Coagulation tests in children. Katrien Devreese, MD, PhD Coagulation Laboratory Ghent University Hospitial
|
|
- Candice Horn
- 7 years ago
- Views:
Transcription
1 Coagulation tests in children Katrien Devreese, MD, PhD Coagulation Laboratory Ghent University Hospitial 25 April
2 Introduction The young are not just miniature adults Physiology of pediatric hemostasis differs from adults Course of hemostatic disorders may differ Correct interpretation of coagulation test results 2 2
3 Introduction Hemostasis Coagulation Anticoagulation 3 3
4 Introduction Primary hemostasis Platelets interact with damaged endothelium Primary hemostatic plug to arrest bleeding Primary platelet plug: fragile and easily dislodges Secundary hemostasis Formation of insoluble fibrin strands Secundary hemostatic plug: a stable plug Involves the coagulation cascade proteins that interact with each other and the platelet plug Fibrinolysis Once healing occured, the clot has to be lysed to prevent occlusion of vessel 4 4
5 Introduction Primary hemostasis Platelet count Platelet morphology Platelet function Secundary hemostasis Clotting assays: aptt, PT, thrombin time Fibrinogen Coagulation factors (FXII, FXI, FIX, FVIII; FII, FV, FVII, FX; FXIII; VWF) Coagulation inhibitors (AT, PC, PS) Fibrinolysis Plasminogen, t-pa, α2-antiplasmin, PAI 5 5
6 Laboratory tests for hemostasis Testing hemostasis in children Bleeding Screening tests: complete blood count prothrombin time (PT) activated partial thromboplastin time (aptt) (Platelet function analysis (PFA)) Further laboratory evaluation: additional tests Thrombosis Inherited thrombophilia markers (antithrombin, protein C, protein S, FVLeiden, FIIG20210A) Issues related to coagulation testing in children 6 6
7 Laboratory tests for hemostasis Sample acquisition for coagulation tests Blood collection Anticoagulated blood with citrate Pre-analytical variables Sufficient blood Not from a heparinised line Not in heparinised syringe No air bubbles No fluid contamination Heparin strongly disturbs coagulation tests! 7 7
8 Laboratory tests for hemostasis Citrated tubes - buffered sodium citrate 0,109 mol/l: 3,2% - proportion 1 part citrate/9 parts blood - allows recalcification for testing False prolonged aptt Normal High hematocrit / underfilling of tube Hct ~ 45% 1 part citrate Plasma ~ 55% Citrate:plasma ~ 1:5 9 parts blood Citrate:plasma ~ 1:3 -dilution effect on plasma -excess of citrate that binds to calcium added in reaction mix 8 8
9 Hemostasis in children Developmental hemostasis Fib (Jaffray et al, Pediatr Clin N Am 2013, 60, ) 9 9
10 Developmental hemostasis Neonatal versus Adult Hemostasis Component Neonatal Functions Global Effect on Hemostasis Coagulation factors Primary hemostasis Fibrinolysis FII, FVII, FIX, FX, XI, XII Fibrinogen, FV, FXIII FVIII VWF Normal Platelet count Platelet Function Plasminogen, t-pa, α 2 - antiplasmin PAI Decreased thrombin generation Enhanced primary hemostasis Hypofibrinolytic state Natural coagulation inhibitors AT, PC, PS Reduced capacity to inhibit activated coagulation proteins (Lippi et al, Sem Thromb Hemost 2007, 33, Guzzetta et al, Ped Anesthesia 2010, 21, 3-9) 10 10
11 Hemostasis in children Developmental hemostasis Maureen Andrew ( ) Mc Master University Hamilton, Canada Reference values for coagulation tests: Healthy full-term infants (day1-6 months) Healthy children (1y-16y) Healthy prematures (30-36 weeks) Healthy fetuses (19-27 weeks) Blood 1992, 80, Blood 1987, 70, Ped J Hematol/oncol 1990,12, Journal of Pediatric Hematology/Oncology, 2001, 23, Tribute To Dr. Maureen Andrew Monagle et al, Blood Reviews 2010, 24,
12 Routine coagulation assays intrinsic neg charged surface XII XII a aptt contact activator PT extrinsic thromboplastin XI PL, CaCl 2 IX XI a IX a VIII a PL Ca++ common TF VII a PL Ca++ X X a V a PL Ca++ activator II thrombin Citrated anticoagulated plasma fibrin 12 12
13 Routine coagulation assays 13 13
14 Routine coagulation assays aptt aptt= is the time it takes to form a clot in activated plasma measured in seconds 6 mth. FXI FXII PK HMWK (M. Andrew et al, Blood 1992, ) 14 14
15 Routine coagulation assays Contactactivator and PL CaCl 2 aptt Incubation 37 C Clotting time PK HMWK XII Kall IX XIa Fibrinogen Fibrin IXa Tissue damage HMWK XI XIa XII XIIa VIII X VIIIa Ca ++ PL Tenase complex Xa aptt= is the time it takes to form a clot In activated plasma measured in seconds 6 mth. FXI FXII PK HMWK (M. Andrew et al, Blood 1992, ) 15 15
16 Routine coagulation assays intrinsic neg charged surface PT XII XII a extrinsic XI IX XI a FII FVII FIX FX IX a VIII a PL Ca++ TF VII a PL Ca++ X II X a V a PL Ca++ thrombin 6 mth. (M. Andrew et al, Blood 1992, ) fibrin 16 16
17 Routine coagulation assays Reference Values for Coagulation Tests in the Healthy Full-term Infant During the First 6 Months of Life day 1 day 5 day 30 day 90 day 180 adult PT (s) 13.0± ± ± ± ± ±0.78 aptt(s) 42.9 ± ± ± ± ± ± 3.44 significantly different from adults (M. Andrew et al, Blood 1987, 70, ) Day 5 FII FVII FIX FX (M. Andrew et al, Blood 1992, ) 17 17
