HAEMOSTASIS


controlled study in cytoreductive surgery for pseudomyxoma peritonei. J Thromb Haemost. 2020; 18 (2): 352–63. doi: 10.1111/jth.14665.


3 2013/14 NHS standard contract for pseudomyxoma peritonei service (adult) A08/S(HSS)/b (www.england.nhs.uk/ wpcontent/uploads/2013/06/a08-pseud- peri-ad.pdf).


4 Smeenk RM, van Velthuysen ML, Verwaal VJ, Zoetmulder FA. Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol 2008; 34 (2): 196–201. doi: 10.1016/j.ejso.2007.04.002.


5 National Institute for Health and Clinical Excellence. Complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique). London: NICE, 2004 (www. nice.org.uk/guidance/ipg56).


6 Sugarbaker PH. Surgical treatment of peritoneal carcinomatosis: 1988 Du Pont lecture. Can J Surg 1989; 32 (3): 164–70.


Four phases of thrombin production.


balanced for sensitivity to procoagulant and anticoagulant protein deficiencies, with calibration needed only once a day.13 Unlike the CAT assay, the Stago analyser is able to deliver a standardised result, with a low coefficient of variation (CV) for reproducibility and repeatability. It provides reference plasma to reduce laboratory variability as well as the variability between different measurement runs.


Particular attention in its development was given to temperature control, which is important for accurate TG measurement.10 Significantly, the pre-analytical stage makes it possible to work directly on normal citrated platelet-poor plasma (PPP) samples, without the need for additives such as corn trypsin inhibitor. It also offers complete traceability and up to three quality control (QC) levels for genuine quality management, with a reference plasma included for normalising results. Outside the immediate realm of


research, and to expand its usefulness to the clinical laboratory, Stago has developed a range of associated reagents: three triggers to explore different aspects of haemostasis through TG – the STG-DrugScreen, STG- BleedScreen and STG-ThromboScreen, which includes an assessment of the effect of thrombomodulin.


Expanded role for ST Genesia Predicting the risk of bleeding and thromboembolic disorders remains a major health issue. Being able to measure


21


thrombin over the whole haemostatic process would provide valuable insight into the mechanisms behind both pro- coagulant and regulatory pathways. As understanding of its importance grows, so does the wider clinical usefulness of Stago’s ST Genesia.


Prior to being selected for the peritoneal cancer study, TG and ST Genesia had featured in another clinical trial looking at the underlying mechanisms of cancer-associated hypercoagulability and early recurrence of breast cancer. Successfully using TG testing to


measure the coagulation profile of patients undergoing surgery and so predict their bleeding risk could lead to major improvements in managing intraoperative bleeding for those suffering with peritoneal cancer. Collectively, selecting ST Genesia for these clinical studies shows the value placed on standardised results and greater reproducibility. In turn it provides more evidence of the benefit of thrombin generation testing for assessing coagulation status, whether in the routine laboratory or as part of clinical research.


References 1 Hampshire Hospitals NHS Foundation


Trust. Peritoneal malignancy (www. hampshirehospitals.nhs.uk/our-services/ az-departments-and-specialties/peritoneal- malignancy).


2 Roy A, Stanford S Nunn s et al. Efficacy of fibrinogen concentrate in major abdominal surgery – A prospective, randomized,


7 Sugarbaker PH, Kern K, Lack E. Malignant pseudomyxoma peritonei of colonic origin. Natural history and presentation of a curative approach to treatment. Dis Colon Rectum 1987; 30 (10): 772–9. doi: 10.1007/ BF02554625.


8 Pott A. Peritoneal cancer – long-term survival with good quality of life. BIOPRO Baden-Württemberg (www. gesundheitsindustrie-bw.de/en/article/ news/peritoneal-cancer-long-term-survival- with-good-quality-of-life).


9 Tripodi A. Thrombin generation: a global coagulation procedure to investigate hypo- and hyper-coagulability. Haematologica 2020; 105 (9): 2196–9. doi: 10.3324/ haematol.2020.253047.


10 Mann KG, Brummel K, Butenas S. What is all that thrombin for?. J Thromb Haemost 2003; 1 (7): 1504–14. doi: 10.1046/j.1538-7836.2003.00298.x.


11 Macfarlane RG, Biggs R. A thrombin generation test; the application in haemophilia and thrombocytopenia. J Clin Pathol 1953; 6 (1): 3–7. doi: 10.1136/ jcp.6.1.3.


12 Hemker HC, Wielders S, Kessels H, Beguin S. Continuous registration of thrombin generation in plasma, its use for the determination of the thrombin potential. Thromb Haemost. 1993; 70 (4): 617–24.


13 Stago UK. Thrombin Generation now available in laboratories (www.stago.com/ products-services/new-products/detail/ article/thrombin-generation-now-available- in-laboratories/).


Further information is available from: Diagnostica Stago UK Theale Lakes Business Park 12 Moulden Way, Sulhamstead Reading RG7 4GB Tel: +44 (0)845 054 0614 Web: www.stago-uk.com


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