888-2002 rev. d vspro coagulation utilization guide · coagulation testing includes the evaluation...
TRANSCRIPT
VSproPT/aPTTCombinationTest
Coagulationtestingincludestheevaluationofbothprothrombintime(PT)andActivatedPartialThromboplastinTime(aPTT).Testingdeterminesifasignificantcoagulationfactordeficiencyexists,andifso,whichfactor(s)areaffected.PTisusedtoevaluatetheextrinsicandcommonpathways,whileaPTTisusedtoevaluatetheintrinsicandcommonpathways.
TheVetScanVSpromakespoint-of-carecoagulationtestingeasy,fastandaffordable.ImmediatePTandaPTTtestresultsoffernumerousclinicalbenefitsforveterinarypatientsandfinancialbenefitsfortheveterinarypractice.
TheVetScanVSproPTandaPTTCombinationTestisusedinconjunctionwiththeVSproAnalyzerforfast,convenientandcost-effective,point-of-carecoagulationtesting.ThistestcartridgeprovidesquantitativedeterminationofPT(prothrombintime)andaPTT(activatedpartialthromboplastintime)simultaneouslyfrom100µLofcitratedcanineorfelinewholeblood.
Cartridge Storage:Refrigerateat2°Cto8°C(36°Fto46°F)
Cartridge Stability: Donotexposecartridgesinthefoilpouchtodirectsunlight,anddonotleavethem atroomtemperature(15-30°C,59-86°F)formorethan3hours.
Usecartridgeswithin10minutesofremovingfrompouch.
Quick Reference Guide
Test/Species
PT
aPTTaPTT
Reference Ranges (seconds): Dynamic Ranges (seconds):
Feline
15-21
86-137
Canine
14-19
75-105
11-35
30-200
Sample well for adding 100 µL citrated whole
blood
Opticaldetectionwindows
Microfluidictechnology
Sample Preparation
Precautions before blood sample collection:
• Aswithanybloodtest,theaccuracyisdependentonthequalityofthebloodsample.Poorsamplequalityiscausedbyimpropercollectionandhandlingtechniques.
• Collectblooddirectlyfromthelargestaccessiblevein.
•Contaminationfromthromboplastin,alcohol,andintravenoussolutionswillinterferewiththecoagulationassay.
• Hemolyzedsamplescanleadtotestingerrorsandinconclusiveresults.
•Thesodiumcitratetubemustbefilledcompletelyforaccurateresults.
Fillanevacuatedsodiumcitratetubetothe“fill line”withwholeblood.Thebloodisdrawnintothetubeuntiltheflowstops.Forbloodcollectedintoaregularsyringe,theneedleshouldberemovedpriortogentlydispensingbloodintothetube.Ifnofilllineisseen,filltubetotopoflabel.NOTE:Under-filled or over-filled citrate tubes may alter results due to the improper anticoagulant to sample ratio, most commonly resulting in a falsely prolonged aPTT.
Fillline
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2 Gentlyinvertthesodiumcitratetubeatleast10timesimmediatelyafterfillingtoensureagoodmixturewiththeanticoagulant.Letthesamplesitfor5minutesbeforetestingtostabilizethemixtureofbloodandcitrate.Ifthetestisdelayed,continuetoinvertevery10minutespriortothetest.Abloodrockermaybeused.NOTE:Blood may be tested up to two hours after it has been properly collected without affecting the test result.
Test Procedure
PT: seconds
aPTT: seconds
740-7021 Rev. B
Normal Range:
Species PTseconds
aPTTseconds
Dog 14 - 19 75 - 105
Cat 15 - 21 86 - 137
ResultsSticker
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RemovethePTandaPTTCombinationTestCartridgefromtherefrigeratorandopenthepouch.Touchthe“Analyze”buttonintheHomemenuscreentostartthetest.
Insertanewtestcartridgewhenthemessage “Please insert new cartridge”isdisplayedonthescreen.
Enterthe9-digit cartridge code locatedonthepouchlabelandtouch“Done”.
Selectspeciesandpress“Done”.
Touch“Confi rm”toacknowledgethatthesamplehasbeenobtainedinasodiumcitrate(bluetop)tube.
Enter“Patient ID”and/or“Sample ID”(optional).Touch“Done”toconfirmandthen“Next”tocontinue.The“Cartridge Warming Up”periodwillbegin.NOTE: Do not add sample while cartridge is warming up!
