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1.
J Int Med Res ; 50(1): 3000605211067321, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35023369

RESUMO

BACKGROUND: A high prevalence of venom-induced consumption coagulopathy has been reported in individuals with viper snakebites. Rotational thromboelastometry (ROTEM) is a rapid technique that could be advantageous in assessing and monitoring coagulation disorders. PURPOSE: To explore correlations between ROTEM and standard coagulation tests. PATIENTS AND METHODS: This prospective observational study was performed among 41 patients with viper envenomation admitted to the Vietnam Poison Control Center from April 2016 to October 2017. Standard coagulation measurements [platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen level] and ROTEM indicators [clotting time (CT), amplitude (at set time: 5 and 10 minutes), clot information time (CFT) and maximum clot firmness (MCF) for extrinsic (EXTEM), intrinsic (INTEM), and fibrin based (FIBTEM) ROTEM] were obtained. RESULTS: For INTEM, EXTEM, the FIBTEM, proportions of patients with prolonged CT were 34.1%, 63.4%, and 61.0% respectively and the proportions of patients with decreased MCF were 62.2%, 62.2%, and 35.5%, respectively. Moderate correlations were observed between PT and EXTEM CT (r = 0.627), aPTT and INTEM CT (r = 0.626), fibrinogen and FIBTEM MCF (r = 0.723), and platelet count and EXTEM MCF (0.60). CONCLUSION: ROTEM indicated a hypocoagulation state in patients with viper snakebite and was moderately correlated with standard coagulation parameters.


Assuntos
Mordeduras de Serpentes , Testes de Coagulação Sanguínea , Humanos , Tempo de Tromboplastina Parcial , Tempo de Protrombina , Mordeduras de Serpentes/diagnóstico , Tromboelastografia
4.
Clin Lab ; 67(12)2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34910442

RESUMO

BACKGROUND: Although routine coagulation tests, such as prothrombin time (PT) and activated partial thromboplastin time (aPTT) are performed before surgery to identify the risk of perioperative bleeding, bleeding complications are rare in minor surgeries, and false-positive results are often observed. Therefore, this study aimed to analyze the common causes of abnormal results of preoperative coagulation tests in previously healthy children undergoing elective minor surgery and determine the usefulness of performing these tests. Additionally, it aimed to identify the distribution of factor XII activity in children with prolonged aPTT. METHODS: The medical records of 363 pediatric patients aged 0 - 18 years, who were referred to the pediatric hematology-oncology department due to abnormal preoperative coagulation tests prior to undergoing minor surgery at the Kyung Hee University Medical Center between March 2008 and October 2020, were retrospectively review-ed. RESULTS: The majority of patients (n = 348, 96%) had prolonged aPTT, few (n = 29, 8%) had a prolonged PT international normalized ratio, and a small number (n = 14, 4%) had both prolonged PT and aPTT. On repeating the coagulation tests, 194 children showed persistent abnormal results. Of these, 184 patients underwent mixing tests, and 176 showed correction for factor deficiency (n = 26) and lupus anticoagulant positive (n = 14). Factor deficiencies included factor XII (n = 16), possibility of von Willebrand disease (vWD; n = 4), factor XI (n = 2), factor VIII (n = 1), factors IX and XII (n = 1), factor VII (n = 1), and factor V (n = 1). The severity of factor deficiency was mild (25 - 38%). One patient with factor VII deficiency received preoperative clotting factors but had postoperative bleeding requiring clotting factor replacement. Another patient with possible vWD received fresh frozen plasma after surgery and had mild symptoms. Linear regression showed no significant correlation between factor XII activity and aPTT in patients with prolonged aPTT (R2 = 0.0002, p = 0.84) or factor XII activity according to aPTT results in those with factor XII deficiency (R2 = 0.04749, p = 0.40). CONCLUSIONS: These results suggest that coagulation tests may be selectively performed in previously healthy children undergoing minor surgery with positive bleeding and/or family history. The distribution of factor XII should be investigated further.