18 Routine coagulation assays Developmental hemostasis Age-dependent reference ranges Definition of healthy children Diagnosis of bleeding and thrombotic disorders Monitoring anticoagulant therapy Labs use published reference ranges Blood samples: ethical stand points, costs Reported reference ranges on small groups Not reagent or instrument adapted 18 18
19 Coagulation assays Age-dependent reference ranges Neonates 1 month-1year 1-5 y 6-10 y 11-16y <1 year Premature neonates Low birth weight vs healthy children (Ignjatovic et al, J Thromb Haemost 2012, 10, ) 19 19
20 20 20
21 Routine coagulation assays Example of aptt Adult reference range: 28,9-38,1 sec 5-30 dag reference range: sec abnormal aptt Repeat testing Mixing test FVIII, FIX, FXI, FXII, VWF, lupus anticoagulant Unnecessary costs, cancellation of surgery, additional clinical consults, overtreatment Misdiagnosis of bleeding or clotting disorder 21 21
22 Prolonged aptt Prolonged aptt and bleeding Increased bleeding tendency No bleeding Thrombosis Von Willebrand Artefact F XII def. LAC Factor XI def. anticoagulants Def. prekallikrein LAC FX, FV, FII, Fg Hemophilia 22 22
23 Mild decreased FXI: normal aptt 23 23
24 Prolonged aptt Sensitivity for factordeficiencies Procoagulant Fg Prothrombine (FII) F V FVII F VIII F IX F X F XI F XII Reference value mg/dl % % % % % % % % Level for normal aptt* 60 mg/dl 15% 40% - 35% 20% 25% 30% 20% * Depends on the reagent used 24 24
25 Von Willebrand disease Screening tests Confirmation tests Tests for further classification aptt VWF:Ag RIPA (2B) Closure time (PFA) VWF:act (VWF:RCo; CBA) Multimer analysis Thrombocytes FVIII:C VWF-FVIII binding assay (2N) Mutation (type 2) 25 VWF:pp 25
26 Von Willebrand disease Screening tests Confirmation tests Tests for further classification aptt VWF:Ag RIPA (2B) Closure time (PFA) VWF:act (VWF:RCo; CBA) Multimer analysis Acute phase proteins Repeat testing! Thrombocytes FVIII:C VWF-FVIII binding assay (2N) Mutation (type 2) 26 VWF:pp 26
27 Prolonged aptt Prolonged aptt and bleeding Increased bleeding tendency No bleeding Thrombosis Von Willebrand Hemophilia Artefact Factor XII def. LAC Factor XI def. anticoagulants Def. prekallikrein LAC FX, FV, FII, Fg Heparin contamination Under filling tube 27 27
28 Prolonged aptt as artefact CRP Acute phase protein Affinity for phospholipids to recognize pathogens and apoptotic cells Prolonged aptt in intensive care patients (van Rossum et al, Br J Haematol, 2012, 157, ) Analytical interference with CRP: binds to phospholipids Falsely prolonged aptt (Devreese, et al Clin Chem Lab Med, 2015, 53(5): 141-5) 28 28
29 Prolonged aptt as artefact 1,30 Normalized ratio aptt 1,20 1,10 1,00 0, sec (refw <38.1 sec) 16.9 mg/dl 0, CRP (mg/dl) PTT-A Pathromtin SL Cephascreen SynthASil C.K. Prest (Schouwers, Delanghe, Devreese. Thromb Res 2010,125:102-4) (Devreese, et al Clin Chem Lab Med, 2015, 53(5): 141-5) 29 29
30 Prolonged aptt Prolonged aptt and bleeding Increased bleeding tendency No bleeding Thrombosis Von Willebrand Hemophilia Artefact Factor XII def. LAC Factor XI def. anticoagulants Def. prekallikrein LAC FX, FV, FII, Fg 30 30
31 intrinsic Prolonged aptt as artefact neg charged surface XII XII a extrinsic XI IX XI a APA IX a VIII a PL Ca++ common TF VII a PL Ca++ X X a V a PL Ca++ II thrombin fibrin Antiphospholipid antibodies: lupus anticoagulant 31 31
32 Prolonged aptt as artefact Lupus anticoagulant Criterion for antiphospholipid syndrome persistently positive > 12 weeks Risk for thrombosis Transient LAC Incidentally found prolonged aptt Infection No association with thrombosis Repeat testing 32 32
33 aptt as screening test A normal aptt is not always an indication of normal hemostasis Mild factor deficiencies with normal aptt can be associated with significant bleeding history (eg FXI >30%, type I VWD) Be aware of the sensitivity of the aptt reagent If bleeding history is suggestive: perform factor dosage even with normal aptt 33 33
34 intrinsic neg charged surface XII Routine coagulation assays XI XII a IX aptt XI a IX a VIII a PL Ca++ common extrinsic TF VII a PL Ca++ X PT X a V a PL Ca++ II trombin fibrin 34 34
35 Normal aptt, normal PT -FXIII activity -Immunoassay for subunit A and subunit B 35 35
36 Routine coagulation assays intrinsic neg charged surface PT XII XII a extrinsic XI IX XI a IX a VIII a PL Ca++ vitamin K dependent factors TF VII a PL Ca++ X II X a V a PL Ca++ trombin fibrin 36 36
37 Prolonged PT Vitamin K deficiency Vitamin K deficiency 37 37
38 Prolonged PT Precursors of factors II, VII, IX, X, protein C and protein S => PIVKA Complete forms of factors II, VII, IX, X, protein C en protein S Ca 2+ Bind to phospholipids 38 38
39 Prolonged PT Vitamin K deficiency bleeding (VKDB) Bleeding: factors <30% Mild vitamin K deficiency: PT prolonged (FVII) Severe vitamin K deficiency: aptt and PT prolonged Diagnosis: PT, aptt, FII, FVII, FIX, FX dosage < PIVKA, vitamin K dosage FV: differentiates liver dysfunction/vit K deficiency 39 39
40 Routine coagulation assays (Sarnaik et al, Clin Ped, 2010, 49, ) 40 40
