Pitfalls in Coagulation Testing

Area of Science:

• Clinical Chemistry
• Hematology
• Laboratory Medicine

Background:

• Coagulation assays are susceptible to numerous variables that can compromise test accuracy.
• Inaccurate results can lead to significant consequences for clinical decision-making, including diagnostic and therapeutic strategies.
• Understanding potential interferences is vital for reliable laboratory diagnostics.

Purpose of the Study:

• To highlight the impact of various interferences on coagulation laboratory assays.
• To educate clinicians and laboratory professionals on common pitfalls in coagulation testing.
• To emphasize the importance of recognizing and mitigating pre-analytical and analytical interferences.

Main Methods:

• Review of seven instructive cases involving (near) miss events in coagulation testing.
• Categorization of interferences into biological, physical, and chemical groups.
• Discussion of how specific variables affect coagulation test outcomes.

Main Results:

• Biological interferences involve actual impairments of the patient's coagulation system (congenital or acquired).
• Physical interferences typically arise during the pre-analytical phase of sample handling.
• Chemical interferences are often caused by the presence of drugs, particularly anticoagulants, in the blood sample.
• Case studies illustrate the practical implications of these interferences.

Conclusions:

• Awareness of biological, physical, and chemical interferences is essential for accurate coagulation testing.
• Proper sample handling and knowledge of patient medication are critical to avoid pre-analytical errors.
• Addressing these interferences improves the reliability of laboratory results and patient care.