Assuntos
Procedimentos Cirúrgicos Menores , Doenças de von Willebrand , Testes de Coagulação Sanguínea , Criança , Humanos , Tempo de Tromboplastina Parcial , Hemorragia Pós-Operatória , Tempo de Protrombina , Estudos Retrospectivos
5.
Int J Mol Sci ; 22(21)2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34768820

RESUMO

Disseminated intravascular coagulation (DIC) is a severe condition characterized by the systemic formation of microthrombi complicated with bleeding tendency and organ dysfunction. In the last years, it represents one of the most frequent consequences of coronavirus disease 2019 (COVID-19). The pathogenesis of DIC is complex, with cross-talk between the coagulant and inflammatory pathways. The objective of this study is to investigate the anti-inflammatory action of ultramicronized palmitoylethanolamide (um-PEA) in a lipopolysaccharide (LPS)-induced DIC model in rats. Experimental DIC was induced by continual infusion of LPS (30 mg/kg) for 4 h through the tail vein. Um-PEA (30 mg/kg) was given orally 30 min before and 1 h after the start of intravenous infusion of LPS. Results showed that um-PEA reduced alteration of coagulation markers, as well as proinflammatory cytokine release in plasma and lung samples, induced by LPS infusion. Furthermore, um-PEA also has the effect of preventing the formation of fibrin deposition and lung damage. Moreover, um-PEA was able to reduce the number of mast cells (MCs) and the release of its serine proteases, which are also necessary for SARS-CoV-2 infection. These results suggest that um-PEA could be considered as a potential therapeutic approach in the management of DIC and in clinical implications associated to coagulopathy and lung dysfunction, such as COVID-19.


Assuntos
Amidas/uso terapêutico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Coagulação Intravascular Disseminada/tratamento farmacológico , Etanolaminas/uso terapêutico , Ácidos Palmíticos/uso terapêutico , Sepse/complicações , Amidas/química , Amidas/farmacologia , Animais , Transtornos da Coagulação Sanguínea/etiologia , COVID-19/patologia , COVID-19/virologia , Citocinas/sangue , Citocinas/metabolismo , Modelos Animais de Doenças , Coagulação Intravascular Disseminada/etiologia , Etanolaminas/química , Etanolaminas/farmacologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Lipopolissacarídeos/toxicidade , Pulmão/metabolismo , Pulmão/patologia , Masculino , Mastócitos/citologia , Mastócitos/efeitos dos fármacos , Mastócitos/metabolismo , Ácidos Palmíticos/química , Ácidos Palmíticos/farmacologia , Tempo de Tromboplastina Parcial , Tempo de Protrombina , Ratos , Ratos Sprague-Dawley , SARS-CoV-2/isolamento & purificação , Sepse/patologia , Serina Proteases/metabolismo
6.
Rinsho Ketsueki ; 62(10): 1515-1518, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34732626

RESUMO

We report a case of pseudo-prolongation of activated partial thromboplastin time (APTT), which was suspected to be caused by an animal-derived phospholipid. A 78-year-old woman was referred to our hospital because of an unexplained APTT prolongation. She had compensated alcoholic liver cirrhosis, with modestly decreased platelet count and normal prothrombin time, and no bleeding tendency. The APTT was 66 seconds in a test using phospholipid extracted from rabbit brain but was 34.9 seconds with synthetic phospholipids. The artifactual pseudo-prolongation of the APTT was seemingly attributable to the susceptibility of the test reagents to low factor XII levels. Thus, tests with different APTT reagents would be useful to physicians in the diagnosis of similar cases.


