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Published on: October 12, 2012
Comparative sensitivity of commercially available aPTT reagents to mulga snake (Pseudechis australis) venom
Lisa F Lincz1, Fiona E Scorgie, Christopher I Johnston
11Hunter Haematology Research Group, Calvary Mater Newcastle Hospital, Newcastle, NSW 2Faculty of Health, University of Newcastle, NSW 3School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, NSW 4NSW Poisons Information Centre, Sydney Children's Hospital Network, NSW 5Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle Hospital, Newcastle, NSW 6Haematology Unit, Royal Hobart Hospital, Hobart, Tas 7Diagnostic Haemostasis Laboratory, Haematology, ICPMR, Westmead Hospital, Westmead, NSW, Australia.
Abstract:
This study aimed to determine the relative sensitivity of activated partial thromboplastin time (aPTT) reagents to the anticoagulant effects of phospholipases in mulga snake (Pseudechis australis) venom.Twenty-one haematology laboratories participating in the Royal College of Pathologists of Australasia Quality Assurance Programs were sent human plasma samples spiked with mulga venom (n=25 total results). Results for 17 patients with mulga snake envenoming were available through the Australian Snakebite Project.Only 12 of 25 venom spiked samples returned an abnormally prolonged aPTT. Tests performed with Dade Actin FS (n=7) did not identify any of the spiked samples as abnormal. Although clotting times were significantly prolonged using the lupus anticoagulant sensitive Actin FSL (n=5, p=0.043), only one was reported as abnormal. Only laboratories using TriniCLOT aPTT S (n=6), HemosIL APTT SP (n=2) and Stago PTT-A (n=1) consistently recorded the spiked sample as being above the upper normal reference interval. Abnormally prolonged aPTTs were recorded for four of eight patients whose tests were performed with Actin FSL, five of eight patients with TriniCLOT aPTT HS, and three of three patients using TriniCLOT aPTT S.We conclude that some reagents used for routine aPTT testing are relatively insensitive to the anticoagulant effects of mulga snake venom. Tests performed with these reagents should be interpreted with caution.
