Rinsho byori. The Japanese journal of clinical pathology
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Acquired hemophilia A (AHA) is a bleeding disorder characterized by autoantibodies directed against coagulation factor VIII (FVIII). Patients with the disorder show a mortality rate of 7.9-25%; therefore, rapid and accurate diagnosis is critical. Isolated prolonged APTT in patients showing spontaneous bleeding with no previous history of a bleeding disorder suggests a diagnosis of AHA. ⋯ Factor assays should be repeated at higher serial dilutions of the test plasma, which will attenuate the effect of the inhibitor or LA on the factor measurement and may also distinguish between AHA and LA. Acquired inhibitors to FVIII often display non-linear type 2 kinetics; therefore, the inhibitor titer measured by the Bethesda assay corresponding to the dilution that is closest to 50% inhibition should be reported. Moreover, plasma samples with some FVIII activity should be preincubated for 30 minutes at 56 degrees C in order to inactivate residual FVIII in the test samples.
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Devices for point of care testing (POCT) and self-monitoring of blood glucose (SMBG) have their own characteristics and understanding them is desirable for appropriate use. However, it is hard to say that all medical care prodivers, who measure blood glucose levels with them, understand the characteristics today. ⋯ All first-year trainee physicians (72 physicians), who worked at the clinical laboratory in our hospital in 2005 and 2006 as rotator physicians in training, were asked to measure blood glucose with a POCT-compatible blood glucose monitor and a questionnaire survey was carried out. The necessity and the importance of the inspection were experienced, and the understanding level of POCT of the trainee physicians who finished clinical training in an indispensable department was higher than that of an inexperienced trainee physicians for clinical training.