Assuntos
Transtornos da Coagulação Sanguínea , Animais , Testes de Coagulação Sanguínea , Feminino , Humanos , Indicadores e Reagentes , Tempo de Tromboplastina Parcial , Tempo de Protrombina , Coelhos
7.
BMJ Open ; 11(10): e047825, 2021 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-34716159

RESUMO

OBJECTIVE: The goal of this systematic scoping review is to collect and summarise scientific evidence regarding the validity of two simultaneous immunochromatographic tests for the conclusive diagnosis of Chagas disease. The research was informed by the following review questions: Will the use of two rapid tests be a valid method for the definitive diagnosis of Chagas disease when compared with conventional serological tests? In what type of population has the operation of two rapid tests been tried for the diagnosis of Chagas disease? What are the biomedical and public health advantages of the diagnostic method resulting from the combination of two rapid tests over the conventional serological method? Will it be a cost-benefit strategy for the diagnosis of Chagas with respect to conventional serological tests? DESIGN: Systematic scoping review. SETTING: A search of the published and unpublished literature in five databases was carried out, in order to identify, screen and select the studies included in this review. RESULTS: 468 studies were identified, of which 46 were screened with a full-text reading, and finally, three articles were included in the review. All studies were in endemic countries with adult and paediatric populations (n=1133) and, together, they evaluated four different rapid tests. The rapid tests showed good sensitivity (97.4%-100%) and specificity (96.1%-100%) for the diagnosis of Chagas when used in combination and compared with the reference tests. CONCLUSIONS: The simultaneous use of at least two immunochromatographic rapid tests is a valid option for the definitive diagnosis of chronic Chagas in endemic rural areas, as long as there are studies that previously evaluate their performance on the areas of implementation. Therefore, this could be an alternative to the current diagnostic standard. However, additional studies are still needed in more countries in order to provide further evidence and to investigate the cost-benefit.


Assuntos
Doença de Chagas , Adulto , Doença de Chagas/diagnóstico , Criança , Testes Diagnósticos de Rotina , Humanos , Motivação , Tempo de Protrombina , Testes Sorológicos
9.
Clin Immunol ; 232: 108852, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34520860

RESUMO

BACKGROUND: The majority of the coronavirus disease 2019 (COVID-19) non-survivors meet the criteria for disseminated intravascular coagulation (DIC). Although timely monitoring of clotting hemorrhagic development during the natural course of COVID-19 is critical for understanding pathogenesis, diagnosis, and treatment of the disease, however, limited data are available on the dynamic processes of inflammation/coagulopathy/fibrinolysis (ICF). METHODS: We monitored the dynamic progression of ICF in patients with moderate COVID-19. Out of 694 COVID-19 inpatients from 10 hospitals in Wenzhou, China, we selected 293 adult patients without comorbidities. These patients were divided into different daily cohorts according to the COVID-19 onset-time. Furthermore, data of 223 COVID-19 patients with comorbidities and 22 critical cases were analyzed. Retrospective data were extracted from electronic medical records. RESULTS: The virus-induced damages to pre-hospitalization patients triggered two ICF fluctuations during the 14-day course of the disease. C-reactive protein (CRP), fibrinogen, and D-dimer levels increased and peaked at day 5 (D) 5 and D9 during the 1st and 2nd fluctuations, respectively. The ICF activities were higher during the 2nd fluctuation. Although 12-day medication returned high CRP concentrations to normal and blocked fibrinogen increase, the D-dimer levels remained high on days 17 ±â€¯2 and 23 ±â€¯2 days of the COVID-19 course. Notably, although the oxygenation index, prothrombin time and activated partial thromboplastin time were within the normal range in critical COVID-19 patients at administration, 86% of these patients had a D-dimer level > 500 µg/L. CONCLUSION: COVID-19 is linked with chronic DIC, which could be responsible for the progression of the disease. Understanding and monitoring ICF progression during COVID-19 can help clinicians in identifying the stage of the disease quickly and accurately and administering suitable treatment.


