To: Chiefs of Service, Attending Physicians, Housestaff, Nurses and Other Concerned Personnel

Memorandum

May 3, 2007

To: Chiefs of Service, Attending Physicians, Housestaff, Nurses and Other Concerned Personnel

From: Eberhard Fiebig, MD

Director, SFGH Clinical Laboratory

Re: Lab Alert: New coagulation instrument and reagents, effective May 22, 2007

Effective 5/22/07, the Clinical Laboratory will be using a new coagulation instrument (STAGO Compact, Diagnostica STAGO, Pasippany, NJ) and reagents for PT/INR, PTT, Fibrinogen and Factor VIII, IX and XI assays performed in-house.

Please be advised of the following changes:

·  Minor adjustments in PT/INR and PTT ranges and critical values (see table below for details).

·  Greater sensitivity of the new PTT reagent for heparin, resulting in upward shift of the therapeutic range for unfractionated heparin (“heparin drip”) from 60-80 to

75-108 secs (corresponding to 0.3 - 0.7 units/mL heparin by anti-Xa assay). A revised Heparin Order form reflecting the new therapeutic range will be available on the CHN website for use effective 5/22/07.

·  Increased sensitivity of the new PTT reagent to factor deficiencies and inhibitors resulting in higher PTT values above the reference range.

PT (sec) / INR / PTT (sec) / Fibrinogen (mg/dL)
Reference Range / 14.8 / 1.2 / 37.6 / 170-440 - no change
Reportable Range / 10.0-100.0 / 0.7-12.6 / 17.0-200.0 / 38-1200
Heparin Therapeutic Range / n/a / n/a / 75.0-108.0 / n/a
Critical Value / 47.4 / 4.9 / 68.9 / 75

Recommendations for INR target ranges for warfarin therapy and transfusion thresholds for FFP (see SFGH Transfusion Guidelines) are not affected.

For questions or comments, please call Dr. Fiebig (206-8588), or the Laboratory Medicine Resident in Hematology (pager 997-9952).

Thank you.