Whentheanalyzerbeepsandflashesthemessage“Add sample and wait”,usethedisposablepipetteprovidedtoaddsampletothewell.NOTE: Prior to adding sample, gently invert sample tube 10X to obtain a uniform mixture for testing.
Nextscreenshows“Test in progress”.Itlastsapproximately10minutesfromthetimethesampleisputintothewell.
Whenanalysisiscomplete,“Test Results”willappear.Usea“Results Sticker”(providedintheVSproStarterKitandcanbere-ordered:PN740-7021)toputthetestresultsintoafile;printresultsifprinterisattached;orsaveresultstoacomputerthroughproperconnectivity.(SeetheVSpromanualformoreinformation).TheVSprostoresupto1000testresults.Press“Done”toexitthetestresult.
“Please remove cartridge”thathasbeenusedanddisposeofitandalltestmaterialappropriately,andplacethesealingcartridgeinthecartridgeslot.
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NormalCoagulationCascade
LikelyCommonPathwayorCombinedPathwayDisorder:•Rodenticidetoxicity•VitaminKdeficiency•FactorXII•Hepaticdisease•Bileinsufficiency•DIC•Anticoagulants•Iatrogenic•Mastcelltumordegranulation
LikelyIntrinsicPathwayDisorder:•FactorVIII (HemophiliaA)•FactorIX (HemophiliaB)•FactorXI (HemophiliaC)•FactorXII•ExcessiveConsumption
Normal Prolonged
Normal NormalProlonged
LikelyExtrinsicPathwayDisorder:•FactorVII•Earlyrodenticide
toxicity•VitaminKdeficiency•Hepaticdisease•Bileinsufficiency
Prolonged
Ifbruisingorpetechia,consider:•VonWillebrand’sdisease•Thrombocytopenia
orplateletdisorder•Vasculardisorder
PT
aPTT aPTT
Test Interpretation
PT (Prothrombin Time):MeasurestheExtrinsicandCommonPathways
aPTT (Activated Partial Thromboplastin Time): MeasurestheIntrinsicandCommonPathways
Test Utilization
Pre-surgicaltestingPre-surgicaltestingshouldbeconsideredforanypatient,regardlessofage.Inheritedorcongenitalhemophiliacannotbedeterminedthroughanyothertestingmethodsoronphysicalexamination.Manyofthesedeficienciescausemildprolongationofclottingtimeswithoutclinicalsigns.
HemophiliaAandBhavebeendescribedinmanydogbreeds,includingmixedbreeds.HemophiliaAhasbeendetectedincats.HemophiliaCismorecommonincatsthanAorB.PT/aPTTtestingisanexcellentscreenfortoxiningestions(oftenlow-grade,subclinical)thatmaycauseprolongedbleedingtimes.Thisisfrequentlydetectedduringapre-surgicalcoagulationscreen.
PreventivecareBaselinevaluesareasimportantforcoagulationtestingastheyareforanyotheranalyte.Stress,illness,injury,medicationsandsurgerycanallaffectcoagulationtestresults,sobaselinevaluesarevitalforinterpretation.
HepaticdiseaseAnypatientwithincreasedliverenzymes,possiblehepaticdysfunction,orconfirmedhepatopathywillbenefitfromcoagulationtesting.Thisbecomesimperativeshouldthepatientrequireinvasivesurgeryorbiopsy/aspirateofaninternalorgan.
Liverdiseasecanaffectthecoagulationcascadeinmultipleways,astheliverproducesmostofthecoagulationfactors.Considerthat:•Manyoftheclottingfactorsaresynthesizedandclearedbytheliver.•VitaminKisfatsoluble,soitsabsorptiondependsonadequatebileproductionandflow.•Severeliverdiseasemayleadtodisseminatedintravascularcoagulation(DIC).
Anydiseasestatethataffectsthelivercanleadtoacoagulationabnormalityincluding:•Inflammation(hepatitis,cholangiohepatitis)•Neoplasia•Biliarystasis•Useofchronicmedications(NSAIDs,anesthetics,chemotherapeutics,etc.)
