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.

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.