Hematology and Coagulation
CONTACT INFORMATION
Staffed 24 hours a day, 365 days a year
Director: William A. Dittman, Jr., MD
Test Menu
Specialized coagulation testing includes:
- Factor Activity Assays (II, V, VII, VIII, IX, X, XI, XII)
- Factor XIII Screen
- Factor VIII Inhibitor (Bethesda Units)
- Factor II, V, VII, IX, X, XI, XII Inhibitor Studies
- Lupus Inhibitor Screen (PNP, DRVVT)
- DIC Screen
- Heparin-Induced Thrombocytopenia
- Von Willebrand Factor Panel (Factor VIII, VWF Ag, Ristocetin Cofactor)
- Hypercoagulation Consultation, Basic
- Antithrombin Activity and Antigen
- Protein C Activity and Antigen
- Protein S Activity, Total and Free Protein S Antigen
- Activated Protein C Resistance
- Unfractionated Heparin Assays
- Low Molecular Weight Heparin Assays
Platelet Function Testing: (NOTE: Specimen stability limitations, see Spec requirements)
- Platelet Aggregation Studies (collagen, ADP, epinephrine, arachacid, ristocetin)
- Platelet Function Screen
Platelet Function Testing: (NOTE: Specimen stability limitations, see Spec requirements)
Molecular-based Coagulation Testing:
CONSULTATION:
Consultation is available in the laboratory diagnosis and management of patients with bleeding disorders and thrombosis.
HEMATOLOGY:
PAML’s Hematology Department offers a full spectrum of routine and special coagulation and thrombosis testing as well as consultation for both appropriate ordering of tests and interpretation of results.
We also offer a variety of specialized tests needed to investigate hematologic and immune disorders. Included are B and T cell subset studies, and leukemia/lymphoma phenotyping on mononuclear cells from peripheral blood, bone marrow, and lymph nodes in conjunction with the flow cytometry facility. Direct Platelet Antibodies, Fetal Hemoglobin F and PNH screens are also available. Special emphasis is placed on coagulation abnormalities, which are evaluated by referral or consultation.
Our fully automated lab, with 3 comprehensive analyzers, allows us to handle more than 1200 samples a day. We are the only coagulation reference lab in this region and one of the few nationally able to do qualitative platelet analysis with whole blood aggregation.
Results are reported with general comments on test interpretation, limitations specific interpretation and recommendations for further investigation and/or patient management - a unique service that is not usually available from reference laboratories.
COAGULATION & FLOW CYTOMETRY
New testing methodologies in the areas of special coagulation and flow cytometry have made the diagnosis and treatment of hematologic malignancies and other hematologic diseases much more accurate.
DIRPLT is one of the most recent autoimmune tests to be offered by PAML. Its purpose is to help evaluate immune contributions to thrombocytopenia. This test is used to detect antibodies bound to platelets (IgG and IgM), which are frequently seen in patients with primary autoimmune thrombocytopenia but may also be seen in thrombocytopenia secondary to medications or neoplasms. Having a high sensitivity, this test may be used adjunctively in the evaluation of patients suspected to have immune thrombocytopenia. The test is not usually limited by low platelet counts. Tests for serum IgG and IgM antibodies are also available through PAML.
Immunophenotyping is a flow cytometry test performed at PAML for detection of leukemias and lymphomas. Immunophenotyping is helpful or diagnostic because in many instances different kinds of benign and malignant hematopoietic cells resemble each other in routinely stained tissue sections and smears. When lymphoma is suspected, the technique helps to distinguish between malignant and benign lymphoid proliferations, between B- and T-cell processes, and between sub-categories of B- and T-cell lymphomas. Immunophenotyping is especially helpful in evaluating tissue and marrow samples, and lymphocytosis in peripheral blood.
PAML offers a quantitative reverse transcriptase PCR assay for BCR/ABL fusion gene, which is present in chronic myelogenous leukemia and some cases of acute lymphoblastic leukemia. By performing this assay on serial blood or bone marrow specimens, the quantitative results can be followed over time to determine whether the number of leukemic cells is increasing or decreasing. If the quantitative BCR/ABL test is negative, and if it is clinically indicated and requested, we can perform the qualitative BCR/ABL test, which we find to be slightly more sensitive than the quantitative test.
Although not a new test, flow cytometry evaluation of cellular expression of glycosyl-phosphoinositol linked proteins is the current gold standard for diagnosis of the protein disorder, paroxysmal nocturnal hemoglobinuria (PNH). Appropriate diagnosis has gained importance with the recent clinical introduction of eculizumab, an antibody that appears to improve symptoms related to PNH.
PAML recently introduced the fetal RBC quantification by flow, a method that is much more accurate than the previously used Kleihauer Betke stain. In local institutions this has essentially replaced the KB stain, and with appropriate use of anti Rh immunoglobulin may also be used by more distant clients. We continue to offer quantification of lymphocyte subsets and HLA b27 determination.
PAML has also added an aspirin sensitivity test to our extensive coagulation menu with the addition of AspirinWorks testing. Differing patient sensitivity to aspirin appears to be a significant clinical issue, and the only current test for aspirin sensitivity that does not require patients to be in proximity to the testing site is the urine-based AspirinWorks test.