Assuntos
Coagulação Sanguínea/fisiologia , COVID-19/complicações , Fibrinólise/fisiologia , Inflamação/etiologia , Inflamação/virologia , Adulto , Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/metabolismo , Transtornos da Coagulação Sanguínea/patologia , Transtornos da Coagulação Sanguínea/virologia , COVID-19/metabolismo , COVID-19/patologia , China , Progressão da Doença , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/metabolismo , Coagulação Intravascular Disseminada/patologia , Coagulação Intravascular Disseminada/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinogênio/metabolismo , Hemorragia/etiologia , Hemorragia/patologia , Hemorragia/virologia , Humanos , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Tempo de Protrombina , SARS-CoV-2/patogenicidade
10.
Air Med J ; 40(5): 322-324, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34535239

RESUMO

OBJECTIVE: We evaluated a point-of-care prothrombin time (PT)/international normalized ratio (INR) cartridge-based analyzer for its feasibility, accuracy, and value in critical care air transport. METHODS: In this prospective study, blood samples from 10 randomly selected adult patients were tested with the cartridge during transport to determine feasibility. The cartridge results were compared with the laboratory results for the same samples. Similarly, blood samples from an additional 20 randomly selected adult patients were tested to determine test accuracy. A chart review identified 110 adult patients with PT/INR cartridge results to determine the clinical value of those results. RESULTS: Data from the first group of 10 patients showed that vibration did not affect use of the cartridge. The average bias between the 2 testing methods was 0.0 INR units. A comparison of the PT/INR cartridge results and the laboratory results from the group of 20 patients showed that 73% of the cartridge values were within 0.2 of the laboratory values, 83% were within 0.4, and 93% were within 0.6. Of the 110 patients whose charts showed PT/INR cartridge results, 23% received blood products (45 trauma patients and 65 medical patients). CONCLUSION: The PT/INR cartridge withstands the rigors of rotor wing transport and provides accurate, valuable results for making clinical decisions.


Assuntos
Anticoagulantes , Sistemas Automatizados de Assistência Junto ao Leito , Adulto , Anticoagulantes/uso terapêutico , Humanos , Coeficiente Internacional Normatizado , Estudos Prospectivos , Tempo de Protrombina
11.
PLoS Negl Trop Dis ; 15(8): e0009666, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34407078

RESUMO

BACKGROUND: Coagulation mechanisms are reported to be affected in dengue illness and evidenced by prolonged activated partial thromboplastin time (APTT) and prothrombin time (PT). The main aim of this systematic review and meta-analysis is to determine the magnitude of coagulation abnormalities among patients with dengue fever infection. METHOD: This systematic review and meta-analysis were conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The Joana Brigg's Institute (JBI) critical appraisal checklist was used for quality appraisal. STATA version 11 software was used for meta-analysis. The magnitude of coagulation abnormalities among dengue fever patients was determined by using a random-effects model. Subgroup and sensitivity analysis were performed to investigate the possible source of heterogeneity. Egger weighted regression tests were used to check the presence of publication bias among the included articles. RESULT: Forty-two studies with a total of 12,221 dengue fever patients were eligible for meta-analysis in this study. Of which 22, 15, and 26 studies were used to determine the magnitude of prolonged APTT, PT, and thrombocytopenia, respectively. The magnitude of prolonged APTT and PT among patients with dengue fever infection were 42.91% (95% CI: 30.95, 54.87) I2 = 99.1% and 16.48% (95% CI: 10.95, 22.01) I2 = 97.0%, respectively. Besides, the magnitude of thrombocytopenia among dengue fever patients was 70.29% (95% CI: 62.69, 77.89) I2 = 99.3%. The magnitude of prolonged APTT in children and adults was 51.21% (95% CI: 24.54, 77.89) and 44.89% (95% CI: 28.32, 61.45), respectively. Similarly, the overall magnitude of prolonged PT in children and adults were 13.40% (95% CI: 6.09, 20.71) and 18.73% (95% CI: 7.49, 29.96), respectively. CONCLUSION: The result of this study showed that there is a high magnitude of prolonged APTT and PT in dengue fever patients. Therefore, screening and early correction of coagulation abnormalities may be helpful to reduce further complications in those patients.