41 Platelet function Neonates: Hyporeactive to thrombin, ADP, tromboxane first 2-4 weeks 41 41
42 Laboratory tests for platelet function Platelet aggregation LTA on PRP -250 µl PRP/agonist= 10 ml blood -platelet aggregometry should be repeated once to ensure reproducibility of results. ADP 2.5µM ADP 5µM Collagen 2.5µg/ml Collagen 5 µg/ml Ristocetine 1.5 mg/ml Ristocetine 0.5 mg/ml Arachidonic acid 1.5 mm Epinephrine 10µM Tromboxane-analogue 42 42
43 Laboratory tests for platelet function Screening platelet function 2x 800µl citrated blood Hct>35% and > plts/µl Closure time in seconds is a measure for function of thrombocytes Adult: Collagen/epinephrine sec Collagen/ADP sec Shorter in neonates 43 43
44 Laboratory tests for platelet function The PFA 100 : a potential rapid screening tool for the assessment of platelet dysfunction (P. Harrison et al. Clin Lab. Haem :25-232) a small number of false negative results (6%) obtained with various milder platelet defects (e.g. Hermansky Pudlak syndrome, storage pool and release defects, type I VWD and macrothrombocytopenia) EPI EPI PFA-100 collagen/adp (CADP) (a) and collagen/epinephrine (CEPI) (b) closure times in patients classified as either normal (N) or diagnosed with von Willebrand's disease (VWD), Bernard Soulier sydrome (BS) and Glanzmann's thrombasthenia (GT); Hermansky Pudlak syndrome (HPS), Storage Pool Disease (SPD), Release Defects (RD), Wiskott Aldrich syndrome (WAS) and Grey Platelet syndrome (GPS). The normal range values are shown (NR) with 2 SD normal range limits (dotted lines).
45 Interpretation of coagulation tests Interpretation with caution Diagnosis of bleeding disorder or thrombophilia based on Clinical symptoms Family history Reproducible laboratory results 45 45
46 Coagulation tests in children: Conclusions Immature hemostatic system 3-6 months Differences between adults and children: physiological Age appropriate reference ranges Sample integrity, repeat testing Routine coagulation tests and additional testing An abnormal laboratory test result is not sufficient to define a disease A normal test result does not exclude a disease 46 46
47 THANK YOU FOR YOUR ATTENTION 47 47
LABORATORY DIAGNOSIS OF BLEEDING DISORDERS
LABORATORY DIAGNOSIS OF BLEEDING DISORDERS Secondary Hemostasis CIRCULATORY SYSTEM Low volume, high pressure system Efficient for nutrient delivery to tissues Prone to leakage 2º 2 to endothelial surface
More informationAbnormal Basic Coagulation Testing Laboratory Testing Algorithms
Global Coagulation Testing Abnormal Basic Coagulation Testing Laboratory Testing Algorithms Jeffrey S. Jhang, M.D. No single global laboratory test Bleeding history is the strongest predictor of bleeding
More informationBleeding disorders or haemorrhagic diatheses are a group of disorders characterised by defective haemostasis with abnormal bleeding.
Bleeding disorders or haemorrhagic diatheses are a group of disorders characterised by defective haemostasis with abnormal bleeding. Bleeding may be spontaneous in the form of small haemorrhages into the
More informationNew Oral Anticoagulants
Laboratory Monitoring of New Oral Anticoagulants.....What you need to know Rita Selby MD Medical Director, Coagulation Laboratories Uniersity Health Network & Sunnybrook HSC Uniersity of Toronto The 15
More informationNote: Page numbers in italics indicate figures. Page numbers followed by a t indicate tables.
INDEX Note: Page numbers in italics indicate figures. Page numbers followed by a t indicate tables. Acquired bleeding disorders, 37-57 acquired combined inhibitor to factor V and thrombin, 55 acquired
More informationConsultative Coagulation How to Effectively Answer Common Questions About Hemostasis Testing Session #5020
Consultative Coagulation How to Effectively Answer Common Questions About Hemostasis Testing Session #5020 Dorothy M. (Adcock) Funk, M.D. Colorado Coagulation Karen A. Moser, M.D. Saint Louis University
More informationOutline. Pearls and Pitfalls in the Hemostasis Laboratory. Disorder of Primary Hemostasis Platelet Defect or Von Willebrand Disease
Pearls and Pitfalls in the Hemostasis Laboratory Texas Society of Pathologists 93 rd Annual Meeting Dorothy M. (Adcock) Funk, MD Esoterix Coagulation January 18, 2014 Outline Pearls and Pitfalls: In the
More informationLupus anticoagulant Pocket card
Lupus anticoagulant Pocket card Issue number 5 2012 Antiphospholipid Syndrome 1 The antiphospholipid syndrome (APS) is diagnosed in patients with recurrent thromboembolic events and /or pregnancy loss
More informationThrombophilia. Steven R. Lentz, M.D. Ph.D. Carver College of Medicine The University of Iowa May 2003
Thrombophilia Steven R. Lentz, M.D. Ph.D. Carver College of Medicine The University of Iowa May 2003 Thrombophilia Hereditary and acquired risk factors for thrombosis Venous thromboembolism Arterial thromboembolism
More informationContents. Abstract... i. Committee Membership... iii. Foreword... vii. 1 Scope... 1. 2 Introduction... 1. 3 Standard Precautions...
