External quality assessment scheme for blood coagulation

Area of Science:

• Clinical Pathology
• Laboratory Medicine
• Hematology

Background:

• Harmonization of blood coagulation testing is crucial for accurate patient diagnosis and treatment.
• External Quality Assessment Schemes (EQAS) play a vital role in achieving laboratory standardization.
• Limited participation in current Indonesian EQAS for blood coagulation highlights a need for broader engagement.

Purpose of the Study:

• To assess the harmonization of blood coagulation test results among Indonesian laboratories through the first EQAS trial.
• To evaluate the performance of different reagent brands used in coagulation testing.
• To identify areas for improvement in blood coagulation testing quality across participating institutions.

Main Methods:

• An EQAS for blood coagulation was organized in Indonesia, involving 65 laboratories.
• Control materials from Organon Teknika were used for Prothrombin Time (PT), International Normalized Ratio (INR), Activated Partial Thromboplastin Time (APTT), and fibrinogen testing.
• Participant results were compared against median values, stratified by reagent brand or overall median, with consensus defined as median +/- 15%.

Main Results:

• Overall, 63-68% of participants achieved consensus for PT, INR, APTT, and fibrinogen.
• Coefficient of Variation (CV) for these parameters ranged from 17.89% to 23.96%, indicating wide variations.
• Laboratories using Behring reagents showed higher consensus (54-82%) than Organon users (48-90%) for specific parameters, with notable discrepancies in APTT and INR.

Conclusions:

• Approximately two-thirds of participating laboratories demonstrated harmonization in blood coagulation test results.
• Significant variations in PT, INR, APTT, and fibrinogen testing persist, necessitating further quality improvement initiatives.
• EQAS is essential for enhancing the reliability and comparability of coagulation testing across Indonesian laboratories.