Assuntos
Transtornos da Coagulação Sanguínea/epidemiologia , Testes de Coagulação Sanguínea/métodos , Dengue/complicações , Trombocitopenia/epidemiologia , Adulto , Coagulação Sanguínea , Transtornos da Coagulação Sanguínea/etiologia , Criança , Humanos , Tempo de Tromboplastina Parcial , Tempo de Protrombina , Trombocitopenia/etiologia
12.
Nutrients ; 13(8)2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34444740

RESUMO

The aim of this study was to evaluate the effects of vitamin K1 on various vitamin K-dependent proteins in critically ill patients with prolonged Owren PT. We included critically ill non-bleeding adult patients without liver failure or anticoagulation treatment, with Owren PT > 1.2, who were prescribed intravenous vitamin K1. Blood was drawn at baseline and at 20-28 h after vitamin K1 administration. At both time points, we measured various vitamin K-dependent proteins and coagulation assays. ClinicalTrials.gov; Identifier: NTC3782025. In total, 52 patients were included. Intravenous vitamin K1 reduced Owren PT, Quick PT, protein induced by vitamin K absence/antagonist-II and desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), but not to normal levels. Concomitantly, there were increases in thrombin generation and the activity of coagulation factors II, VII, IX and X that was only counteracted with a small increase in Protein C activity. In conclusion, the results suggest that vitamin K1 strengthens coagulation as measured by PT decrease and increases in the activity of vitamin K-dependent clotting factors and thrombin generation. The decreased dp-ucMGP, and its potential positive short- and long-term non-coagulative effects, merits further research.


Assuntos
Coagulação Sanguínea/efeitos dos fármacos , Estado Terminal , Tempo de Protrombina , Vitamina K 1/administração & dosagem , Idoso , Biomarcadores/sangue , Fatores de Coagulação Sanguínea/metabolismo , Proteínas de Ligação ao Cálcio/sangue , Proteínas da Matriz Extracelular/sangue , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Proteína C/metabolismo , Precursores de Proteínas/sangue , Protrombina , Trombina/metabolismo
13.
J Vet Emerg Crit Care (San Antonio) ; 31(5): 557-563, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34216531

RESUMO

OBJECTIVE: To compare hemostatic variables performed on blood samples obtained from indwelling jugular catheters or direct venipuncture over a 72-hour period. DESIGN: Prospective experimental study. SETTING: University research laboratory. ANIMALS: Five healthy neutered male purpose-bred Beagle dogs. INTERVENTIONS: Each dog was sedated to facilitate placement of a long-stay 20-Ga polyurethane IV catheter into the jugular vein. Blood samples were obtained from the preplaced catheters at 4 time points corresponding to 0, 24, 48, and 72 hours relative to placement. Blood samples were also obtained by direct venipuncture of a peripheral vein using a 21-Ga butterfly catheter and evacuated blood tubes at the same time points. Platelet count, platelet closure time, prothrombin time, activated partial thromboplastin time, fibrinogen, and kaolin-activated thromboelastography were performed on these paired samples at each time point. The patency of the indwelling catheters was maintained by flushing every 6 hours with heparinized saline. MEASUREMENTS AND MAIN RESULTS: No significant differences were identified in any of the hemostatic variables obtained by either blood collection technique at any time point during the study (P > 0.05). There was also no significant day-to-day variation in any catheter-derived hemostatic variable obtained from individual dogs identified over the course of the study. CONCLUSIONS: These data suggest that accurate hemostatic variables may be obtained using blood collected from indwelling jugular catheters, maintained with heparinized saline for at least 72 hours, in healthy dogs.


Assuntos
Hemostáticos , Animais , Cateteres de Demora/efeitos adversos , Cateteres de Demora/veterinária , Cães , Veias Jugulares , Masculino , Tempo de Tromboplastina Parcial/veterinária , Estudos Prospectivos , Tempo de Protrombina/veterinária
14.
Bull Cancer ; 108(10): 931-939, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34247763