Vol. 28 No. 20 Replaces H47-A Vol. 16 No. 3 One-Stage Prothrombin Time (PT) Test and Activated Partial Thromboplastin Time (APTT) Test; Approved Guideline Second Edition This document provides guidelines
More informationUniversity of Utah CME Statement
University of Utah CME Statement The University of Utah School of Medicine adheres to ACCME Standards regarding industry support of continuing medical education. Speakers are also expected to openly disclose
More informationHow to Interpret and Pursue an Abnormal Prothrombin Time, Activated Partial Thromboplastin Time, and Bleeding Time in Adults
CONCISE REVIEW FOR CLINICIANS PROLONGED PT AND APTT How to Interpret and Pursue an Abnormal Prothrombin Time, Activated Partial Thromboplastin Time, and Bleeding Time in Adults ARIF H. KAMAL, MD; AYALEW
More informationNew anticoagulants: Monitoring or not Monitoring? Not Monitoring
The 2 nd World Congress on CONTROVERSIES IN HEMATOLOGY (COHEM) Barcelona, Spain September 6 8, 2012 New anticoagulants: Monitoring or not Monitoring? Not Monitoring Anna Falanga, MD Immunohematology and
More informationHANDBOOK OF DIAGNOSTIC HEMOSTASIS AND THROMBOSIS TESTS
HANDBOOK OF DIAGNOSTIC HEMOSTASIS AND THROMBOSIS TESTS Offered by University of Washington Department of Laboratory Medicine Reference Laboratory Services Third Edition 2005 UNIVERSITY OF WASHINGTON DEPARTMENT
More information75515-7 Lupus anticoagulant aptt & drvvt screening panel W Reflex
75515-7 file:///c:/users/cholck/appdata/local/temp/relma_2_49_user_75515-... Page 1 of 1 75515-7 Lupus anticoagulant aptt & drvvt screening panel W Reflex PANEL HIERARCHY LOINC# LOINC Name R/O/C CardinalityEx.
More informationMCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013. Anticoagulants
MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013 Anticoagulants Anticoagulants are agents that prevent the formation of blood clots. Before we can talk about
More informationPhase 1 Study of ALN-AT3 An Investigational RNAi Therapeutic for the Treatment of Hemophilia and Rare Bleeding Disorders.
Phase 1 Study of ALN-AT3 An Investigational RNAi Therapeutic for the Treatment of Hemophilia and Rare Bleeding Disorders January 12, 2015 1 Agenda Welcome Cynthia Clayton Vice President, Investor Relations
More informationHemostasis analyzer system
Hemostasis analyzer system Providing fast, actionable results to help you reduce risks, complications and costs Get the whole picture with TEG Hemostasis analyzer system For more than forty years, hospitals
More informationPlatelet Review July 2012. Thomas S. Kickler M.D. Johns Hopkins University School of Medicine
Platelet Review July 2012 Thomas S. Kickler M.D. Johns Hopkins University School of Medicine Hemostasis Hemostasis is the process that leads to the stopping of bleeding Hemostasis involves blood vessels,
More informationLaboratory Testing in Patients on Novel Oral Anticoagulants (NOACs)
Laboratory Testing in Patients on Novel Oral Anticoagulants (NOACs) Dr. Art Szkotak artur.szkotak@albertahealthservices.ca University of Alberta Hospital Edmonton, AB NOACs Direct Thrombin Inhibitors (DTI):
More informationPlatelet Transmission Electron Microscopy and Flow Cytometry 11/15/2015
Welcome to Mayo Medical Laboratories Hot Topics. These presentations provide short discussion of current topics and may be helpful to you in your practice. Today our topic looks at hereditary platelet
More informationPer Morten Sandset p.m.sandset@medisin.uio.no. Hemostasis parameters and medication prior to radiological interventions
Per Morten Sandset p.m.sandset@medisin.uio.no Hemostasis parameters and medication prior to radiological interventions The challenge Familial or acquired defects in the hemostatic system that dispose for
More informationYvette Marie Miller, M.D. Executive Medical Officer American Red Cross October 20, 2012 45 th Annual Great Lakes Cancer Nursing Conference Troy, MI
Yvette Marie Miller, M.D. Executive Medical Officer American Red Cross October 20, 2012 45 th Annual Great Lakes Cancer Nursing Conference Troy, MI Overview of Hematology, http://www.nu.edu.sa/userfiles/mhmorsy/h
More informationDe effecten van Cofact op Rivaroxaban plasma in trombine generatie assays
De effecten van Cofact op Rivaroxaban plasma in trombine generatie assays In vitro assessment, using thrombin generation, of the applicability of Prothrombin Complex Concentrate as an antidote for Rivaroxaban
More informationMonitoring Thrombin Generation: The Holy Grail of Laboratory Hemostatic Assessment.
