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Italian DOCUMENTI - Documents
Volume:
Biochimica Clinica 2020; 44(2) 168-173
Pubblicato on-line:
March 6, 2020
DOI:
DOI: 10.19186/BC_2020.013
Proposta di un protocollo per la gestione degli approfondimenti in ambito coagulativo nel percorso preoperatorio
Proposal for a protocol aimed to investigate the alterations of the coagulation tests in patients undergoing surgical procedures
AUTORI
1Laboratorio Analisi - Ospedale S. Giacomo, Castelfranco Veneto (Treviso) – ULSS2 Marca Trevigiana
ABSTRACT
Proposal for a protocol aimed to investigate the alterations of the coagulation tests in patients undergoing surgical procedures.
A hemostatic assessment is usually included in the evaluation of patients undergoing surgical procedures. The aim of this work is to present a protocol shared with the Intensive Care, Hematology and Clinical Laboratory Units of the San Giacomo Hospital (Castelfranco Veneto, Treviso, Italy) to investigate the causes of the prolonged coagulation tests in these patients. In case of altered coagulation screening tests, a form is filled in with the pertinent anamnestic information and sent to the laboratory together with an adequate amount of blood. Following a pre-defined algorithm, the clinical laboratory performs the second level tests. The most relevant one for the purpose is the mixing test that permits an easy identification of the appropriate subsequent tests. The results of these tests allow clinicians to take the appropriate decisions. In case of a negative bleeding anamnesis, and/or in presence of a factor XII deficiency or a lupus anticoagulant positive test, the patient undergoes the surgical intervention; in other cases, the hematologist carefully evaluates the hemorrhagic risk of the specific patient.
In 2017, the protocol was applied to 37 cases of prolonged PT/APTT. In 8% of the patients the alteration was not confirmed, in 11% of cases the investigations could not identify the cause of the alterations. In the remaining 81% ofcases, the identification of the specific coagulative defect was possible.
The application of this protocol can achieve a number of benefits: it reduces the number of accesses to the hospital for the patients, only the appropriate tests are performed on the basis of reflex testing procedures, the clinician is provided with all the relevant tests at one time with no need to request the tests one after another. The value of the mixing test in this clinical scenario is confirmed.