By Donna Castellone, MS, MASCP, MT(ASCP)SH
A few of the most complicated questions in coagulation are: Did my mixing study correct? Does this patient have an inhibitor or a factor deficiency? Will this patient bleed or clot? Coagulation testing is complex under the best of circumstances, and providing clinicians with the answer to the presence or absence of an inhibitor is pivotal in patients requiring some type of intervention or knowing if it is just a complication of a non-specific inhibitor.
In my ASCP 2018 Annual Meeting session, Is That an Inhibitor? Coagulation Questions Answered!, I will present patient case studies and demonstrate the different ways one can go about diagnosing the presence or absence of an inhibitor, and what can complicate outcomes. Providing clinicians with a correct assessment of the patient is important in both the short term and long term treatment of patients. The results in these patients may not be clear cut. It’s a conundrum in the coagulation lab seen as a “riddle wrapped in a mystery inside an enigma.”
Since there are no published standards or guidelines on what constitutes a correction in a mixing study, participants will review specific cases and participate in deciding how testing should best proceed. The implementation of direct oral anticoagulants has further complicated the identification of inhibitors and these will also be presented in case studies. We will look at lupus testing, inhibitor testing and the impact of reagents on testing. We’ll work through the laboratory process and confounding variables that can influence the outcome of the patient.
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Donna Castellone, MS, MASCP, MT(ASCP)SH is a quality assurance manager of specialty testing and supervisor of special coagulation and hematology at New York Presbyterian-Columbia University Medical Center, New York. She will present the session, Is That an Inhibitor? Coagulation Questions Answered!, on Thursday, Oct. 4, at 4:40 p.m. during the ASCP 2018 Annual Meeting in Baltimore.