Monitoring Thrombin Generation: The Holy Grail of Laboratory Hemostatic Assessment. Marcus E. Carr, Jr., MD, PhD Professor of Medicine, Pathology, and BioMedical Engineering Director of the Central Virginia
More informationAntithromboticthrombotic Monitoring
Introduction to Antithromboticthrombotic Monitoring 1 Topics What is thrombosis, and why is it significant? Coagulation Cascade Pathways of coagulation, anticoagulation, and fibrinolysis Thrombophilia
More informationINTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia
INTRODUCTION Thrombophilia (Hypercoagulability) is a condition in which a person forms blood clots more than normal. Blood clots may occur in the arms or legs (e.g., deep vein thrombosis DVT), the lungs
More informationLaboratory Detection of Newer Anticoagulant Drugs
Laboratory Detection of Newer Anticoagulant Drugs Dorothy M. (Adcock) Funk, M.D. Colorado Coagulation, Laboratory Corporation of America Holdings Outline Newer Oral Anticoagulant Therapies A brief introduction
More informationEasy Bruising and Bleeding in the Adult Patient: A Sign of Underlying Disease
Review of Clinical Signs Series Editor: Bernard M. Karnath, MD Easy Bruising and Bleeding in the Adult Patient: A Sign of Underlying Disease Bernard M. Karnath, MD Achief complaint of easy bruising and
More informationINR = (patient PT/mean normal PT) ISI.
The Relationship of the International Normalized Ratio () to the Prothrombin Time (PT) By: William DePond MD, President and Chief Medical Officer MEDLAB In 1983, it was determined that patients receiving
More informationATHN Assets for the Community: ATHNdataset Michael Recht, MD PhD 10/30/2014 1
ATHN Assets for the Community: ATHNdataset Michael Recht, MD PhD 10/30/2014 1 Sept. 2010 Dec. 2011 Mar. 2011 Jun. 2011 Sept. 2011 Dec. 2011 Mar. 2012 Jun. 2012 Sept. 2012 Dec. 2012 Mar. 2013 Jun. 2013
More informationPlatelet Function analysis using Multiple Electrode Aggregometry (Multiplate )
Platelet Function analysis using Multiple Electrode Aggregometry (Multiplate ) Multiplate platelet function analysis in whole blood based on impedance aggregometry Multiplate instrument 5 channels for
More informationRational for secondary prophylaxis in VWD
Rational for secondary prophylaxis in VWD Susan Halimeh Medical Thrombosis and Haemophilia treatment Center, Duisburg, Germany Dr. med. Susan Halimeh When is prophylaxis in patients with VWD recommended?
More informationINTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia
INTRODUCTION Thrombophilia (Hypercoagulability) is a condition in which a person forms blood clots more than normal. Blood clots may occur in the arms or legs (e.g., deep vein thrombosis DVT), the lungs
More informationThibodeau: Anatomy and Physiology, 5/e. Chapter 17: Blood
Thibodeau: Anatomy and Physiology, 5/e Chapter 17: Blood This chapter begins a new unit. In this unit, the first four chapters deal with transportation one of the body's vital functions. It is important
More informationScreening Tests of Platelet Function: Update on their appropriate uses for diagnostic testing
Screening Tests of Platelet Function: Update on their appropriate uses for diagnostic testing Paul Harrison Oxford Haemophilia & Thrombosis Centre Churchill Hospital Oxford, UK 10 th February 2011 Namur
More informationDisclosure. New Agents for Treatment of DVT. Prevalence of DVT VTE. Normal Hemostasis 7/17/2015. Mark Oliver, MD, RVT, RPVI,FSVU
New Agents for Treatment of DVT Disclosure PI Adopt and Amplify trials Mark Oliver, MD, RVT, RPVI,FSVU BMS and Pfizer Speaker VTE Venous Thromboembolism Recognized DVT s New : 170,000 Recurrent : 90,000
More informationHemostas under graviditet och förlossning. Ove Karlsson Sahlgrenska Universitetssjukhuset
Hemostas under graviditet och förlossning Ove Karlsson Sahlgrenska Universitetssjukhuset Handledare Margareta Hellgren, professor Obstetriska kliniken, Område 1 Sahlgrenska Universitetssjukhuset Anders
More informationPlatelet storage pool disease case discussions. Tzu-Fei Wang The Hemostasis and Thrombosis Center The Ohio State University
Platelet storage pool disease case discussions Tzu-Fei Wang The Hemostasis and Thrombosis Center The Ohio State University Case I 29 yo WF presented for evaluation of possible platelet storage pool disease,
More informationProvided by the American Venous Forum: veinforum.org
CHAPTER 3 CLOTTING DISORDERS Original authors: Edith A. Nutescu, Jessica B. Michaud, Joseph A. Caprini, Louis W. Biegler, and Robert R. McCormick Abstracted by Kellie R. Brown Introduction The normal balance
More informationCoagulation Made Simple. Thomas A. Whitehill, M.D. Section of Vascular Surgery
Coagulation Made Simple Thomas A. Whitehill, M.D. Section of Vascular Surgery Objectives of This Presentation Identify and describe the critical elements of the hemostatic mechanisms of the body Develop
More informationDVT/PE Management with Rivaroxaban (Xarelto)
DVT/PE Management with Rivaroxaban (Xarelto) Rivaroxaban is FDA approved for the acute treatment of DVT and PE and reduction in risk of recurrence of DVT and PE. FDA approved indications: Non valvular
More informationHaemostasis. Catalogue
Haemostasis Catalogue A Contents Reagents TriniCLOT Routine Reagents PT 2 aptt 2 Fibrinogen 3 Thrombin Time 3 Factor Deficient Plasmas 3 Solutions 3 TriniLIA D-Dimer TriniLIA D-Dimer 4 TriniCLOT Speciality
More informationCoagulation Disorders In Pregnancy
Coagulation Disorders In Pregnancy Dr Rashmi Sharma, M.D, FRCA SpR Anaesthetics Blackburn Royal Infirmary Dr Anna Bewlay FRCA Consultant Anaesthetist Royal Preston Hospital Physiological changes in pregnancy
More informationTo aid practitioners in prescribing unfractionated heparin and low-molecular-weight heparins to patients.
