Archives of pathology & laboratory medicine
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Arch. Pathol. Lab. Med. · Nov 2014
Observational StudyThe influence of free hemoglobin and bilirubin on heparin monitoring by activated partial thromboplastin time and anti-Xa assay.
Elevated free hemoglobin (Hb) and bilirubinemia complicate extracorporeal membrane oxygenation and could affect unfractionated heparin (UH) therapy monitoring by anti-Xa assay and activated partial thromboplastin time (aPTT). ⋯ Activated partial thromboplastin time and anti-Xa assay are affected by elevated level of free Hb and/or bilirubin in the presence of UH, and lower anti-Xa activity is noted in extracorporeal membrane oxygenation patients with elevated free Hb. Severe hemolysis and/or hyperbilirubinemia could compromise UH monitoring based on these assays.
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Arch. Pathol. Lab. Med. · Nov 2014
Analysis of addenda in anatomic pathology as a quality monitoring initiative.
Along with the integration of immunohistochemical markers and molecular techniques into routine practice, addenda in surgical pathology reporting have not only increased in frequency but also evolved to include prognostic and therapeutic information. Because of the lack of uniform practice with respect to issuing addenda, information that can significantly change the diagnosis, prognosis, or treatment plan may be issued as an addendum as opposed to an amendment. ⋯ Our study demonstrates that not infrequently, surgical pathology addenda contain information that significantly alters the report and thus merit an amendment. Quality monitoring initiatives that evaluate pathologist and departmental performance should assess both addenda and amendments.
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Arch. Pathol. Lab. Med. · Sep 2014
Case Reports Comparative StudyMegakaryocytic morphology and clinical parameters in essential thrombocythemia, polycythemia vera, and primary myelofibrosis with and without JAK2 V617F.
Megakaryocytes are the "hallmark" of Philadelphia chromosome-negative myeloproliferative neoplasms, such as essential thrombocythemia, polycythemia vera, and primary myelofibrosis; their morphology in correlation with Janus kinase 2 (JAK2 V617F) mutation as well as clinical and laboratory parameters remains unknown. ⋯ Our results indicate that primary myelofibrosis JAK2 V617F and polycythemia vera JAK2 V617F share pathogenetic pathways, resulting in morphologically similar megakaryocytes.
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Arch. Pathol. Lab. Med. · Sep 2014
Multicenter Study Comparative StudyTrends in parenteral direct thrombin inhibitor use in pediatric patients: analysis of a large administrative database.
Parenteral direct thrombin inhibitors (DTIs) may be used in pediatric patients with contraindications to heparin therapy, such as heparin-induced thrombocytopenia. Few data exist regarding the use of DTIs in pediatric patients. ⋯ Pediatric use of DTIs is infrequent and occurs in patients with high morbidity and mortality.
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Arch. Pathol. Lab. Med. · Jul 2014
Reliability of point-of-care capillary blood glucose measurements in the critical value range.
Point-of-care glucose (POCG) testing on capillary blood specimens is central to maintaining glycemic control in patients with diabetes. Although there are known performance issues with POCG methods, especially for maintaining tight glucose control, there is little information about the accuracy of results in the critical ranges that may involve life-threatening conditions. ⋯ POCG measurements in the critical range are frequently erroneous, which is likely caused by preanalytic factors associated with sampling capillary blood. POCG testing practices should include retesting to confirm critical results.