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Biomedical subjects

L Poller

Publications and source records attributed to L Poller.

At least 91 records · Page 5Linked to original sources
PubMed1985

Questions and answers on prothrombin time standardisation in oral anticoagulant control.

One of the reasons why oral anticoagulants fell into disrepute is the absence of internationally accepted standardised procedures for controlling the level of anticoagulation. This deplorable situation resulted in over- and under-coagulation and uncertainty in the therapeutic range. International conformity can now be obtained by using an International Normalised Ratio (INR) which is derived from the individual result obtained in a given plasma sample and the International Sensitivity Index (ISI) of the tissue thromboplastin reagent used. Any thromboplastin reagent can be calibrated against an international primary or secondary W. H. O. reference preparation, so as to obtain its International Sensitivity Index. The new system of reporting the level of anticoagulation was designed and can only safely be applied in patients taking oral anticoagulants.

Administration, Oral↗
PubMed1984

The calibration of the second primary international reference preparation for thromboplastin (thromboplastin, human, plain, coded BCT/253).

An international collaborative exercise has been undertaken to calibrate a replacement for the first WHO primary international reference preparation (IRP) for thromboplastin. The replacement preparation is a lyophilised batch of British Comparative Thromboplastin (BCT/253, human plain) for use in the Quick prothrombin time test. Seventeen centres participated. The experimental design, calibration model and statistical analysis were based on the recommended WHO procedure. As a result of this calibration exercise an International Sensitivity Index (ISI) of 1.1 has been assigned to the preparation by WHO and it has been officially recognised as the second primary IRP for thromboplastin. The calibration of BCT/253 is an essential link in a new hierarchical structure for the standardisation of the prothrombin time. The aim is to provide a uniform international system of reporting prothrombin time results using International Normalised Ratios (INR) derived from the ISI of individual thromboplastins.

Humans↗
PubMed1984

The diagnosis of lupus anticoagulants by the activated partial thromboplastin time--the central role of phosphatidyl serine.

Liposomes of pure phospholipids were used in a modified APTT test system and the role of phosphatidyl serine (PS) in determining the sensitivity of the test system to the presence of lupus anticoagulants was assessed. Six consecutive patients with lupus anticoagulants and seven haemophiliacs with anticoagulants directed at specific coagulation factors, were studied. Increasing the concentration of phospholipid in the test system markedly reduced the sensitivity to lupus anticoagulants but had marginal effect on the specific factor inhibitors. The same effect was achieved when the content of PS alone was increased in a vehicle liposome of constant composition. The results suggest that the lupus anticoagulants can best be detected by a screening method using an APTT test with a reagent of low PS content. The use of a reagent rich in PS will largely abolish the lupus anticoagulant's effect on the APTT. An approach using the two different types of reagent may facilitate differentiation of lupus inhibitors from other types of anticoagulant.

Adult↗
PubMed1984

The bleeding time: current practice in the UK.

A questionnaire survey of current practice in the bleeding time test has been undertaken by the UK External Quality Assessment Scheme in blood coagulation. Completed returns have been received from 358 centres. Most centres (88.5%) perform bleeding times and of these the Ivy test is the most commonly performed. Only 13.6% perform the Duke method. Templates are used to control the procedure by approximately half of the hospitals. There is considerable variability in the type and depth of incision and interpretation of the endpoint. The upper limit of normality not unexpectedly differs considerably between the centres with both Ivy and Duke methods. The use of a commercial template method, 'Simplate', provides a measure of agreement amongst the group of hospitals using this instrument but it remains to be established whether this is the most reliable procedure. In the interim, gross discrepancies in technique or interpretation should be corrected in the light of the findings of the survey.

Bleeding Time↗
PubMed1983

Lipid class composition and heparin sensitivity in the activated partial thromboplastin time.

In an APTT reagent, prepared from purified lipids, the role of phosphatidyl serine (PS) in determining the sensitivity of the APTT test system to measurement of the effect of heparin in plasma has been evaluated. As the concentration of PS decreases sensitivity to heparin increases but procoagulant activity decreases. Dilution of the test liposome over a wide range (1 g/l to 30 mg/l) had a minimal effect on the clotting time. At levels below 30 mg/l, however, the amount of total lipid appeared to be rate limiting; a loss of procoagulant activity being paralleled by an increase in heparin sensitivity. Phosphatidyl inositol (PI) was not a satisfactory substitute for PS in the APTT method studied. The degree of unsaturation of test liposomes appeared to have no effect on either procoagulant activity or sensitivity to heparin at the lipid concentration employed. In the light of these findings, a more critical appraisal of the phospholipid components of APTT reagents should facilitate the development of more reliable reagents for heparin control. A further benefit of this type of approach should be a reduction in the acknowledged wide variations in sensitivity to heparin which exist between available APTT reagents.