UNFRACTIONATED HEPARIN AND LOW-MOLECULAR-WEIGHT HEPARIN TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To aid practitioners in prescribing unfractionated heparin and low-molecular-weight
More informationPFA-100 Platelet Function Analyzer In vitro method for platelet function testing
PFA-100 Platelet Function Analyzer In vitro method for platelet function testing Clinical issue Insufficient bleeding tendency assessment before operation------- history taking, CBC,aPTT, PT, BT (Koscient
More informationNew Anticoagulants: When and Why Should I Use Them? Disclosures
Winship Cancer Institute of Emory University New Anticoagulants: When and Why Should I Use Them? Christine L. Kempton, MD, MSc Associate Professor of Pediatrics and Hematology and Medical Oncology Hemophilia
More informationDISCLOSURES CONFLICT CATEGORY. No conflict of interest to disclose
DISCLOSURES CATEGORY Employment Research support Scientific advisory board Consultancy Speakers bureau Major stockholder Patents Honoraria Travel support Other CONFLICT No conflict of interest to disclose
More informationWhat Does Pregnancy Have to Do With Blood Clots in a Woman s Legs?
Patient s Guide to Prevention of Blood Clots During Pregnancy: Use of Blood-Thinning A Patient s Guide to Prevention of Blood Clots During Pregnancy: Use of Blood-Thinning Drugs to Prevent Abnormal Blood
More informationWhat You Should Know About Abnormal Blood Clotting
What You Should Know About Abnormal Blood Clotting Abnormal blood clotting (thrombosis) is the major cause of death in the United States and a leading cause of morbidity, with an annual incidence of about
More informationReview of the clinical applications for thrombin generation
Review of the clinical applications for thrombin generation François Mullier, Jonathan Douxfils, Damien Gheldof, Christian Chatelain, Bernard Chatelain, Jean-Michel Dogne August 2012, 29th 1 1 Background
More informationUSE AND INTERPRETATION OF LABORATORY COAGULATION TESTS IN PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN)
USE AND INTERPRETATION OF LABORATORY COAGULATION TESTS IN PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN) TARGET AUDIENCE: All Canadian health care professionals:
More informationBlood Sticky, opaque fluid with a metallic taste (Fe 2+ ) Varies from scarlet (P O2 = 100) to dark red (P O2 = 40) ph is between 7.35 and 7.45 Average volume in an adult is 5 L (7% of body weight) 2 L
More informationFREQUENTLY ASKED QUESTIONS (FAQ)
FREQUENTLY ASKED QUESTIONS (FAQ) Questions What is the ABDR? How does the National Blood Authority (NBA) know that I ve ordered clotting factor product? Which bleeding disorders are within the scope of
More informationSession 3 Topics. Argatroban. Argatroban. Drug Use and Adverse Effects. Laboratory Monitoring of Anticoagulant Therapy
~~Marshfield Labs Presents~~ Laboratory Monitoring of Anticoagulant Therapy Session 3 of 4 Michael J. Sanfelippo, M.S. Technical Director, Coagulation Services Session 3 Topics Direct Thrombin Inhibitors:
More informationTransfusion Medicine
Transfusion Medicine Chapter 5 Transfusion Medicine Routine Transfusion Therapy Blood products should not be transfused on a unit basis in children Base the volume of transfusion products on weight to
More informationSARASOTA MEMORIAL HOSPITAL BLOOD COMPONENT CRITERIA AND INDICATIONS SCREENING GUIDELINES
SARASOTA MEMORIAL HOSPITAL BLOOD COMPONENT CRITERIA AND INDICATIONS SCREENING GUIDELINES TABLE OF CONTENTS SUBJECT PAGE ADULT CRITERIA Red Blood Cells/Autologous 2 Washed Red Blood Cells 2 Cryoprecipitate
More informationEvaluation of von Willebrand factor and Factor VIII levels in multiple myeloma patients treated with Thalidomide
chapter 7 Evaluation of von Willebrand factor and Factor VIII levels in multiple myeloma patients treated with Thalidomide A.M.W. van Marion* J.A. Auwerda* T. Lisman P. Sonneveld H.M. Lokhorst F.W.G. Leebeek
More informationWarfarin Reversal with Prothrombin Complex Concentrates and Challenges of the New Oral Anticoagulants.
Warfarin Reversal with Prothrombin Complex Concentrates and Challenges of the New Oral Anticoagulants. Irene Sadek Medical Director Blood Transfusion Services Capital Health Overview Plasma products and
More informationGuidelines for the Laboratory Investigation of Heritable Disorders of Platelet Function
Guidelines for the Laboratory Investigation of Heritable Disorders of Platelet Function British Committee for Standards in Haematology Writing group: Paul Harrison 1, Ian Mackie 2, Andrew Mumford 3, Carol
More information510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY DEVICE AND INSTRUMENT TEMPLATE
510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY DEVICE AND INSTRUMENT TEMPLATE A. 510(k) Number: K041502 B. Purpose for Submission: To change the name of a previously cleared analyzer, and
More informationUsefulness of PFA-100 Ò testing in the diagnostic screening of patients with suspected abnormalities of hemostasis: comparison with the bleeding time
Journal of Thrombosis and Haemostasis, 5: 2393 2398 ORIGINAL ARTICLE Usefulness of PFA-100 Ò testing in the diagnostic screening of patients with suspected abnormalities of hemostasis: comparison with
More informationLearning Objectives. Qualitative and Quantitative Platelet Disorders. Platelet Signaling. Platelet vs. Coagulation Bleeding.
