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Coagulation Laboratories

In Clinical Pathology, under the umbrella of Hematology, reside the disciplines of Hematology (blood cell counting and evaluation), Urinalysis, Body Fluid analysis (spinal, serous, synovial, and any other body fluid), as well as Blood Coagulation. 

Clinical Coagulation assesses hemostatic conditions associated with bleeding or thrombosis. Patient workups utilize platelet counts performed on automated Hematology instrumentation and analysis of coagulation and other hemostatic factors, platelet activity, and anticoagulant monitoring. At Loyola, coagulation testing is performed in both the Core Laboratory and in the Specials Coagulation Laboratory. Technologies employed include the traditional clot-based assays (plasma and whole blood), as well as chromogenic assays, immunoassays, and platelet function tests. Automated instrumentation and semi-manual techniques are used. 

The general, high volume screening tests with a fast turnaround time performed in the Core Laboratory include the coagulation factor screening PT and APTT tests. Quantitative fibrinogen, D-dimer, and fibrin split product (FSP) tests are also performed. The kinetics of whole blood clotting is assessed in real time using the viscoelastic properties of thromboelastometry on the ROTEM (a second analyzer is located in the OR for direct observation during surgical procedures). Therapeutic levels of warfarin are determined by the PT/INR (the outpatient Anticoagulation Clinic utilizes a parallel system to determine INR at the point-of-care). Therapeutic heparin levels are determined by the APTT and/or the anti-FXa heparin assay, which is also able to quantitate levels of low molecular weight heparin. The immunoassay that detects the antibody responsible for heparin-induced thrombocytopenia (HIT) is performed in this laboratory.

More challenging coagulation tests, where test performance and result interpretation require extra skill and time, are performed in the Special Coagulation Laboratory. Diagnostic tests performed here include quantitative assays for coagulation factors, antithrombin, and protein C. Genetic testing for FV Leiden and the prothrombin mutation are performed in the Molecular Laboratory. A comprehensive testing algorithm is followed to diagnose lupus anticoagulant. Coagulation factor inhibitors are identified and quantitated. Platelet function is assessed by platelet aggregation profiling and the VerifyNow test that assesses antiplatelet therapeutic efficacy. A platelet aggregation assay to diagnose HIT is also performed.

The Clinical Coagulation Laboratories have maintained their high standard of patient care support for over 40 years. The Medical Director brings national and international expertise and recognition to this laboratory in keeping with state-of-the-art diagnostic assays, technologies, and therapeutic drug assessments. Expertise among the technical specialists and highly trained staff members is an essential component of this operation. Clinical consultations are often a team approach linking Clinical Coagulation with Transfusion Medicine and Hematopathology. Requests for hemostatic tests not performed in the Loyola Clinical Laboratories are sent to a reputable reference lab with assistance from the staff as needed.