FOCUS ON HAEMOSTASIS
Viscoelastic POC testing helps to stem post-partum haemorrhage
Point-of-care testing has found application across the breadth of healthcare, a recent prime example being the role of viscoelastic POC testing in post- partum bleeding management in obstetrics.
The value of point-of-care (POC) coagulation testing using viscoelastic technology to address obstetric bleeding is leading to a new approach in managing post-partum haemorrhage (PPH), which is still the main cause of maternal death.1 It is recognised that PPH can be exacerbated by coagulopathy, with a
Clot formation Platelets Platelets
Control of bleeding vessels Uterine contraction
Clotting factors (thrombin)
FFP Platelet
aggregation Fibrin clot formation
Fibrinolysis
decline in fibrinogen levels known to be the first indicator of the condition. However, the clinical utility of laboratory fibrinogen testing to predict progression of PPH has always been limited because ‘time to results’ can be 60–90 minutes. Faced with PPH, this can be too long to wait. The bleed will either have stopped or results are retrospective, with the
clinician having relied on empirical transfusion ratios.
The ability to monitor fibrinogen and other parameters at the point of care within 10–15 minutes would enable surgeons to deliver early, targeted fibrinogen replacement that might stem the progression of PPH. It is equally important to be able to monitor and interpret other coagulation parameters at the same time, as research shows that replacing fibrinogen will not improve outcomes if these levels are normal.2
Quantra POCT delivers laboratory comparable results The specific role of viscoelastic testing (VET) at the point of care to carry out this measurement has come to the fore with clinicians now reviewing a role for this technology in PPH bleeding management.
Pharmacological Surgical/radiological
Quantra, Stago’s point-of-care VET solution, delivers laboratory comparable results within 15 minutes and is already being used by cardiac surgeons at New Cross Hospital.3,4
Pathology in Practice had previously highlighted, from the IBMS Congress in 2019, the original study carried out by the hospital’s core laboratory as part of its ISO15189 accreditation and to approve its use in surgery.
This is in line with the latest guidelines Fibrinogen Cryoprecipitate Fibrinogen concentrate Steps to halt obstetric bleeding. 38
from the Institute of Biomedical Science, which makes it clear that point-of-care testing (POCT) should be operated within “the framework of a clearly defined policy that recognises the essential role of laboratory trained personnel”.
Laboratory evaluation study The New Cross laboratory compared the precision of critical parameters (including fibrinogen) between the laboratory and point of care. The positive outcomes of
AUGUST 2022
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