VitaminKdeficiencyorantagonismVitaminKisanessentialcofactorforcoagulationfactorsII,VII,IXandX.FactorVIIhastheshortesthalf-lifeandwilldepletetheearliest,therefore,PTisoftenprolongedfirst.SomecausesofVitaminKdeficiencyare:•Rodenticidetoxicity•Cholestaticliverdisease(reducedbileflowreducesabsorption)•LiverFailure•Malabsorptiondisorders•Medications
Otherdiseasestateswherecoagulationtestingisindicated:•Anypatientwithunexplainedbleeding,bruisingorpetechialhemorrhage•Snakebite •Infectiousdisease •Immune-mediateddisease•Shockorseveresystemicdisease(potentialforDIC)•Activelybleedingpatients
VSproFibrinogenTest
Sample well for adding diluted platelet-poor plasma
Opticaldetectionwindows
Microfluidictechnology
Quick Reference Guide
TheVetScanVSproFibrinogenTestcartridgeisusedinconjunctionwiththeVSproAnalyzertoevaluatethefibrinogenlevelinhorses,asensitiveandspecificmarkerforinflammation.Earlyrecognitionofsystemicinflammationisessentialfordiagnosisofdiseaseandformulatingatreatmentplan.Quantitativeserialtestingforfibrinogencanhelpeffectivelymonitortreatmentandtheresponsetotherapy.
Cartridge Storage:Refrigerateat2°Cto8°C(36°Fto46°F)
Cartridge Stability: Donotexposecartridgesinthefoilpouchtodirectsunlight,anddonotleavethem atroomtemperature(15-30°C,59-86°F)formorethan3hours.
Usecartridgeswithin10minutesofremovingfrompouch.
Equine
Reference Range: Dynamic Range:
mg/dL
150-400
g/L
1.5-4.0
g/L
0-20
mg/dL
0-2000
Sample Preparation
Precautions before blood sample collection:
• Aswithanybloodtest,theaccuracyisdependentonthequalityofthebloodsample.Poorsamplequalitycanbecausedbyimpropercollectionandhandlingtechniques.
• Collectblooddirectlyfromthelargestaccessiblevein.
•Contaminationfromthromboplastin,alcoholandintravenoussolutionswillinterferewiththefibrinogenassay.
• Useofhemolyzedsamplesmayresultinlowerthanexpectedvalues.
•Ensureprecisionwhenmixingplatelet-poorplasmaanddiluent,andonlyusethepre-filledmicrotubesupplied.
•Theplatelet-poorplasmaanddiluentsolutionmustbemixedgently.Donotuseavortexmixer,anddonotshakethesample
•Thetubemustbefilledcompletelyforaccurateresults.
Fillanevacuatedsodiumcitratetubetothe“fill line”withwholeblood.Thebloodisdrawnintothetubeuntiltheflowstops.Forbloodcollectedintoaregularsyringe,theneedleshouldberemovedpriortoplacingbloodintothesodiumcitratetube.Donotplacesampleonarocker.NOTE:Under-filled or over-filled citrate tubes may alter results due to the improper anticoagulant-to-sample ratio.
Spinthecitratedwholebloodsampletoplatelet-poorplasmausingacentrifuge.Refertopackageinsertforcentrifugerequirements.
Useapipetteandoneofthesuppliedpipettetipstoextract100µLofplatelet-poorplasmafromthecentrifugedsampletube.Depositthe100µLofplatelet-poorplasmaintothepre-filleddiluenttubebypiercingthefoillidwiththepipettetip.
Gentlymixthediluentandsamplebyextractinganddepositingthemixtureusingthepipette.Thesampleisnowreadyfortesting.
Fillline
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Test Procedure
ResultsSticker
RemovetheFibrinogenTestCartridgefromrefrigeration10-15minutespriortoanalysistowarmuptoroomtemperature.Touchthe“Analyze”buttonintheHomemenuscreentostartthetest.
Insertanewtestcartridgewhenthemessage“Please insert new cartridge”isdisplayedonthescreen.
Enterthe9-digitcartridge codelocatedonthepouchlabelandtouch“Done”.
Touch“Confirm”toacknowledgethatthesamplehasbeenobtainedinasodiumcitratetube,spundowntoplatelet-poorplasmaanddilutedbyadding100µLoftheplasmatothesuppliedpre-filleddiluenttube.
Enter“Patient ID”and/or“Sample ID”.Touch“Done”toconfirmandthen“Next”tocontinue.The“Cartridge Warming Up”periodwillbegin.NOTE:Do not add sample while cartridge is warming up!
