FOCUS ON HAEMOSTASIS The second Quantra cartridge, the


QPlus, offers clot times with and without heparinase (CT and CTH), CS and FCS. From these, two unique parameters are automatically calculated: the clot time ratio (CTR) and platelet contribution to clot stiffness (PCS). The PCS accounts for the platelet count and platelets’ ability to aggregate, contract and contribute to clot strengthening.12


Improving bleeding management Point-of-care VET testing has a potentially life-saving role to play when PPH blood loss reaches 1000 mL – indicating if early intervention with fibrinogen replacement would be of value, while also providing data on the patient’s coagulation status. Greater awareness of the role of fibrinogen parameters can support actual measurement of blood loss rather than relying on estimated loss while waiting for laboratory tests to be processed. This in turn can reduce clinical anxiety13 when faced with increasing PPH, with previously little choice but to administer blood products.


Acute perioperative situations demand fast action on whether or not to transfuse critically bleeding patients. Confidence in the Quantra algorithm and the precision of its parameters enables informed clinical decision-making based on laboratory comparable results with a turnaround time for urgent results of under 15 minutes.


References 1 World Health Organization. WHO


recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO, 2012 (https://apps.who. int/iris/bitstream/handle/10665/75411/97? sequence=1).


2 Collis RE, Kenyon C, Roberts TCD, McNamara H. When does obstetrics coagulopathy occur and how do I manage it? Int J Obstet Anesth 2021; 46:102979. doi: 10.1016/j.ijoa.2021.102979.


3 Diagnostica Stago. Novel POCT transforms transfusion decision-making In the cardiac theatre. Pathology in Practice 2019 Oct; 20 (5): 15–8 (www. pathologyinpractice.com/story/31112/ novel-poct-transforms-transfusion- decision-making-in-the-cardiac-theatre).


The Quantra QStat cartridge.


4 Baryshnikova K, Di Dedda U, Ranucci M. A comparative study of SEER sonorheometry versus standard coagulation tests, rotational thromboelastometry, and multiple electrode aggregometry in cardiac surgery. J Cardiothorac Vasc Anesth 2019; 33 (6):1590–8. doi: 10.1053/j. jvca.2019.01.011.


5 Charbit B, Mandelbrot L, Samain E et al.; PPH Study Group. The decrease of fibrinogen is an early predictor of the severity of postpartum haemorrhage. J Thromb Haemost 2007; 5: 266–73. doi: 10.1111/j.1538-7836.2007.02297.x.


6 Cortet M, Deneux-Tharaux C, Dupont C et al. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth 2012; 108 (6): 984–9. doi: 10.1093/bja/aes096.


7 Collins PW, Bell SF, de Lloyd L, Collis RE. Management of postpartum haemorrhage: from research into practice, a narrative review of the literature and the Cardiff experience. Int J Obstet Anesth 2019; 37: 106–17. doi: 10.1016/j.ijoa.2018.08.008.


8 Bell SF, Kitchen T, John M et al. Designing and implementing an all Wales postpartum haemorrhage quality improvement project: OBS Cymru (the Obstetric Bleeding Strategy for Wales). BMJ Open Quality 2020; 9 (2): e000854. doi:10.1136/ bmjoq-2019-000854


9 Royal College of Obstetricians and


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


40


Gynaecologists. Post haemorrhage, prevention and management, Green-top guideline No. 52. London: RCOG, 2016 (www.rcog.org.uk/guidance/browse- all-guidance/green-top-guidelines/ prevention-and-management-of- postpartum-haemorrhage-green-top- guideline-no-52/).


10 Collins PW, Cannings-John R, Bruynseels D et al. Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial. Br J Anaesth 2017; 119 (3): 411–21. doi: 10.1093/bja/aex181.


11 Leadbetter NH, Givens TB, Viola F. Unique approach to quality assurance in viscoelastic testing. J Appl Lab Med. 2020; 5 (6): 1228–41. doi: 10.1093/jalm/jfaa057.


12 Hemsonics White Paper. QPlus Platelet Contribution to Clot Stiffness. Principles of Design, Key Characteristics, and Clinical Utility (https://hemosonics.com/ wp-content/uploads/2021/08/WP-01-ALL- Rev.06102019_PCS-Whitepaper_WEB. pdf).


13 Elmissiry D. Implementation of POC sonorheometry testing in cardiothoracic surgery. NATA Symposium on Patient Blood Management, Haemostasis and Thrombosis (www.youtube.com/ watch?v=69lT8bp3pNA).


For more information visit www.quantrapocsolution.com or email pocsolutions@uk.stago.com


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


AUGUST 2022 WWW.PATHOLOGYINPRACTICE.COM


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