CAP Pro Course - Hematology - Common Coagulation Tests

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Author: Margaret Reinhart, MS, MT(ASCP)
Reviewer: Laurie Bjerklie, MA, MLS(ASCP)CM

Continuing Education Credits

Objectives

  • Identify preanalytical factors that could affect coagulation testing, explain the error that would result from each factor, and recommend how to resolve the errors.
  • Identify the coagulation factors associated with the pathways in secondary hemostasis and correlate the prothrombin time (PT) and activated partial thromboplastin time (aPTT) tests with each of the pathways.
  • Predict which coagulation pathway(s) were affected by a factor deficiency or by a therapeutic treatment based on the results of the PT and aPTT test; calculate the INR based on the PT and understand its therapeutic potential.
  • Discuss the principles and procedures of PT/aPTT mixing studies, factor assays, and the thrombin time (TT) test in the diagnosis and monitoring of coagulopathies.
  • Describe the role of fibrinogen, as well as the process of fibrinolysis.
  • Correlate D-dimer test results with fibrinolysis and explain why D-dimer has a very high negative predictive value.

Course Outline

  • Identify preanalytical factors that could affect coagulation testing, explain the error that would result from each factor, and recommend how to resolve the errors.
      • Preanalytical Factors Affecting Coagulation Tests
      • Other Factors That May Affect Coagulation Tests
      • A blood specimen from a patient who is very difficult to draw from arrives in the laboratory for prothrombin time (PT) testing. The tube is approximat...
      • A blue-top tube for activated partial thromboplastin time (aPTT) testing is spun down in the centrifuge for five minutes at 2500 rpm. However, the rec...
      • After centrifugation, hemolysis is seen in the sodium citrate tube which was drawn for coagulation testing. Which of the following is not true about t...
      • You are performing a prothrombin time (PT) test on a patient who has a hematocrit of 59%. What should be your next step?
  • Identify the coagulation factors associated with the pathways in secondary hemostasis and correlate the prothrombin time (PT) and activated partial thromboplastin time (aPTT) tests with each of the pathways.
      • Hemostasis
      • Secondary Hemostasis
      • Prothrombin Time (PT) Testing
      • PT Testing and International Normalized Ratio (INR) Reporting
      • Activated Partial Thromboplastin Time (aPTT) Testing
      • Basics on Coagulation Testing Instrumentation
      • The process of primary hemostasis involves which of the following?
      • A PT test is ordered on a patient. Which of the following is not a possible reason why a PT test was ordered on this patient?
      • Which of the following is not a possible reason why aPTT tests are ordered on patients?
      • A patient who is showing a tendency of prolonged bleeding is found to have a prolonged aPTT. Upon further testing, the only factor that was found to b...
  • Predict which coagulation pathway(s) were affected by a factor deficiency or by a therapeutic treatment, based on the results of the PT and aPTT test; calculate the INR based on the PT and understand its therapeutic potential.
      • Coagulation Testing and Patient Treatment
      • Mechanism of Action of Common Anticoagulant Drugs
      • You are doing coagulation testing on a patient with a diagnosis of disseminated intravascular coagulation (DIC). Which test(s) would you expect to be ...
      • A PT and an aPTT are performed on a patient that is on warfarin therapy. What would you expect the PT and aPTT results to be?
      • A newly admitted patient has a PT of 23 seconds (reference range 10-13 seconds) and an aPTT of 61 seconds (reference range 25-36 seconds). She is not ...
      • You received a blue top tube from a hospital patient being treated with heparin for a pulmonary embolism. Which of the following coagulation tests wou...
  • Discuss the principles and procedures of PT/aPTT mixing studies, factor assays, and the thrombin time (TT) test in the diagnosis and monitoring of coagulopathies.
      • Mixing Studies
      • Thrombin Time Assay
      • Factor Assays
      • A patient has a prolonged aPTT, which is corrected by a 1:1 mix of normal pooled plasma. What should the next step be in the testing process?
      • Which of the following is not a cause for prolonged thrombin time tests?
      • A child is brought to the emergency room with a deep hematoma from a fall. Coagulation tests were performed with the following results: PT: 12.2 secon...
      • A patient is being evaluated for a possible bleeding disorder. The thrombin time (TT) was prolonged at 42 seconds (reference range <20 seconds). Wh...
  • Describe the role of fibrinogen, as well as the process of fibrinolysis. Correlate D-dimer test results with this process, and explain why D-dimer has a very high negative predictive value.
      • Fibrinogen
      • Fibrinolytic System
      • D-dimer
      • A patient is consistently showing decreased fibrinogen levels. Which of the following could cause this?
      • Which of the following is the active enzyme responsible for breaking down fibrin clots?
      • After returning from a trip to Europe, a patient complains of pain and swelling in her right leg. The physician suspects deep vein thrombosis (DVT) an...
      • A patient seen in the emergency room for a suspected pulmonary embolism (PE) is tested for D-dimer levels. The test shows a result within the referenc...
  • References
      • References

Additional Information

Level of Instruction: Intermediate
Intended Audience: This program is designed as an educational and training tool for MLS, MT, and MLT personnel, medical laboratory science students and interns, pathology residents, and practicing pathologists.
Author: Margaret Reinhart MS, MT(ASCP) is the MLS Program Director and Senior lecturer in Biological Sciences at the University of the Sciences in Philadelphia PA where she teaches hematology, clinical immunology, parasitology and other related courses. She is also adjunct instructor in Hematology at Pennsylvania Hospital, Philadelphia PA. She holds a Masters Degree in Biology and in Health Care Administration.
Reviewer Information: Laurie Bjerklie, M.A., MLS(ASCP)CM is currently a Content Developer for MediaLab and LabCE. She earned a B.S. in Medical Laboratory Science from the University of North Dakota and an M.A. in Curriculum and Instruction from Saint Xavier University. She has over 14 years of experience in higher education and has held faculty positions in both MLT and MLS programs. She most recently served as the Program Manager of Medical Laboratory Science at Saint Louis University.

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