RESUMO

BACKGROUND: Both modified Child-Pugh (MCP) and Albumin-bilirubin (ALBI) grade were reported that simpler, more objective and evidence-based alternative to the Child-Pugh (CP) class for assessing liver function. AIMS: To investigate whether the MCP and ALBI grade could better evaluate the liver reserve of Hepatocellular Carcinoma (HCC) patients treated with TACE (transcatheter arterial chemoembolization) than CP grade. METHODS: Three hundred seventy-six consecutive HCC patients treated with TACE between December 2007 and October 2011 were enrolled. The baseline characteristics and clinical information were collected. Homogeneity and discriminatory ability were compared between the MCP grade and ALBI class or CP grade. RESULTS: Compared with the CP and ALBI, the MCP grade had a higher predictive accuracy for overall survival (OS) in terms of homogeneity and discriminatory ability. Most of the HCC patients had CP class A disease (84.0%) at presentation, and within this CP class, although the ALBI grade revealed two clear and nonoverlapping groups, the MCP grade revealed three clearly different prognostic groups. Both in the ALBI grade 1 or ALBI grade 2 group, the MCP grade still showed a significant progressive decrease in OS from the smallest to the largest grades, but the CP class was unsatisfactory in stratifying these patients. CONCLUSIONS: The stratification ability and prognostic predictive power of the MCP grade for HCC patients treated with TACE may be better than that of the ALBI grade or CP class.


Assuntos
Bilirrubina/análise , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/mortalidade , Neoplasias Hepáticas/mortalidade , Albumina Sérica Humana/análise , Idoso , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Estudos de Coortes , Progressão da Doença , Feminino , Encefalopatia Hepática/diagnóstico , Humanos , Cirrose Hepática/epidemiologia , Testes de Função Hepática , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Tempo de Protrombina , Taxa de Sobrevida
15.
Clin Lab ; 67(7)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34258962

RESUMO

BACKGROUND: Low-volume sample tubes reduce unnecessary blood loss due to repeated blood collection and are more convenient to collect blood from patients with difficult veins. However, different sample tubes may be sources of preanalytical bias, and the corresponding test results may reflect clinically important differences. We compared the new low-volume sodium citrate tube to the conventional sodium citrate tube to determine any significant differences between the two types of tubes for routine coagulation testing. METHODS: We collected blood samples from 48 random patients, who were referred for routine coagulation testing, into low-volume (1 mL) and conventional (2.7 mL) sodium citrate tubes. We assayed the samples for prothrombin time (PT), activated partial thromboplastin time (aPTT), and D-dimer using the automated coagulation analyzer. RESULTS: There was excellent correlation (r > 0.97) between the results of the two tubes for PT, aPTT, and D-dimer. The PT and aPTT for the low-volume sodium citrate tube were significantly shorter than those of the conventional sodium citrate tube. There was no statistically significant difference in the results for D-dimer. The percent biases calculated with Bland-Altman analysis were 0.8% for PT and 2.0% for aPTT. Both of them were within the desirable specifications for bias with 2.0% for PT and 2.3% for aPTT. CONCLUSIONS: It is imperative to perform local validation before introducing new sodium citrate tubes into the routine blood collection practice. Every laboratory needs to standardize the procedures for evaluation of these tubes.


Assuntos
Coleta de Amostras Sanguíneas , Testes de Coagulação Sanguínea , Humanos , Tempo de Tromboplastina Parcial , Tempo de Protrombina , Citrato de Sódio
16.
Clin Lab ; 67(7)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34258977

