Policies and practices in haemostasis testing among laboratories in Croatia: a survey on behalf of a Working Group for Laboratory Coagulation of the Croatian Society of Medical Biochemistry and Laboratory Medicine

Abstract

IntroductionThe objective of this survey was to assess current policies and practice in haemostasis testing among both hospital and outpatient laboratories in Republic of Croatia.Materials and methodsA questionnaire with seventy questions divided into nine sections was created in May 2015. Participants were asked about their practice related to test request form, sample collection, prothrombin time (PT) and activated partial thromboplastin time assays, other individual haemostasis assays, point-of-care testing (POCT), reporting of coagulation tests results and quality assurance of procedures, the personnel and other laboratory resources, as well as on issues related to education and implementation of additional coagulation assays in their laboratory. The survey was administered and data were collected between June and September 2015.ResultsA total survey response rate was 104/170 (61.2%). Most respondents were faced with incomplete information on prescribed therapy and diagnosis on the test request or inappropriate samples withdrawn on distant locations, but also do not have protocols for handling samples with high haematocrit values. Reporting of PT-INR and D-dimer results was different between laboratories. Although almost all laboratories developed a critical value reporting system, reporting a value to general practitioners is still a problem. Result on coagulation POCT testing showed that not all devices were supervised by laboratories, which is not in compliance with Croatian Chamber of Medical Biochemistry acts.ConclusionObtained results highlighted areas that need improvement and different practice patterns in particular field of haemostasis testing among laboratories. A harmonization of the overall process of haemostasis testing at national level should be considered and undertaken.

Croatian Society of Medical Biochemistry and Laboratory Medicine: National recommendations for blood collection, processing, performance and reporting of results for coagulation screening assays prothrombin time, activated partial thromboplastin time

“…Recommendations on procedures in preanalytical, analytical and postanalytical phases of coagulation screening assays PT, aPTT, TT, fibrinogen, and D-dimer testing were created by the Working Group for Laboratory Coagulation (WGLC) formed by the Croatian Society of Medical Biochemistry and Laboratory Medicine (CSMBLM). Creation of the recommendations was prompted by the results obtained in the survey carried out by WGLC in 2015 among Croatian medical biochemistry and transfusion laboratories performing coagulation testing ( 6 ). Data provided in this review were collected by searching the PubMed and Ovid databases, as well as relevant publications of the Clinical & Laboratory Standards Institute (CLSI), British Society for Haematology (BSH) and International Society on Thrombosis and Haemostasis (ISTH).…”

“…The recent survey conducted among diagnostic laboratories performing coagulation testing, showed that one of the main problem is related to the lack of information on the test request ( 6 ). Lack of appropriate information such as suspected diagnosis or anticoagulation therapy can lead to misinterpretation of test results as well as to unnecessary testing or retesting which could result in additional costs.…”

“…In healthy adults, the reference interval for fibrinogen is generally between 1.8-4.0 g/L but it could be different for diverse commercial fibrinogen tests ( 42 ). Recent survey among Croatian laboratories showed that laboratories use reference interval according to document on harmonisation published by CCMB in 2005 but as it is based on the results obtained from 3.8% citrate tubes this certainly should be revised ( 6 , 33 ). Reference interval for fibrinogen could be adopted from manufacturer or from the literature but verification should be performed.…”

“…Recent survey among diagnostic laboratories in Croatia showed that only small number of laboratories interprets the results of the coagulation test report or recommendations for further testing ( 6 ). Nowadays, as an integral part of laboratory service, laboratories are increasingly encouraged to provide interpretative and/or informative comments related to interferences and findings discovered by the laboratory for a particular patient´s sample ( 56 ).…”

“…The recent survey conducted among medical biochemistry and transfusion laboratories in Croatia showed the existence of different practice policies in particular areas of coagulation testing and highlighted areas that need improvement ( 6 ). As standardization and harmonization of the overall haemostasis testing process at national level should be implemented, recommended procedures related to preanalytical, analytical and postanalytical phases of coagulation screening assays PT, aPTT, thrombin time (TT), fibrinogen and D-dimer testing are presented in this review.…”