By Michael Laposata
Coagulation problems on a daily basis pathologists are confronted with ordering laboratory exams with which they're strange. An incorrectly ordered try out or blunders in reading try out effects can result in errors that compromise sufferer safeguard. Coagulation problems is designed to teach scientific pathologists, lab managers, scientific technologists, and citizens easy methods to keep away from universal blunders in try choice and outcome interpretation in diagnostic coagulation. using a case-based procedure, each one bankruptcy contains a concise evaluation of an immense analysis, with a number of illustrative instances, after which a listing of instructed criteria of care pertinent to the matter. simply because it is key for the practitioner within the prognosis of bleeding and thrombotic issues to understand the proper plan of action to set up a analysis or to correctly deal with a sufferer, it's both necessary to additionally understand what to not do. keeping off the error is a serious first step to optimizing sufferer consequence and maximizing sufferer security. good points of Coagulation problems comprise: An emphasis on deciding upon proven, evidence-based criteria in coagulation checking out real case illustrations of usually obvious blunders in addition to the results of these blunders on sufferer end result and laboratory administration Examples of mistakes which compromise sufferer protection throughout all significant components of laboratory medication Pocket-sized for portability concerning the sequence A key factor for each laboratory and person laboratory practitioner is the review of danger and a present operating wisdom of the factors of care verified for diagnostic checking out through directions, significant reviews and trials. The Diagnostic criteria of Care sequence offers universal mistakes linked to diagnoses in scientific pathology, utilizing case examples to demonstrate powerful research in accordance with present facts and criteria. as well as being sensible diagnostic publications, every one quantity demonstrates using caliber insurance and the position of the pathologist in making sure caliber and sufferer safeguard.
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Extra resources for Coagulation Disorders: Quality in Laboratory Diagnosis
TEST ORDERING MISTAKES Failing to measure the creatinine or other assessment of renal function before administering fondaparinux. Case with Error A 68-year-old woman receives a therapeutic dose of fondaparinux for a spontaneous deep vein thrombosis. Although she receives the appropriate weight-based dose, she develops gastrointestinal bleeding. An assessment of her renal function, after she has received a subcutaneous injection of fondaparinux, shows a moderate decline in function. The doctor recognizes that fondaparinux is cleared by the kidney, and therefore monitoring the concentration of fondaparinux would be clinically informative, particularly while she is actively bleeding.
5 mg daily therapeutic dose of fondaparinux begins to develop significant hematomas with blood sample collection. 2 mcg/mL. This value is at first thought to be above the therapeutic range. 2 U/mL for unfractionated heparin or low molecular weight heparin would be supratherapeutic. 2 mcg/mL for her patient being treated with fondaparinux is within the therapeutic range. Another cause is pursued to explain the new hematomas. Explanation and Consequences In this case, the inquiry of the doctor about the therapeutic range prevented the incorrect conclusion that the anti-factor Xa level in this fondaparinux-treated patient was supratherapeutic and a possible explanation for the hematomas.
Unlike the situation with renal disease and lepirudin, however, it is common to use argatroban in patients with liver disease, but at a reduced dose. In patients with liver disease, monitoring of the PTT more than once per day to determine if the standard argatroban dose has been correctly reduced is essential to avoid under- or over-anticoagulation of the patient. Case with Error A 75-year-old man undergoes surgery to remove a bowel obstruction, and postoperatively he develops HIT, associated with a deep vein thrombosis.