Comparison of Plasma With Whole Blood Prothrombin Time and Fibrinogen on the Same Instrument

Amukele, Timothy; Ferrell, Chris; Chandler, Wayne L.

doi:10.1309/ajcpldt9ovx1tdgt

Cited by 20 publications

(16 citation statements)

References 28 publications

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“…One problem with pointof-care assays, whether they use standard or viscoelastic methodology, is variation due to the effect of hematocrit on the effective plasma sample volume in the assay. In one study, whole-blood INRs were similar to plasma INRs, but the whole-blood assays showed more variability [14]. Variation in hematocrit was the major determinant of the accuracy of the whole-blood INR, with increased error at higher INRs.…”

Section: Standard Assaysmentioning

confidence: 96%

“…Due to the slow turnaround time for fibrinogen assays in many central clinical laboratories [6], rapid whole-blood estimates of fibrinogen can be made using viscoelastic assays, but wholeblood measurements of fibrinogen are affected by the hemocrit in the sample being tested. As discussed above, hematocrit must be taken into account when interpreting whole-blood fibrinogen results [14].…”

Section: Viscoelastic Global Hemostasis Ass Aysmentioning

confidence: 99%

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Emergency assessment of hemostasis in the bleeding patient

Chandler

2013

Int J Lab Hematology

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Summary Emergency hemostasis testing is typically used to determine which blood products are needed to correct hemostatic defects associated with bleeding. Rapid assessment of hemostasis can be performed using standard or viscoelastic hemostasis tests in the clinical laboratory, satellite laboratory, or using point‐of‐care methods. The major drawback of standard coagulation testing is that most clinical laboratories are focused more on accuracy than on turnaround time. Improving turnaround times may require revision of the entire approach to performing the testing in the clinical laboratory including specimen processing, testing, and reporting. An advantage to rapid central laboratory testing is the availability to all areas of the hospital, not just the emergency department or operating rooms. Use of point‐of‐care assays can improve turnaround times, but point‐of‐care tests typically show more variation and lower precision. Viscoelastic global hemostasis tests can be used for rapid assessment as well, but care needs to be taken in the interpretation of the results. Viscoelastic testing is currently the only method that can detect severe fibrinolysis. Platelet function testing is useful for detection of hereditary platelet function problems and some antiplatelet medication monitoring, but is less useful for preoperative bleeding risk assessment or diagnosing the cause of acquire bleeding syndromes. This review will highlight different approaches to the rapid assessment of hemostasis.

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Section: Standard Assaysmentioning

confidence: 96%

Section: Viscoelastic Global Hemostasis Ass Aysmentioning

confidence: 99%

Emergency assessment of hemostasis in the bleeding patient

Chandler

2013

Int J Lab Hematology

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“…Accuracy is limited by variations in haematocrit [20], and is worse for high INRs and low fibrinogens. Within the range of INR (1.5-2.5) where decisions are usually taken to initiate treatment, it has acceptable accuracy and compares well with conventional coagulation tests [21]. Before introducing any POC technology it is essential to evaluate the performance in the specific context of their potential use against central laboratory tests [22].…”

Section: Simple Poc Tests Of Coagulationmentioning

confidence: 99%

Point‐of‐care monitoring of haemostasis

Mallett

Armstrong

2014

Anaesthesia

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SummaryRecent research in the management of haemorrhage has led to several changes in clinical practice. Evidence is accumulating that point‐of‐care testing results in fewer transfusions, improved patient outcomes, and reduced hospital costs. However, there is still insufficient high quality evidence to support transfusion guidelines and algorithms based on point‐of‐care tests alone, and more robust studies are needed. The implementation of point‐of‐care testing requires institutional support and senior clinical leadership to realise the benefits, with educational programmes, audit, and feedback regarding transfusion practice. A change in philosophy is required, from performing testing only when there is an obvious bleeding problem, towards the concept of routinely monitoring high‐risk patients throughout the surgical procedure. This informs clinical practice, establishes normal ranges for that population, identifies patients at risk and allows early identification and treatment of evolving coagulopathy.

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“…The turnaround time for selected tests can be substantially shortened by attention to the processing details and policies [36]. Although point-of-care, whole-blood coagulation tests offer promise, results for the prothrombin time/International Normalized Ratio and fibrinogen may be dependent on the hematocrit and difficult to standardize for samples with abnormal values [38]. Key factors that need to be considered in the execution of traditional laboratory tests with rapid turnaround time are listed in Table 2.…”

Section: Question 5 Usefulness Of Laboratory Tests: What Do Coagulatmentioning

confidence: 99%

Clinical review: Canadian National Advisory Committee on Blood and Blood Products - Massive Transfusion Consensus Conference 2011: report of the panel

et al. 2011

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In June 2011 the Canadian National Advisory Committee on Blood and Blood Products sponsored an international consensus conference on transfusion and trauma. A panel of 10 experts and two external advisors reviewed the current medical literature and information presented at the conference by invited international speakers and attendees. The Consensus Panel addressed six specific questions on the topic of blood transfusion in trauma. The questions focused on: ratio-based blood resuscitation in trauma patients; the impact of survivorship bias in current research conclusions; the value of nonplasma coagulation products; the role of protocols for delivery of urgent transfusion; the merits of traditional laboratory monitoring compared with measures of clot viscoelasticity; and opportunities for future research. Key findings include a lack of evidence to support the use of 1:1:1 blood component ratios as the standard of care, the importance of early use of tranexamic acid, the expected value of an organized response plan, and the recommendation for an integrated approach that includes antifibrinolytics, rapid release of red blood cells, and a foundation ratio of blood components adjusted by results from either traditional coagulation tests or clot viscoelasticity or both. The present report is intended to provide guidance to practitioners, hospitals, and policy-makers.

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Comparison of Plasma With Whole Blood Prothrombin Time and Fibrinogen on the Same Instrument

Cited by 20 publications

References 28 publications

Emergency assessment of hemostasis in the bleeding patient

Emergency assessment of hemostasis in the bleeding patient

Point‐of‐care monitoring of haemostasis

Clinical review: Canadian National Advisory Committee on Blood and Blood Products - Massive Transfusion Consensus Conference 2011: report of the panel

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