By Michael Laposata
Coagulation problems every day pathologists are confronted with ordering laboratory checks with which they're strange. An incorrectly ordered try or errors in examining try effects can result in error that compromise sufferer protection. Coagulation problems is designed to teach scientific pathologists, lab managers, clinical technologists, and citizens tips to stay away from universal mistakes in try out choice and end result interpretation in diagnostic coagulation. using a case-based process, each one bankruptcy incorporates a concise review of an important analysis, with a number of illustrative situations, after which a listing of urged criteria of care pertinent to the matter. simply because it is key for the practitioner within the analysis of bleeding and thrombotic problems to understand definitely the right plan of action to set up a prognosis or to safely deal with a sufferer, it's both necessary to additionally recognize what to not do. warding off the error is a severe first step to optimizing sufferer end result and maximizing sufferer defense. beneficial properties of Coagulation problems contain: An emphasis on picking proven, evidence-based criteria in coagulation checking out real case illustrations of normally obvious error in addition to the results of these mistakes on sufferer consequence and laboratory administration Examples of error which compromise sufferer protection throughout all significant components of laboratory drugs Pocket-sized for portability in regards to the sequence A key factor for each laboratory and person laboratory practitioner is the evaluation of probability and a present operating wisdom of the factors of care verified for diagnostic checking out through guidance, significant reports and trials. The Diagnostic criteria of Care sequence offers universal error linked to diagnoses in medical pathology, utilizing case examples to demonstrate potent research in keeping with present proof and criteria. as well as being functional diagnostic courses, each one quantity demonstrates using caliber insurance and the position of the pathologist in making sure caliber and sufferer security.
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Additional info for Coagulation Disorders: Quality in Laboratory Diagnosis
This case shows that the dose of lepirudin can be adjusted within the therapeutic range for lepirudin, and not interfere with the INR, for patients receiving lepirudin and warfarin concomitantly. An appropriate decision was made regarding lepirudin discontinuation in this case because the value for the INR was interpretable and largely independent of interference from lepirudin. The sixth case in Chapter 1 on monitoring warfarin anticoagulation also shows a case that illustrates the concept above.
Subtherapeutic and supratherapeutic anti-factor Xa values must be recognized in a timely fashion, though it may be difficult to minimize the risk of bleeding if the value is supratherapeutic because there is no reversal agent for fondaparinux. Samples collected for monitoring the effect of fondaparinux with an anti-factor Xa assay must not be collected before 3 hours from the time of the subcutaneous injection of the drug. 5 Monitoring of Anticoagulant Therapy in Patients Being Treated with Lepirudin or Argatroban Overview 43 Test Ordering Mistakes 44 Result Interpretation Mistakes Standards of Care 47 48 OVERVIEW Direct thrombin inhibitors, which include lepirudin and argatroban, are commonly used anticoagulants in patients with HIT and in individuals tested for whatever reason and found to have antibodies to the heparin–platelet factor 4 complex in the absence of thrombocytopenia or thrombosis.
Complications were avoided because of prompt dose adjustment. In addition, the doctor understood that the low body mass index was among several indications that should prompt the monitoring of low molecular weight heparin. Failing to pursue a diagnosis of heparin-induced thrombocytopenia upon a decline in the platelet count to 50% or less of the baseline platelet count in a patient exposed to low molecular weight heparin by any route at any dose, in the absence of an alternative explanation for the decrease in platelets.