| Evolution of hemostasis/thrombosis laboratory methods including laboratory automation (ELISA-->LIA, manual-->automated ADAMTS13, on-demand vs.batch testing, new von Willebrand assays) Rusty Higgins. |
Abstract
Laboratory Hemostasis has continued to evolve with new technologies. Labor-intensive or batched tests are becoming more automated and accessible. Platelet-dependent von Willebrand factor (vWF) activity methods and terminology have changed substantially, and newer methods are being recommended by international guidelines. Rapid ADAMTS13 activity may become available in the future, as the hemostasis laboratory industry incorporates chemiluminescence technology into automated instruments. The newer automated tests may alter our interpretation of the laboratory data, either due to improved performance or recognized biases/interferences. Additionally, the relatively recent incorporation of preanalytical modules for hemolysis, icterus, lipemia (HIL) into automated coagulation analyzers may help flag samples at risk for significant interference, and laboratories will need create workflows to address these risks. Data analysis is more important than ever, and the new instruments and middleware capabilities can improve workflow and throughput. Specific examples of middleware applications including autoverification of factor testing (i.e. with parallelism assessment) and lupus anticoagulant algorithms will be discussed briefly. Lastly, hemostasis analyzers are increasingly being attached to track-driven automation systems, either as modular hemostasis workcells or as a part of total laboratory automation. Each laboratory will need to address their risks and benefits of these systems. With total laboratory automation (i.e. including hemostasis analyzers with chemistry and immunochemistry), the centrifugation protocol to produce platelet poor plasma, is an important consideration. Other considerations for track systems, including test menu, space, and staff engagement, will be discussed.
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