Descarga: Problems and Solutions in Laboratory Testing for Hemophilia
Archivo: tromboembolia-venosa/tvp/STH 2013 Problems and Solutions Lab testing.pdf
A diagnosis of hemophilia A or hemophilia B begins with clinical assessment of the patientandisfacilitatedbylaboratorytesting.Theinfluenceofthelatteronadiagnosis ofhemophiliaAorhemophiliaBisclear—adiagnosiscannotbemadewithoutlaboratory confirmation of a deficiency of factor FVIII (FVIII) or factor IX (FIX), respectively. Moreover, the degree of hemophilia severity is specifically characterized by laboratory testresults.Inturn,patientmanagement,includingchoiceandapplicationoftherapies, isinfluenced by the diagnosis, as well as by identification of respective disease severity. An incorrect diagnosis may lead to inappropriate management and unnecessary therapy, and thus to adverse outcomes. Moreover, identification of factor inhibitors in hemophilia will lead to additional and differential treatments, and incorrect identification of inhibitors or inhibitor levels may also lead to inappropriate management. Problems in hemophilia diagnosis or inhibitor detection can occur at any stage in the clinicaldiagnosis/laboratoryinterface,fromthe“pre-preanalytical”to“preanalytical”to “analytical” to “postanalytical” to“post-postanalytical.” Thisreportoutlinesthevarious problems in laboratory testing for hemophilia and provides various strategies or solutions to overcome these challenges. Although some outlined solutions are specific to the potential errors related to hemophilia, others are general in nature and can be applied to other areas of laboratory hemostasis. Key to improvement in this area is adoption of best practice by all involved, including clinicians, phlebotomists, and laboratories. Also key is the recognition that such errors may occur, and thus that clinicians should assess laboratory test results in the context of their patient’s clinical history and follow-up any potential errors, thus avoid misdiagnoses, by requesting repeat testing on a fresh sample.
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