PubMed · 4687263
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H B Soloway. 1973-03-29. "Per cent prothrombin activity" unacceptable.. https://doi.org/10.1056/nejm197303292881316
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Coagulometer-induced errors in International Normalized Ratios (INR) may be corrected by assigning an International Sensitivity Index (ISI) specific for the local combination of coagulometer and thromboplastin reagent (System ISI). In the present study, 57 laboratories determined the INR of eight frozen coumarin plasmas. There was considerable variation in INR reported at the different centres, with coefficients of variation (CV) ranging from 11.30% to 17.29%. In addition, their consensus mean INR values were consistently higher than those obtained manually. The overall mean percentage deviation was 20.06%, indicating that correction was required to reduce the over-estimation of INR that occurred even in those Systems incorporating a thromboplastin reagent with an instrument-specific ISI. Local correction using coumarin plasma calibrants reduced this value to < or = 7% with current reference thromboplastins BCT 441, OBT 79 and RBT 90 and also lowered the CV to < 5%. In contrast, when adsorbed plasma calibrants were employed, mean percentage deviations were 7.87% with BCT 441, 12.47% with OBT 79 and 77.37% with RBT 90 as reference respectively. This difference may be due, in part, to the difficulty in assigning an INR to adsorbed plasma calibrants, which contain no protein induced by vitamin K antagonists (PIVKA). This study demonstrates that coumarin plasma calibrants are superior in System ISI calibration.
The current practice standard for coagulation studies on venous blood specifies the use of the second (or subsequent) tube for testing. Unless other tests are ordered, the first tube is discarded. This practice, derived from early experience using nondisposable materials, gained support from a report based on modern phlebotomy methods but inexperienced phlebotomists. For our study, paired blood specimens were collected by experienced phlebotomists from 175 outpatients whose physicians had ordered coagulation tests. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were performed on the first and second tubes. Similar values were obtained for PT and APTT. (PT: n = 174; mean = 15.36 seconds; mean difference = 0.10 seconds; y = 1.02x - 0.28; t = 0.24; P>.81; r = 0.995; APTT: n = 160; mean = 38.25 seconds; mean difference = 0.48 seconds; y = 1.03x - 0.71; t = 0.25; P=.80; r = 0.993.) For coagulation tests on specimens collected by experienced phlebotomists, the first tube yields accurate results and need not be discarded.
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