Archives of pathology & laboratory medicine
-
Arch. Pathol. Lab. Med. · Apr 2011
The 2010 Haiti earthquake: a pathology perspective aboard the USNS Comfort.
The US Navy hospital ship USNS Comfort played an integral role in the initial phases of Operation Unified Response-Haiti following the devastating earthquake that struck near Port-Au-Prince, Haiti, on January 12, 2010. Deployed to Haiti from its home in Baltimore, Maryland, just 4 days after the earthquake, the USNS Comfort would become the region's primary tertiary casualty receiving center for 6 weeks. The pathology and laboratory department staff onboard the ship helped support the mission and experienced unique mass casualty/disaster relief scenarios while underway. This article reviews the accounts of the core laboratory, microbiology, anatomic pathology, and blood bank divisions on the USNS Comfort from the chaotic first few weeks to the final patient discharge 40 days after Operation Unified Response-Haiti began.
-
Arch. Pathol. Lab. Med. · Apr 2011
Comparative StudyEvaluation of first-draw whole blood, point-of-care cardiac markers in the context of the universal definition of myocardial infarction: a comparison of a multimarker panel to troponin alone and to testing in the central laboratory.
Previous studies evaluating point-of-care testing (POCT) for cardiac biomarkers did not use current recommendations for troponin cutoff values or recognize the recent universal definition of acute myocardial infarction. Traditionally, achieving optimal sensitivity for the detection of myocardial injury on initial presentation required combining cardiac troponin and/or creatine kinase isoenzyme MB with an early marker, usually myoglobin. In recent years, the performance of central laboratory combining cardiac troponin assays has improved significantly, potentially obviating the need for a multimarker panel to achieve optimum sensitivity. ⋯ Testing for combining cardiac troponin alone using newer, commercially available, central laboratory or POCT assays performed with equal or greater sensitivity to acute myocardial infarction as the older, traditional, multimarker panel. In the near future, high-sensitivity, central laboratory troponins will be available for routine clinical use. As a result, the quality gap between central laboratories and older POCT methods will continue to widen, unless the performance of the POCT methods is improved.
-
Arch. Pathol. Lab. Med. · Apr 2011
International normalized ratio versus plasma levels of coagulation factors in patients on vitamin K antagonist therapy.
The key question when managing patients on warfarin therapy who present with life-threatening bleeding is how to use the international normalized ratio (INR) to best direct corrective therapy. The corollary question for the clinical laboratory is at what level will the INR reflect a critical value that requires notifying the clinician. ⋯ Levels of factors II, VII, IX, and X declined with increasing INR but not at the same rate and not to the same level at a given INR. However, most of the values were below the hemostatic value once the INR was 3.6 or more, the level that was also considered critical for physician notification.