RESUMO

BACKGROUND: Analytical performance should be evaluated before a new coagulation analyzer is adopted in a clinical laboratory. The objective of this study was to evaluate analytical performances of three new coagulation analyzers (STA-R Max3, CN-6000, and Cobas t511) and compare them based on the following four coagulation parameters: prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer. METHODS: A total of 427 plasma samples, including fresh and frozen/thawed plasma spanning wide ranges. Each of the manufacturers' quality control samples were used for the evaluation. Analytical performances were evaluated. Parameters considered were precision, carryover, verification of analytical measurement range, auto-dilution, and reference range according to the CLSI guidelines (H57-A). The results of each parameter were compared between STA-R compact (currently in use) and three new analyzers using fresh plasma. The results were compared among three new analyzers using fresh and frozen/thawed plasma, and samples with interferences of hemolysis/icterus/ lipemia (H/I/L). RESULTS: Analytical performances were excellent for all analyzers within each manufacturer's target based on results of precision, carryover, linearity, and verifications of auto-dilution, and reference range. Results for four parameters (PT/aPTT/fibrinogen/D-dimer) with the three new analyzers using fresh samples were well-correlated with those of STA-R Compact except for D-dimer tests (Pearson's r: 0.84 to 1.00). Good correlations were observed between the new analyzers with the total samples (fresh and frozen/thawed samples) (Pearson's r, 0.86 to 0.97). However, weaker correlation and/or higher mean bias% were observed for aPTT and D-dimer with total samples and for four parameters with normal samples rather than abnormal samples across the three analyzers. Differences were more prominent with H/I/L samples, especially between STA-R Max3 and CN-6000 or Cobas t511 for PT, aPTT, and D-dimers. CONCLUSIONS: With excellent analytical performances, the three new coagulation analyzers demonstrated good correlations, although high variabilities were seen for aPTT and D-dimers. High variability in comparison analysis might be mainly attributed to differences in reference and reportable ranges of each parameter across the three different analyzers.


Assuntos
Coagulação Sanguínea , Laboratórios , Testes de Coagulação Sanguínea , Humanos , Tempo de Tromboplastina Parcial , Tempo de Protrombina
17.
Vet Clin Pathol ; 50(3): 348-353, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34287993

RESUMO

BACKGROUND: Different thromboplastins are available to measure prothrombin time (PT). Stago coagulation analyzers and reagents are currently used in veterinary laboratories and enable PT measurements to explore the coagulation cascade (extrinsic pathway). OBJECTIVES: The main objective was to compare PT measurements obtained with the STA-NeoPTimal reagent with the commonly used STA-Neoplastine CI Plus reagent. The secondary objective was to compare the PT ratio with the international normalized ratio (INR) calculated from our derived clotting times. METHODS: Analytical performance was evaluated with intra-assay and inter-assay precision. Seventy-two individual canine plasma samples were collected. Each sample was tested with both thromboplastins, using an STA Satellite Max analyzer. The PT, PT ratio, and INR values obtained with the two reagents were compared using Passing-Bablok regression for correlations and Bland-Altman plots for method agreements. RESULTS: The analytical performance of STA-NeoPTimal reagent was acceptable. Compared with the STA-Neoplastine CI Plus reagent, the STA-NeoPTimal reagent showed a positive proportional bias for PT values. Narrow range analyses showed good agreement for normal PT values (less than 9.5 seconds, internal reference cutoff with STA-Neoplastine CI Plus), and clinical concordance was achieved. When PT was prolonged (more than 9.5 seconds), PT increases were more marked with the STA-NeoPTimal reagent. Agreement was good for INR values across the whole range of PT results. CONCLUSION: STA-NeoPTimal can be reliably implemented in veterinary laboratories for canine PT measurements, as agreement between the PT results measured with the two reagents was clinically acceptable.


Assuntos
Tromboplastina , Animais , Testes de Coagulação Sanguínea/veterinária , Cães , Indicadores e Reagentes , Coeficiente Internacional Normatizado/veterinária , Tempo de Protrombina/veterinária
18.
Int J Lab Hematol ; 43 Suppl 1: 36-42, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34288440

RESUMO

The alterations in the hemostatic balance in COVID-19 patients are strongly disturbed and contribute to a high prothrombotic status. The high rate of venous thromboembolism in COVID-19 patients goes along with derangements in coagulation laboratory parameters. Hemostasis testing has an important role in diagnosed COVID-19 patients. Elevated D-dimer levels were found to be a crucial laboratory marker in the risk assessment of thrombosis in COVID-19 patients. The diagnostic approach also includes prothrombin time and platelet count. Fibrinogen might give an indication for worsening coagulopathy. Other markers (activated partial thromboplastin time (aPTT), fibrinolysis parameters, coagulation factors, natural anticoagulants, antiphospholipid antibodies and parameters obtained by thromboelastography or thrombin generation assays) have been described as being deranged. These may help to understand the pathophysiology of thrombosis in COVID-19 patients but have currently no place in diagnosis or management in COVID-19 patients. For monitoring the heparin anticoagulant therapy, the anti-Xa assay is suggested, because the severe acute-phase reaction (high fibrinogen and high factor VIII) shortens the aPTT.


