vspro coagulation utilization guide abx-00069 r1 · vspro pt/aptt combination test coagulation...
TRANSCRIPT
-
UtilizationGuide
VSpro
-
VSproPT/aPTTCombinationTest
Coagulationtestingincludestheevaluationofbothprothrombintime(PT)andactivatedpartialthromboplastintime(aPTT).Testingdeterminesifasignificantcoagulationfactordeficiencyexists,andifso,whichfactor(s)areaffected.PTisusedtoevaluatetheextrinsicandcommonpathways,whileaPTTisusedtoevaluatetheintrinsicandcommonpathways.
TheVETSCANVSpromakespoint-of-carecoagulationtestingeasy,fast,andaffordable.ImmediatePTandaPTTtestresultsoffernumerousclinicalbenefitsforveterinarypatientsandfinancialbenefitsfortheveterinarypractice.
TheVETSCANVSproPTandaPTTCombinationTestisusedinconjunctionwiththeVSproAnalyzerforfast,convenient,andcost-effectivepoint-of-care coagulationtesting.ThistestcartridgeprovidesquantitativedeterminationofPTandaPTTsimultaneouslyfrom100µLofcitratedcanineorfelinewholeblood.
Cartridge Storage:Refrigerateat2°Cto8°C(39°Fto46°F)
Cartridge Stability: Donotexposecartridgesinthefoilpouchtodirectsunlight,anddonotleavethem atroomtemperature(15-30°C,59-86°F)formorethan3hours.
Usecartridgeswithin10minutesofremovingfrompouch.
Quick Reference Guide
Test/Species
PT
aPTTaPTT
Reference Ranges (seconds): Dynamic Ranges (seconds):1
Feline2
15-21
86-137
Canine1
14-19
75-105
11-35
30-200
Sample well for adding 100 µL citrated whole
blood
Opticaldetectionwindows
Microfluidictechnology
-
Sample Preparation
Precautions before blood sample collection:
• Aswithanybloodtest,theaccuracyisdependentonthequalityofthebloodsample.Poorsamplequalityiscausedbyimpropercollectionandhandlingtechniques.
• Collectblooddirectlyfromthelargestaccessiblevein.
•Contaminationfromthromboplastin,alcohol,andintravenoussolutionswillinterferewiththecoagulationassay.3,4
• Hemolyzedsamplescanleadtotestingerrorsandinconclusiveresults.
•Thesodiumcitratetubemustbefilledcompletelyforaccurateresults.5
Fillanevacuatedsodiumcitratetubetothe“fill line”withwholeblood.Thebloodisdrawnintothetubeuntiltheflowstops.Forbloodcollectedintoaregularsyringe,theneedleshouldberemovedpriortogentlydispensingbloodintothetube.Ifnofilllineisseen,filltubetotopoflabel.NOTE:Under-filled or over-filled citrate tubes may alter results due to the improper anticoagulant to sample ratio, most commonly resulting in a falsely prolonged aPTT.
Fillline
1
2 Gentlyinvertthesodiumcitratetubeatleast10timesimmediatelyafterfillingtoensureagoodmixturewiththeanticoagulant.Letthesamplesitfor5minutesbeforetestingtostabilizethemixtureofbloodandcitrate.Ifthetestisdelayed,continuetoinvertevery10minutespriortothetest.Abloodrockermaybeused.NOTE:Blood may be tested up to two hours after it has been properly collected without affecting the test result.
-
Test Procedure
PT: seconds
aPTT: seconds
740-7021 Rev. B
Normal Range:
Species PTsecondsaPTT
seconds
Dog 14 - 19 75 - 105
Cat 15 - 21 86 - 137
ResultsSticker
###-###-###
RemovethePTandaPTTCombinationTestCartridgefromtherefrigeratorandopenthepouch.Touchthe“Analyze”buttonintheHomemenuscreentostartthetest.
Insertanewtestcartridgewhenthemessage “Please insert new cartridge”isdisplayedonthescreen.
Enterthe9-digit cartridge code locatedonthepouchlabelandtouch“Done”.
Selectspeciesandpress“Done”.