Whentheanalyzerbeepsandflashesthemessage“Add 100 µL sample and wait”,usepipetteanddisposablepipettetiptoadd100µLofsampletothewell.NOTE:Prior to adding sample, extract and re-deposit the sample in the tube to obtain a uniform mixture of plasma and diluent for testing. Do not introduce bubbles to the mixture.
Nextscreenshows“Test in progress”.Itlastsapproximately15minutesfromthetimethesampleisputintothewell.
Whenanalysisiscomplete,“Test Results”willappear.Usea“Results Sticker”(providedintheVSproStarterKitandcanbere-ordered:PN740-7041)toputtestresultsintoafile;printresultsifprinterisattached;orsaveresultstoacomputerthroughproperconnectivity.(SeetheVSpromanualformoreinformation).TheVSproautomaticallystoresupto1000testresults.Press“Done”toexitthetestresult
“Please remove cartridge”thathasbeenusedanddisposeofitandalltestmaterialappropriately,andplacethesealingcartridgeinthecartridgeslot.
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Test Utilization
Fibrinogentestingside-by-sidewithcompletebloodcount(CBC)FibrinogenconcentrationsshouldbeincludedwhenperformingaCBCinthehorse.•Fibrinogenisanacutephaseproteinmadeintheliverthatdetectsinflammation.•Fibrinogenincreases24hoursafteraninflammatoryprocesshasstartedandpeaksbetween4and7days.•Fibrinogenmayindicateinflammationinthesubclinicalhorsewhentheleukogramiswithinnormallimits.•Fibrinogenlevelsareverysensitive,andevenamildincreaseshouldbeconsideredsignificant.
SystemicinflammatorymarkerEarlyrecognitionofsystemicinflammationusingfibrinogenisessentialforformulatinganeffectivetreatmentplan.Inflammationthatgoesunrecognizedcanimpairapatient’sgrowthandperformance.•Fibrinogenbloodlevelsaredirectlyrelatedtotheseverityoftheunderlyingcondition.•Fibrinogenisthepreferredinflammatorymarkerforearlydetection(subclinical)ofRhodococcusequipneumonia.1
•FibrinogenincreasesmorequicklyinsynovialfluidthanserumamyloidA(SAA)(byseveralhours)followingendotoxinadministrationintothejoint.2
•Whentestedserially,fibrinogenprovidesinformationregardingtreatmentefficacyandlength,prognosis,especiallyconsideringsuchinfectiousorinflammatoryconditionsas:R.equiinfections,strangles,pigeonfever,pleuropneumonia,abdominalabscess,septicarthritis,endometritis,clostridialmyonecrosis,andendocarditis.
Fibrinogenspecificity•Plasmafibrinogenmayincreasewithdehydrationandmaydecreasewithseverehepaticdiseaseduetodecreasedproteinproduction.•IncasesofDIC,fibrinogenmaybedecreasedduetoincreasedutilization(maskingthehyperfibrinogenemiaassociatedwiththeinflammatoryprocess).
Patientmonitoringtool•Thedegreeofhyperfibrinogenemiaapproximatestheseverityofdisease.•Whenused,inconjunctionwiththeclinicalfindingsandotherlaboratorydata,themosteffectivetreatmentprotocolandprognosiscanbemonitoredclosely.•Fibrinogenlevelsmaybeusedaloneindeterminingresolutionoftheinflammatoryprocesswhentheleukogramisunchangedorhasreturnedtonormal.
1.Passamonti,Fetal.Rhodococcusequipneumoniainfoals:anassessmentoftheearlydiagnosticvalueofserumamyloidAandplasmafibrinogenconcentrationsinequineclinicalpractice.VetJ.2015Feb;203(2):211-8.2.Andreassen,Metal.Changesinconcentrationsofhaemostaticandinflammatorybiomarkersinsynovialfluidafterintra-articularinjectionoflipopolysaccharideinhorses.BMCVetRes.2017Jun19;13(1):182
Plasma Protein:Fibrinogen (PP:F) Ratio
Usefulintheinterpretationoffibrinogenconcentrationwhenhyperproteinemiaispresent.Thisratioiscalculatedas:
PP:FRatio=fibrinogenmg/dl
(plasmaTPmg/dl-fibrinogenmg/dl)
15-20Normal
>20Dehydration
<15Inflammation
Interpretation:
TheVetScanVSproisintendedforveterinaryuseonly.AbaxisandVetScanareregisteredtrademarksofAbaxis,Inc.©Abaxis2018
GLOBAL DIAGNOSTICS
888-2002Rev.D
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