The laboratory is provided with minimal information regarding patients... making diagnosing a bleeding disorder in the laboratory a challenge.
Proficiency testing in the hemostasis laboratory is not only required but it is an important part of a quality management system.
Just when you think you have heard everything, technology comes up with something new.
TEG measures the elasticity and strength of a clot with a rotating pin, which is converted into electric signals which result in a graphical and numerical output.
In a trauma situation you need rapid assessment to determine what treatment is needed. Speed is critical; the goal is accuracy in the shortest amount of time to determine what is the problem, and what treatment is need. Two major causes of coagulopathy in trauma are a coagulopathy due to severe head injury or hemorrhagic shock due to massive bleeding.
Here are some valuable lessons that I have learned over the years. This information is important to understand not only from the laboratory perspective, but also for clinicians, residents and anyone trying to understand coagulation results.
Hemophilia A is four times more common that type B and occurs in approximately 1 in 5000 males. There are about 400,000 people worldwide with the disease.
According the New York Times, someone between the ages of 69 and 71 is considered elderly. As we age, how does that impact hemostasis; are we more likely to bleed or thrombosis? How do comorbidities and medication impact these processes?
Patients still come and go, reagents need to be validated, competency assessment still happens and all year end records need to be completed and 2018 ones generated.
Everyone knows there are issues with coagulation reagents- just look at a proficiency testing survey for factor assays - results are all over the place.
Thrombosis can affect anyone, up to 900,000 people in the US are affected by blood clots. Of those, 100,000 will die. This is greater than the total number of people who die from AIDS, breast cancer and motor vehicle accidents combined. It doesn't discriminate and can affect all ethnicities and ages.
How is your coagulation laboratory at diagnosing patients with factor deficiencies? What impacts your laboratories capacity for detecting levels that correlate with the patients' clinical diagnosis?