LABORATORY EVALUATION ON HEMOSTASIS

Factors that affect specimen for hemostasis:

 Prime concern is premature activation of the clotting process

1. Tissue thromboplastin contamination

 Prematurely activates the clotting process
 Must only be activated when reagent is added
2. Glass surfaces
 Associated with collagen
 Activates contact group
 Activates platelets
 Syringes used for evaluation of hemostasis:
3. Temperature
 Factors V and VIII:
 Factors VII and XI:
4. Hemolysis
 Releases tissue thromboplastin like substance that will activate clotting system
 Release ADP
5. Tourniquet application
 Prolonged tourniquet application (causes venous occlusion/stasis)
 Activation of clotting factors
6. pH
 increased pH
 associatd with loss of carbon dioxide
 will deteriorate clotting factors
 unopened samples
7. Polycythemia vera
 will increase hematocrit (>50%)
 will prolong clotting time tests (PT, APTT)
8. amount of anticoagulant
 blood to anticoagulant ratio:
 anticoagulant of choice for coagulation studies:
 incomplete filling of tubes
 will increase the amount of citrate

ANTICOAGULANTS NOT TO BE USED:

1. EDTA
 Don’t preserve labile clotting factors
 Inhibits thrombin-fibrinogen reaction
 Only for platelet counts; NOT for coagulation studies
2. Heparin
 Binds with anti-thrombin III
 Inhibits all reactions in coagulation
 For platelet retention test/glass bead retention test only
3. Oxalates
 Shortened clotting time because it forms insoluble complexes/precipitates

HEM 323 WEEK 7 LEC I LABORATORY EVALUATION OF HEMOSTASIS 1

Notes to remember:

 ETS is preferred than syringe method: it is because blood directly mixes with the anticoagulant reducing
chances of clotted samples
 ORDER OF DRAW FOR COAGULATION TESTING:
1. Red top tube
2. Light Blue
3. EDTA
4. Plastic syringe

In doing syringe system:

 Requires two syringes

 Sample in the first syringe is discarded or used for tests that require serum
 Sample in the second syringe is collected for coagulation studies

PROCESSING OF SAMPLES FOR HEMOSTASIS

1. Platelet poor plasma (PPP)

 Platelet count:
 Centrifugation:
 Test within 2 hours
 Can be refrigerated but not more than 4 hours
 If freezing temperature
 Used for coagulation studies

2. Platelet rich plasma (PRP)

 Platelet count:
 Centrifugation:
 Used for platelet studies
 STORED AT ROOM TEMP

DRUGS TO BE AVOIDED

1. Aspirin
 Inhibits cyclooxygenase
 platelet aggregation test:
 Bleeding time:

2. Heparin
 Affects coagulation studies
 Inhibits most clotting factors

3. Warfarin/Coumadin
 Antagonist of prothrombin group/Vit K. dependent clotting factors
 Prevents gamma-carboxylation of vitamin K on clotting factors

4. Penicillin
 Alters blood vessel walls
 Induces hemolysis

HEM 323 WEEK 7 LEC I LABORATORY EVALUATION OF HEMOSTASIS 2