauschalen und Zusatzentgelte mit Mengenschwellen, die Therapieentscheidungen beeinflussen können, sind zukünftig zu eliminieren.
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