Learning Objectives Qualitative and Quantitative Platelet isorders Jeffrey S. Jhang, M.. Assistant Professor of Clinical Pathology College of Physicians and Surgeons New York, New York Understand the evaluation
More informationHemostatic Defects in End Stage Liver Disease
Crit Care Clin 21 (2005) 563 587 Hemostatic Defects in End Stage Liver Disease Jody L. Kujovich, MD Division of Hematology and Medical Oncology, Mail Code: L-586, Oregon Health & Science University, 3181
More informationFACTOR XII DEFICIENCY AN INHERITED BLEEDING DISORDER AN INFORMATION BOOKLET
FACTOR XII DEFICIENCY AN INHERITED BLEEDING DISORDER AN INFORMATION BOOKLET Acknowledgements This information booklet on Factor XII Deficiency was prepared by: Nathalie Aubin Nurse Coordinator, Hemophilia
More informationAnticoagulation Essentials! Parenteral and Oral!
Anticoagulation Essentials! Parenteral and Oral! Anti-Xa and Anti-IIa! Parenteral Anticoagulants! Heparin family (indirect anti-xa and anti-iia):! UFH! LMWH (enoxaparin, fondaparinux)! Direct thrombin
More informationThe new oral anticoagulants & the future of haemostasis laboratory testing. Alcohol: the good, the bad and the ugly
The new oral anticoagulants & the future of haemostasis laboratory testing Emmanuel J Favaloro Diagnostic Haemostasis Laboratory, Institute of Clinical Pathology & Medical Research, ICPMR, Pathology West,
More informationSimulation of Thrombin Generation During Plasmatic Coagulation and Primary Hemostasis
Simulation of Thrombin Generation During Plasmatic Coagulation and Primary Hemostasis Pascal Ballet (l), Jean-Franqois Abgrall(2), Vincent Rodin (1) and Jacques Tisseau (I) (1) PhD - Software Engineering
More informationBlood Management Today Incorporating TEG
Blood Management Today Incorporating TEG AMSECT NABM meeting Mike Miller Manager Clinical Manager Hemostasis Training Haemonitics Rx Only 2011 Haemonetics Corporation. Haemonetics, TEG, RapidTEG and Thrombelastograph
More informationCollection Guidelines for Routine & Special Coagulation Testing
Revised May 2010 Collection Guidelines for Routine & Special Coagulation Testing Best samples come from peripheral stick with evacuated tube system 19 to 22 gauge needle (smaller or bigger could cause
More information9/16/2014. Advances in the Field of Bleeding Disorders Janus Series
Advances in the Field of Bleeding Disorders Janus Series Elizabeth Varga, MS, LGC Nationwide Children s Hospital Division of Hematology/Oncology/BMT Clinical Assistant Professor of Pediatrics The Ohio
More informationVenous Thrombosis and Pulmonary Embolism in Children and Young Adults
Venous Thrombosis and Pulmonary Embolism in MSRHTC P.O. Box 6507 Aurora, CO 80045-0507 (303) 724-0724 An Overview for Patients and Health Care Providers 2 15 GLOSSARY: venous thrombosis = a condition of
More informationA Cell-based Model of Hemostasis
Thromb Haemost 2001; 85: 958 65 2001 Schattauer GmbH, Stuttgart Review Article A Cell-based Model of Hemostasis Maureane Hoffman, Dougald M. Monroe III Pathology and Laboratory Medicine Service, Durham
More informationReversal of Antiplatelet and Anticoagulant Therapy: What You Need To Know. Ronald Walsh, MD Chief Medical Officer Community Blood Services
Reversal of Antiplatelet and Anticoagulant Therapy: What You Need To Know Ronald Walsh, MD Chief Medical Officer Community Blood Services HEMOSTATIC PROCESS Initiation and formation of the platelet plug
More informationGuideline Statement for the Treatment of Disseminated Intravascular Coagulation
Guideline Statement for the Treatment of Disseminated Intravascular Coagulation Introduction Though a rare occurrence in the perioperative setting, disseminated intravascular coagulation (DIC) is a syndrome
More informationKEY CHAPTER 14: BLOOD OBJECTIVES. 1. Describe blood according to its tissue type and major functions.
KEY CHAPTER 14: BLOOD OBJECTIVES 1. Describe blood according to its tissue type and major functions. TISSUE TYPE? MAJOR FUNCTIONS connective Transport Maintenance of body temperature 2. Define the term
More informationHAEMOPHILIA & UMBILICAL CORD BLOOD TRANSPLANT
HAEMOPHILIA & UMBILICAL CORD BLOOD TRANSPLANT Haemostatic System in Body Blood vessels Platelets Plasma coagulation system Proteolytic or Fibrinolytic system How Bleeding Stops Vasoconstriction Platelet
More informationBiomarkers for new anticoagulants vice and virtue
Biomarkers for new anticoagulants vice and virtue Dagmar Kubitza, MD AGAH, München 2014 Page 1 Definition of Biomarkers?. Surrogate markers are primary measures the effectiveness of investigational drugs.
More informationCOPYRIGHTED MATERIAL. Approach to the patient with an inherited bleeding disorder. Peter A Kouides and Claire Philipp.
1 Approach to the patient with an inherited bleeding disorder Peter A Kouides and Claire Philipp Introduction At the time of injury to the endothelium, the integrity of the high-pressure circulatory system
More informationPublished by. Coagulation. Simplified
Published by Coagulation Simplified ACKNOWLEDGEMENTS CONTENTS We gratefully acknowledge the support and funding provided by the Ontario Ministry of Health and Long-Term Care. Special thanks to the following
More informationTo assist clinicians in the management of minor, major, and/or life-threatening bleeding in patients receiving new oral anticoagulants (NOACs).
