Development of a rapid emergency hemorrhage panel

Chandler, Wayne L.; Ferrell, Chris; Trimble, Shirley; Moody, Suzanne

doi:10.1111/j.1537-2995.2010.02753.x

Cited by 71 publications

(46 citation statements)

References 16 publications

(26 reference statements)

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“…One typical source of increased turnaround time in most clinical laboratories is checking samples for hemolysis and clotting followed by rejection of the sample if either of these are found, even though these checks are seldom performed for point-of-care or whole-blood viscoelastic testing. In one study, hemolysis was shown to have no clinically significant effect on the PT or fibrinogen [4]. Clotted samples were rare (1.1%) and shortened the PT by only 0.7 s. Clotted samples lowered fibrinogen on average 18%, but resulted in only one of 2300 samples changing from normal to low fibrinogen.…”

Section: Standard Assaysmentioning

confidence: 99%

“…In a trauma situation, for example, where stabilization of the patient in the first hour is critical, turnaround times of nearly an hour may be almost useless even if very accurate. One approach for improving the speed of critical hemostasis results using a central coagulation laboratory is development of a specific emergency hemorrhage panel [4]. This may require revision of the entire approach to performing the testing in the clinical laboratory including bypassing login, minimizing specimen checking and retesting, and modification of test processing and testing protocols to reduce the time required.…”

Section: Standard Assaysmentioning

confidence: 99%

“…In one study, the standard process for performing stat coagulation testing was mapped out, followed by an analysis of how to eliminate unneeded steps and to minimize the time required for steps that were needed [4]. Turnaround time was reduced by moving the sample immediately to the testing area rather than logging and relabeling it in the specimen processing area.…”

Section: Standard Assaysmentioning

confidence: 99%

“…Rapid hemostasis testing may be carried out in the clinical laboratory [3,4], in a satellite laboratory [5], or as point-of-care testing in the operating room or trauma suite [6][7][8][9][10][11].…”

Section: Clinical Situationmentioning

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: 99%

Section: Standard Assaysmentioning

confidence: 99%

Section: Standard Assaysmentioning

confidence: 99%

Section: Clinical Situationmentioning

confidence: 99%

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Emergency assessment of hemostasis in the bleeding patient

Chandler

2013

Int J Lab Hematology

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“…27 Prior to the EHP, turnaround times for coagulation panels were 35 Ϯ 37 minutes. By ensuring sample prioritization in work queues, streamlining pre-analytical sample processing and adjustment of calibration curves, the turnaround time was reduced to 14 Ϯ 3 minutes.…”

Section: Coagulation Testing In Postpartum Hemorrhagementioning

confidence: 99%

Postpartum hemorrhage: a continuing challenge

Lockhart

2015

Hematology

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Obstetric hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Many postpartum hemorrhages (PPHs) do not have identifiable risk factors; maternity units should therefore have obstetric hemorrhageprotocols in place for all parturients as every pregnancy has the potential to be complicated by hemorrhage. This review will examine the epidemiology of PPH as well as current recommendations for key elements in obstetric hemorrhage protocols. Recent advances in hematologic management of PPH will be also be reviewed, including: (1) recognition of hypofibrinogenemia as a risk factor for severe PPH, (2) use of antifibrinolytic therapy, and (3) strategies for fibrinogen replacement therapy.

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