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Hemostasis/Coagulation

Blood Bank, Compliance & Safety, General Information, Hemostasis/Coagulation, Referral/Sendouts, Test Utilization

Coagulation Blue Top Tube Shortage

There is currently a national shortage of sodium citrate (“blue top”) blood collection tubes used for coagulation testing as a result of unprecedented demand, in part due to COVID-19 surges, vaccine and treatment development. This is anticipated to last through August 2021. Please take this into consideration when ordering coagulation testing (i.e. Protime, aPTT, Fibrinogen, D-dimer, Lupus Screens, Factor Assays, Mixing Studies, von Willebrand testing, etc.).

Here are additional steps you can take to help:

• Eliminate collection of extra blue top tubes

• Discontinue standing orders for coagulation tests, when possible

• Avoid the use of coagulation tubes as discard tubes

• Please refrain from ordering Lupus Screens ( LAB478) when patients are actively taking non vitamin K antagonists, including apixaban, dabigatran, and rivaroxaban. They have a significant impact on clot-based coagulation testing.  It is best to carry these tests out prior to drug administration or during a trough setting.

• Reduce cancelled specimens by making sure to collect specimens correctly by using the lab catalog for specimen collection instructions.

Thank you for your help during this exceptional time.

If you have any questions or concerns, please use the “Contact Us” link above.

Chemistry, Compliance & Safety, General Information, Hematology, Hemostasis/Coagulation, Microbiology, Referral/Sendouts

CSF Priorities on QNS Specimens

When a Cerebrospinal fluid (CSF) specimen arrives into the laboratory and is deemed Quantity Not Sufficient (QNS) for ordered testing, the ordering provider is contacted to identify testing priorities. Occasionally, the laboratory is unable to secure these priorities.

If the lab is unable to secure priorities from the ordering provider within an hour of collection, the following will occur:

1. We will move forward with the Cell count with differential, Culture, and Protein/Glucose

2. The rest of the ordered testing will hold until we can clarify the priorities

Laboratory is partnering with Epic Beaker to discover if a prioritization of orders, upon CSF order entry, is possible.

If you have questions or concerns, please use the “Contact Us” link above.

Hemostasis/Coagulation, Referral/Sendouts

Supply Change Notification: 4.5 mL Blue Citrate Blood Tubes

Effective April 26th, 2021, Spectrum Health Laboratories will discontinue 4.5 mL blue citrate blood tubes. These are a vendor discontinued item. The replacement item will be the 2.7 mL blue citrate blood tubes.

Due to this change, there may be a difference in the number of tubes required to collect for the lab tests below. Please refer to the lab catalog for specimen collection requirements. Continue Reading

General Information, Hemostasis/Coagulation

Update: Platelet Aggregation Studies

The Spectrum Health Regional Laboratory Coagulation Department will be going live with the Helena AggRam analyzer on February 3, 2021.  This analyzer uses platelet rich plasma to analyze human platelet aggregation which is measured by absorbance.  The following aggregating agents are used in these studies: Arachidonic Acid, ADP, Collagen, Epinephrine, and Ristocetin.

Patients for platelet aggregation studies should be resting, fasting, and non-smoking. Patients should avoid taking any prescription or over the counter medications known to affect platelet function for ten (10) days to two (2) weeks prior to the studies. For a list of medications known to have anti-platelet effects, click here. Continue Reading

Hemostasis/Coagulation, Test Spotlight

New Reference Range: APTT and APTT Assay

Beginning September 8, at approximately 2PM, Spectrum Health Laboratories will go live with their new lot of APTT reagent.  This lot change triggered a new therapeutic curve resulting in new heparin nomograms for the system.  The standard heparin therapeutic range will change from the current 45-65 seconds to a new range of 37-52 seconds based off the new curve.  Reference ranges for the APTT assay will also be updated.  Grand Rapids APTT reference range will be 21-27 seconds and the Regional Hospitals will be 21-31 seconds.

APTT specimens that are unable to reach an endpoint (no clot is detected), will reflex to the Unfractionated Heparin (UFH) (Test Code LAB3389) anti-Xa assay.  To accommodate this change, UFH values have been added to heparin nomograms. The UFH anti-Xa assay is currently only performed in the Grand Rapids labs and valid only for unfractionated heparin.  Any questions concerning these changes may be directed to the Spectrum Health Regional Laboratory Coagulation department at 616-267-2740.

General Information, Hemostasis/Coagulation

Test Update: D-Dimer

Effective April 30, 2020, Spectrum Health Laboratories will no longer be performing the D-Dimer Semi-Quantitative assay. D-Dimer (quantitative) will be the only orderable for the D-Dimer assay. This D-Dimer will be reportable up to 35,000 ng/mL FEU. The cut-off value used in the diagnosis of venous thromboembolism (VTE), deep vein thrombosis (DVT), or pulmonary embolism (PE) remains at 500 ng/mL FEU. It is important to note inpatients can be (falsely) elevated in many underlying non-thrombotic conditions common in hospitalized patients.

Questions and inquiries regarding this change may be sent to the Coagulation Department using the “Contact Us” link above.

 

TEST INFORMATION

D-Dimer – [Epic Code: LAB313, Interface Code: 10123, CPT 85379]

Discontinued: D-Dimer Semiquantitative for DIC [Epic Code: LAB760, Interface Code: 10122, CPT: 85378]

Hemostasis/Coagulation

New Test: Thrombin Time

Effective March 4th, 2020, Thrombin Time will change from a sendout reference test performed by Mayo Clinic Laboratories to an in-house test performed by Spectrum Health Regional Laboratory. This test will be performed in the Coagulation Laboratory and will include a new reference range (please see link in Test Information below).

Thrombin Time is suitable for monitoring fibrinolysis therapy, screening for disorders of fibrin formation and in cases of suspected fibrinogen deficiency states. It is also useful for the differentiation between a heparin induced prolongation of the thrombin time and fibrin formation disorders.

For questions around this test, please contact the Coagulation Department at 616-267-2740.

TEST INFORMATION

Thrombin Time – Epic Code: #LAB11230581, Interface Code: #11230581, CPT: #85670