MANAGEMENT OF BLEEDING IN PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN) TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To assist clinicians
More informationTranexamic Acid. Tranexamic Acid. Overview. Blood Conservation Strategies. Blood Conservation Strategies. Blood Conservation Strategies
Overview Where We Use It And Why Andreas Antoniou, M.D., M.Sc. Department of Anesthesia and Perioperative Medicine University of Western Ontario November 14 th, 2009 Hemostasis Fibrinolysis Aprotinin and
More informationPoint-of-care testing Thrombelastography and platelet transfusion
Point-of-care testing Thrombelastography and platelet transfusion Gisela Scharbert Department of Anesthesiology, Intensive Care and Pain Management Vienna Medical University, Austria Trauma-induced coagulopathy
More information3. The Circulatory System
3. The Circulatory System A. Introduction B. Blood 1. Circulatory system transports water, electrolytes, hormones, enzymes, antibodies, cell, gases and nutrients to all cells and carries away metabolic
More informationMultiplate platelet function analysis - application and interpretation
Dr. Andreas Calatzis PD Dr. Michael Spannagl Department for Haemostasis and Transfusion Medicine Munich University Clinic Ludwig-Maximilians University Ziemssen Str. 1 80336 Munich, Germany calatzis@haemostasis.de
More informationLaboratory Evaluation of Hemostasis
Laboratory Evaluation of Hemostasis Roger S. Riley, M.D., Ph.D., Ann R. Tidwell, MT(ASCP) SH, David Williams, M.D., Ph.D., Arthur P. Bode, Ph.D., Marcus E. Carr, M.D., Ph.D. Table of Contents Table of
More informationSTARTING, SWITCHING OR STOPPING NEW ORAL ANTICOAGULANTS: A Practical Approach
STARTING, SWITCHING OR STOPPING NEW ORAL ANTICOAGULANTS: A Practical Approach Jeffrey I Weitz, MD, FRCP(C), FACP Professor of Medicine and Biochemistry McMaster University Canada Research Chair in Thrombosis
More informationMeasurement of Maximum Thrombin Generation Capacity in Blood and Plasma Using the Thrombin Generation Assay (THROGA)
Measurement of Maximum Thrombin Generation Capacity in Blood and Plasma Using the Thrombin Generation Assay (THROGA) Q1 Götz Nowak, M.D., 1 Ute Lange, Ph.D., 2 Annett Wiesenburg, 1 and Elke Bucha, M.D.
More informationMedical Laboratory Technology Program. Student Learning Outcomes & Course Descriptions with Learning Objectives
Medical Laboratory Technology Program Student Learning Outcomes & Course Descriptions with Learning Objectives Medical Laboratory Technology Student Learning Outcomes All Colorado Mesa University associate
More informationAnticoagulation and Reversal
Anticoagulation and Reversal John Howard, PharmD, BCPS Clinical Pharmacist Internal Medicine Affiliate Associate Clinical Professor South Carolina College of Pharmacy Disclosures I have no Financial, Industry,
More informationBlood products and pharmaceutical emergencies
Blood products and pharmaceutical emergencies Kasey L. Bucher PharmD, BCPS Clinical Specialist, Emergency Medicine Mercy Health Saint Mary s September 12, 2013 Disclosures None significancemagazine.com
More informationNnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl
NnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl Mikele Wissing, RN June 2014 Introduction until recently, was the unrivaled medication for treatment
More informationEvaluation of a Platelet Function Analyser (PFA-100 ) in patients with a bleeding tendency
Original article Peer reviewed article SWISS MED WKLY 2002;132:443 448 www.smw.ch 443 Evaluation of a Platelet Function Analyser (PFA-100 ) in patients with a bleeding tendency Walter A. Wuillemin a, Katharina
More informationJuan Pablo Escobar Arcos
UNIVERSIDAD SAN FRANCISCO DE QUITO Thrombin generation Development and validation of a thrombin generation-based APC resistance assay Juan Pablo Escobar Arcos Tesis de grado presentada como requisito para
More informationBLOOD BANK SPECIMEN COLLECTION PROCEDURE
BLOOD BANK SPECIMEN COLLECTION PROCEDURE INTRODUCTION Scientific and technical advances in blood group serology have made the transfusion of blood a relatively safe procedure, but serious adverse effects
More informationThrombin Generation Assay
Thrombin Generation Assay Kit insert Version: February 2013 Summary Thrombin is a key enzyme of the coagulation cascade. Its measurement gives direct information about the thrombogenicity of a biomaterial
More informationFunctions of Blood. Collects O 2 from lungs, nutrients from digestive tract, and waste products from tissues Helps maintain homeostasis
Blood Objectives Describe the functions of blood Describe blood plasma Explain the functions of red blood cells, white blood cells, and platelets Summarize the process of blood clotting What is Blood?
More informationSpeaker Disclosure. Outline. Pharmacist Objectives. Patient Case. Outline 9/4/2014
Speaker Disclosure Matthew K. Pitlick, Pharm.D., BCPS St. Louis College of Pharmacy/VA St. Louis HCS mpitlick@stlcop.edu Matthew K. Pitlick, Pharm.D., BCPS declares no conflicts of interest, real or apparent,
More informationAre laboratories following published recommendations for lupus. anticoagulant testing? An international evaluation of practices
Are laboratories following published recommendations for lupus anticoagulant testing? An international evaluation of practices The original article is published in: Thrombosis and Haemostasis 2009;101(1):178-184.
More informationOptimization of Plasma Fluorogenic Thrombin-Generation Assays
Coagulation and Transfusion Medicine / Optimizing ThrombinGeneration Assays Optimization of Plasma Fluorogenic ThrombinGeneration Assays Wayne L. Chandler, MD, and Mikhail Roshal, MD, PhD Key Words: Thrombin
More information