Abstract
Coagulation is the result of a coordinated interaction of blood proteins, circulating cells, endothelium cells and extracellular matrix proteins in the vessel wall. This process works in conjunction with other mechanisms that have to keep the blood in an effective flow, without hemorrity when damage occurs or without a thrombus when clotting begins. Most of the time, there is not so much information that a clotting test gives us, however, in the face of a real clinical scenario that concurrent with a personal haemorrhage, this is essential to take action. In addition, there is a thrombophilic scenario that has to be investigated. In all of them, it is important to note that doctors have to take into account that the pre-analytical phase plays a fundamental role, so it is very important to look around any situation that may impact the patient's results. There is a wide range of laboratory tests to evaluate different mechanisms of hemostasis, according to the history and characteristic of the clinical patient. With this in mind, there is a right time to ask for the right test, to get a better result for diagnosis and treatment. Analytical quality is the set of actions that are carried out in the laboratory with the aim of obtaining an accurate result, reflecting the real situation of the patient. Grossly, platelets, clotting factors and the fibrinolytic system could be studied, not all patients need all tests, they could be solved with a simple test, but may require a deep focus; that is why the patient with a history of mucocutaneous bleeding has to be studied for thrombocytopaties or VWD; a patient with muscle or joint bleeding has to be a factor deficiency test. We propose an initial approach to detecting the pathological situations essential to make decisions. Each person has different symptoms and different approaches, which is why identification and the right tests give us the greatest opportunity to get the right diagnosis.
Highlights
Coagulation [1] is the result of a coordinated interaction of blood proteins, circulating cells, cells of the vasculature and proteins of the extracellular matrix in the vessel wall
When is necessary study a patient with abnormal coagulation test, the preanalytical phase plays a fundamental role, if this takes wrong way, the results will not be assessable, affecting the efforts from hemostasis laboratory team that are aimed providing excellence in care, which means reporting an accurate results, in the shortest time and the lowest possible cost according with the International standard care
Blood samples for coagulation tests, should be drawn into siliconized sodium citrated tubes in a 9:1, the tubes must be filled up to 90% but no more than 110%, it is important that if the amount of anticoagulant is inappropriate, because higher citrate concentrations may lead to longer clotting times, results that confuse the clinician, the amount of citrate interferes with the Ca2+, used during the test, this mistake has been significantly reduced with the vacuum tubes with negative pressure currently available, since they are calibrated to extract the exact amount of blood to maintain the proper proportion with the anticoagulant
Summary
Coagulation [1] is the result of a coordinated interaction of blood proteins, circulating cells, cells of the vasculature and proteins of the extracellular matrix in the vessel wall. This complex mechanism makes it difficult to evaluate it in the laboratory, which only restricts itself to measuring the coagulation proteins and circulating cells, while the vascular elements are not measurable. When is necessary study a patient with abnormal coagulation test, the preanalytical phase plays a fundamental role, if this takes wrong way, the results will not be assessable, affecting the efforts from hemostasis laboratory team that are aimed providing excellence in care, which means reporting an accurate results, in the shortest time and the lowest possible cost according with the International standard care
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