Table Of ContentSeries Editor Series Editor
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The Diagnostic Standards of Care series presents common
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Coagulation Disorders is designed to show clinical pathologists, s
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Michael Laposata
Recommended
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Coagulation Disorders
Quality in Laboratory Diagnosis
http://avaxhome.ws/blogs/ChrisRedfield
Diagnostic Standards of Care
MICHAEL LAPOSATA, MD, PHD
Series Editor
Coagulation Disorders
Quality in Laboratory Diagnosis
Michael Laposata, MD, PhD
Forthcoming in the Series
Clinical Microbiology
Diagnostic Standards of Care Series
Coagulation Disorders
Quality in Laboratory Diagnosis
Michael Laposata, MD, PhD
Edward and Nancy Fody Professor and
Executive Vice Chair of Pathology
Professor of Medicine
Vanderbilt University School of Medicine
Pathologist-in-Chief
Vanderbilt University Hospital
Nashville, Tennessee
New York
Acquisitions Editor: Richard Winters
Cover Design: Joe Tenerelli
Compositor: S4Carlisle Publishing Services
Printer: Hamilton Printing Company
Visit our website at www.demosmedpub.com
© 2011 Demos Medical Publishing, LLC. All rights reserved. This book is protected by copyright.
No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written
permission of the publisher.
M edicine is an ever-changing science. Research and clinical experience are continually e xpanding
our knowledge, in particular our understanding of proper treatment and drug therapy. The authors,
editors, and publisher have made every effort to ensure that all information in this book is in
a ccordance with the state of knowledge at the time of production of the book. N evertheless, the
authors, editors, and publisher are not responsible for errors or omissions or for any consequences
from application of the information in this book and make no warranty, express or implied, with
respect to the contents of the publication. Every reader should examine carefully the package
i nserts accompanying each drug and should carefully check whether the dosage schedules men-
tioned therein or the contraindications stated by the manufacturer differ from the statements made
in this book. Such examination is particularly important with drugs that are either rarely used or
have been newly released on the market.
Library of Congress Cataloging-in-Publication Data
Laposata, Michael.
Coagulation disorders: quality in laboratory diagnosis / Michael Laposata.
p. cm.—(Diagnostic standards of care)
Includes bibliographical references and index.
ISBN 978-1-933864-82-2 (alk. paper)
1. Blood coagulation disorders—Diagnosis. 2. Diagnosis, Laboratory. I. Title. II. Series:
Diagnostic standards of care.
[DNLM: 1. Blood Coagulation Disorders—diagnosis. 2. Anticoagulants—therapeutic use.
3. Blood Coagulation—physiology. 4. Clinical Laboratory Techniques—methods.
5. Medical Errors—prevention & control. WH 322 L315c 2011]
RC647.C55L37 2011
616.1(cid:2)57075—dc22
2010021811
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Made in the United States of America
10 11 12 13 14 5 4 3 2 1
To my wonderful brother, Sam, 12 years my senior,
who has loved, inspired, mentored, and emotionally
supported me for my entire life.
Contents
Series Foreword ix
Preface xi
Acknowledgments xiii
1 Monitoring of Anticoagulant Therapy in Patients Being
Treated with Warfarin 1
2 Monitoring of Anticoagulant Therapy in Patients Being
Treated with Unfractionated Heparin 11
3 Monitoring of Anticoagulant Therapy in Patients Being
Treated with Low Molecular Weight Heparin 23
4 Monitoring of Anticoagulant Therapy in Patients Being
Treated with Fondaparinux 35
5 Monitoring of Anticoagulant Therapy in Patients Being
Treated with Lepirudin or Argatroban 43
6 Evaluation for Heparin-induced Thrombocytopenia 49
7 Evaluation of Prolongations of the PT and the PTT and
Assessment for Defi ciencies of Coagulation Factors 59
8 Evaluation for Disseminated Intravascular Coagulation 75
9 Evaluation for a Congenital Hypercoagulable State 85
viii Contents
10 Evaluation for Antiphospholipid Antibodies 99
11 Evaluation for von Willebrand Disease 107
12 Evaluation for a Coagulation Factor VIII Inhibitor 115
13 Evaluation for Thrombocytopenia That Is Not
Associated with Heparin Exposure 121
14 Evaluation for Platelet Dysfunction in the Presence
or Absence of Antiplatelet Agents 131
Annotated Bibliography 139
Index 141
Series Foreword
“ Above all, do no harm.” This frequently quoted admonition to
healthcare providers is highly regarded, but despite that, there are
few books, if any, that focus primarily on how to avoid harming
patients by learning from the mistakes of others.
Would it not be of great benefit to patients if all health care
providers were aware of the thrombotic consequences from
heparin induced thrombocytopenia before a patient's leg is ampu-
tated? The clinically significant, often lethal, thrombotic events
that occur in patients who develop heparin induced thrombocy-
topenia would be greatly diminished if all health care providers
appropriately monitored platelet counts in patients being treated
with intravenous unfractionated heparin.
It was a desire to learn from the mistakes of others that led to
the concept for this series of books on diagnostic standards of care.
As the test menu in the clinical laboratory has enlarged in size and
complexity, errors in selection of tests and errors in the interpreta-
tion of test results have become commonplace, and these mistakes
can result in poor patient outcomes. This series of books on diag-
nostic standards of care in coagulation, microbiology, transfusion
medicine, hematology, clinical chemistry, immunology, and labo-
ratory management are all organized in a similar fashion. Clinical
errors, and accompanying cases to illustrate each error, are presented
within all of the chapters in several discrete categories: errors
in test selection, errors in result interpretation, other errors, and
diagnostic controversies. Each chapter concludes with a summary
list of the standards of care. The most common errors made by
thousands of healthcare providers daily are the ones that have been
selected for presentation in this series of books.
