Emerging technologies and quality assurance in hemostasis: a review of findings from the Royal College of Pathologists of Australasia Quality Assurance Program.
Regular multilaboratory surveys of laboratories by the Royal College of Pathologists of Australasia Quality Assurance Program (QAP) have been conducted to assess proficiency in tests of hemostasis for the last 40 years. This article focuses primarily on specialized assays of hemostasis, for which surveys have been conducted for some 10 years. For von Willebrand disease (vWD) evaluations, a total of 47 plasma samples have been dispatched to survey participants, including representative samples from normal individuals plus all of the major vWD subtypes (i.e., types 1, 2A, 2B, 2M, 2N, and 3). These surveys have focused partly on the issue of diagnostic interpretive error rates associated with different assays and test panels. In this context, considerable improvement is seen when laboratories incorporate the vWF:collagen-binding assay into the test panel. Thrombophilia-associated tests assessed by the program and discussed in this review include activated protein c resistance, lupus anticoagulant, and deficiencies of protein C, protein S, and antithrombin. Other tests briefly reviewed here include factor assays and inhibitors, D-dimer, and heparin/anti-Xa assays. Anticardiolipin antibody and anti-beta(2)-glycoprotein I antibody (aB(2)GPI) testing, assessed by the Immunology QAP, is also reviewed briefly, as are genetic tests associated with thrombophilic markers such as factor V Leiden and the prothrombin gene.
Favaloro
Emmanuel J
EJ
Department of Haematology, RCPA Quality Assurance Program, Institute of Clinical Pathology and Medical Research, Westmead Hospital, New South Wales, Australia. emmanuel@icpmr.wsahs.nsw.gov.au
Bonar
Roslyn
R
D020016:Activated Protein C Resistance / Q000175:diagnosis; D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000096:biosynthesis; D044362:Australasia; D002624:Chemistry, Clinical / Q000379:methods* / Q000639:trends*; D006487:Hemostasis; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000096:biosynthesis; D020151:Protein C Deficiency / Q000175:diagnosis; D018455:Protein S Deficiency / Q000175:diagnosis; D011516:Prothrombin / Q000096:biosynthesis; D011786:Quality Control; D016896:Treatment Outcome; D014842:von Willebrand Diseases / Q000175:diagnosis*; D014841:von Willebrand Factor
D000925:Anticoagulants; D000991:Antithrombins; D016682:Lupus Coagulation Inhibitor; D014841:von Willebrand Factor; D011516:Prothrombin