Assuntos
Testes de Coagulação Sanguínea , COVID-19/sangue , SARS-CoV-2 , Trombofilia/etiologia , Anticorpos Antifosfolipídeos/sangue , Biomarcadores/sangue , Fatores de Coagulação Sanguínea/análise , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/etiologia , Fator Xa/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Fibrinólise , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Tempo de Tromboplastina Parcial , Contagem de Plaquetas , Tempo de Protrombina , Tromboelastografia , Trombina/biossíntese , Trombofilia/sangue , Trombofilia/tratamento farmacológico
19.
Int J Lab Hematol ; 43 Suppl 1: 109-116, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34288452

RESUMO

There are many preanalytical variables (PAV) that are known to affect coagulation testing. The more commonly acknowledged PAV addressed by the clinical laboratory tend to start with their influence on blood collection, but realistically coagulation PAV starts with the patient, where the laboratory has less influence or control. Patient selection and appropriate timing for blood collection may be integral for assuring proper diagnosis and management. Laboratory control and assurance for ideal phlebotomy practice would mitigate most PAVs related to blood collection to minimize suboptimal sample collection. Laboratory oversight of sample transportation, processing and storage will assure sample integrity until testing can be facilitated. The purpose of this document is to review common PAV that should be taken into consideration when ordering, performing and interpreting a coagulation test result, with additional attention to the effect of direct oral anticoagulants (DOACs).


Assuntos
Anticoagulantes/administração & dosagem , Testes de Coagulação Sanguínea , Coagulação Sanguínea/efeitos dos fármacos , Administração Oral , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Humanos , Tempo de Tromboplastina Parcial , Flebotomia , Tempo de Protrombina , Manejo de Espécimes/métodos , Manejo de Espécimes/normas , Fatores de Tempo
20.
Transfusion ; 61 Suppl 1: S111-S118, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269464

RESUMO

BACKGROUND: Never frozen liquid plasma (LP) has limited shelf life versus fresh frozen plasma (FFP) or plasma frozen within 24 h (PF24). Previous studies showed decreasing factor activities after Day (D)14 in thawed FFP but no differences between LP and FFP until D10. This study examined LP function through D40. STUDY DESIGN AND METHODS: FFP and PF24 were stored at -20°C until assaying. LP was assayed on D5 then stored (4°C) for testing through D40. A clinical coagulation analyzer measured Factor (F)V, FVIII, fibrinogen, prothrombin time (PT), and activated partial thromboplastin time (aPTT). Thromboelastography (TEG) and thrombogram measured functional coagulation. Ristocetin cofactor assay quantified von Willebrand factor (vWF) activity. Residual platelets were counted. RESULTS: FV/FVIII showed diminished activity over time in LP, while PT and aPTT both increased over time. LP vWF declined significantly by D7. Fibrinogen remained high through D40. Thrombin lagtime was delayed in LP but consistent to D40, while peak thrombin was significantly lower in LP but did not significantly decline over time. TEG R-time and angle remained constant. LP and PF24 (with residual platelets) had initially higher TEG maximum amplitudes (MA), but by D14 LP was similar to FFP. CONCLUSION: Despite significant declines in some factors in D40 LP, fibrinogen concentration and TEG MA were stable suggesting stored LP provides fibrinogen similarly to frozen plasmas even at D40. LP is easier to store and prepare for prehospital transfusion, important benefits when the alternative is crystalloid.


Assuntos
Testes de Coagulação Sanguínea , Coagulação Sanguínea , Preservação de Sangue , Plasma , Criopreservação , Humanos , Tempo de Tromboplastina Parcial , Plasma/metabolismo , Tempo de Protrombina , Temperatura , Tromboelastografia
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