Blood Coagulation Tests↗
PubMed1982

The procoagulant activity of partial thromboplastin extracts: the role of phosphatidyl serine.

The role of phosphatidyl serine (PS) in the procoagulant activity of the APTT test has been studied further, using extracts of improved purity derived from a combination of high performance liquid chromatography and thin layer chromatography. The central role of PS in the APTT has been confirmed but the anticoagulant effect described in our previous report has been localised to contamination with phosphatidyl inositol (PI). A comparatively weak procoagulant activity was detected in purified PI- and lyso PS-containing liposomes and the former had an inhibitory action in mixtures diluted to less than 1 microgram/litre. This was enhanced by the presence of PS in combination experiments. Some correlation was noted between the degree of unsaturation of test liposomes and their procoagulant activity. The observations suggest that PS has a precise and unique role in the procoagulant activity expressed in this test system. PS possesses a strong negative charge and has two fatty acid groups. Other negatively charged phospholipids in this test system were less active. It appears, therefore, that the packing of PS into the lipid bilayer, which depends upon the length and degree of unsaturation of its fatty acid groups, is of considerable importance in establishing the surface topography essential for optimal procoagulant activity. Knowledge of the role played by various phospholipids in the procoagulant activity of the APTT reagent should enable improved standardisation and quality control in the future.

Blood Coagulation↗
PubMed1982

An evaluation of APTT monitoring of low-dose heparin dosage in hip surgery.

The activated partial thromboplastin time has been used to monitor the effects of low-dose subcutaneous heparin in two groups of patients undergoing hip surgery. The study was performed to determine the degree of anticoagulation required to protect these high-risk patients from post-operative deep vein thrombosis. The patients were randomised to receive a fixed regimen of subcutaneous calcium heparin (5,000 units eight-hourly) or a dose of calcium heparin monitored by maintaining the standardised APTT at 50 secs. In the adjusted group the APTT achieved the target figure in 46% of observations compared to 27% in the fixed group (p less than 0.005). Nine patients showed positive 125I-fibrinogen scans and in all, the APTT was below the target value the day before the scan became positive. In contrast, in six of the nine thrombotic patients heparin was detected by antifactor Xa clotting assay. The APTT, therefore, appears to give a better guide to the antithrombotic effect of heparin than the antifactor Xa clotting assay. These preliminary observations suggest that prolonging the standardised APTT method to just above 50 secs improves prophylaxis in high-risk cases. Furthermore, an increased dose of heparin is required than is proved during the conventional low-dose regime of 5,000 units tds. With regular control using the standardised APTT, increasing the dose to the target value does not increase post-operative haemorrhage. Further studies with larger numbers of patients are required in order to show a significant reduction in the incidence of post-operative deep vein thrombosis in hip surgery patients receiving low-dose adjusted heparin.

Adult↗
PubMed1982

Dosage and control of oral anticoagulants: an international collaborative survey.

An international survey of oral anticoagulant dosage has been carried out comparing the mean dosage prescribed in hospitals in 23 countries. In addition, participants using the Quick prothrombin time test were asked to assess the adequacy of dosage of a lyophilized test plasma which was mid-therapeutic using the British Comparative Thromboplastin (BCT). The overall mean dosage proved similar for the groups of laboratories using the Quick test and human brain thromboplastin and Thrombotest although wide differences existed between individual centres. The survey indicated that these discrepancies were due partly to the adoption of different intensities of anticoagulation. In addition, local differences in patients' response to anticoagulants were apparent, e.g. North American centres prescribed a higher mean dose with a more intense therapeutic range than Europeans. Hong Kong physicians appear to prescribe a much lower dose than the rest of the world although the intensity of their treatment is comparable, whereas South African hospitals give moderate doses of warfarin despite a conservative therapeutic range. Such geographical variation in response would invalidate standardization of anticoagulant treatment based on the mean dosage approach.

Administration, Oral↗