Touch“Confi rm”toacknowledgethatthesamplehasbeenobtainedinasodiumcitrate(bluetop)tube.
Enter“Patient ID”and/or“Sample ID”(optional).Touch“Done”toconfirmandthen“Next”tocontinue.The“Cartridge Warming Up”periodwillbegin.NOTE: Do not add sample while cartridge is warming up!
Whentheanalyzerbeepsandflashesthemessage“Add sample and wait”,usethedisposablepipetteprovidedtoaddsampletothewell.NOTE: Prior to adding sample, gently invert sample tube 10X to obtain a uniform mixture for testing.
Nextscreenshows“Test in progress”.Itlastsapproximately10minutesfromthetimethesampleisputintothewell.
Whenanalysisiscomplete,“Test Results”willappear.Usea“Results Sticker”(providedintheVSproStarterKitandcanbere-ordered:PN740-7021)toputthetestresultsintoafile;printresultsifprinterisattached;orsaveresultstoacomputerthroughproperconnectivity.(SeetheVSpromanualformoreinformation).TheVSprostoresupto1000testresults.Press“Done”toexitthetestresult.
“Please remove cartridge”thathasbeenusedanddisposeofitandalltestmaterialappropriately,andplacethesealingcartridgeinthecartridgeslot.
1
2
3 1 2 3
4
5
6
4 5 6
7 8
9 10
7
8
9
10
VSpro
-
NormalCoagulationCascade
Likely Common Pathway or Combined Pathway Disorder:• Rodenticide toxicity• Vitamin K defi ciency• Factor XII• Hepatic disease • Bile insuffi ciency• DIC• Anticoagulants• Iatrogenic• Mast cell tumor
degranulation
LikelyIntrinsicPathwayDisorder:•FactorVIII (HemophiliaA)•FactorIX (HemophiliaB)•FactorXI (HemophiliaC)•FactorXII•ExcessiveConsumption
Normal Prolonged
Normal NormalProlonged
Likely Extrinsic Pathway Disorder:• Factor VII• Early rodenticide
toxicity• Vitamin K defi ciency• Hepatic disease• Bile insuffi ciency
Prolonged
Ifbruisingorpetechia,consider:•VonWillebrand’sdisease•Thrombocytopenia
orplateletdisorder•Vasculardisorder
PT
aPTT aPTT
Test Interpretation6
PT (Prothrombin Time):MeasurestheExtrinsicandCommonPathways
aPTT (Activated Partial Thromboplastin Time): MeasurestheIntrinsicandCommonPathways
-
Suggested Test Utilization
Pre-surgicaltestingPre-surgicaltestingshouldbeconsideredforanypatient,regardlessofage.Inheritedorcongenitalhemophiliacannotbedeterminedthroughanyothertestingmethodsoronphysicalexamination.Manyofthesedeficienciescausemildprolongationofclottingtimeswithoutclinicalsigns.
HemophiliaA,orfactorVIIIdeficiency,isthemostcommoninheritedcoagulopathyofanimals.HemophiliaAismostprevalentinGermanSheparddogs.HemophiliaB,factorIX,deficiencyaffectscatsanddogs.Otherlesscommonhereditarycoagulationdeficiencieshavebeenreportedinanimalsaswell.7
PreventivecareBaselinevaluesareasimportantforcoagulationtestingastheyareforanyotheranalyte.Stress,illness,injury,medicationsandsurgerycanallaffectcoagulationtestresults,sobaselinevaluesarevitalforinterpretation.
Hepaticdisease8
Anypatientwithincreasedliverenzymes,possiblehepaticdysfunction,orconfirmedhepatopathywillbenefitfromcoagulationtesting.Thisbecomesimperativeshouldthepatientrequireinvasivesurgeryorbiopsy/aspirateofaninternalorgan.
Liverdiseasecanaffectthecoagulationcascadeinmultipleways,astheliverproducesmostofthecoagulationfactors.Considerthat:•Manyoftheclottingfactorsaresynthesizedandclearedbytheliver.•VitaminKisfatsoluble,soitsabsorptiondependsonadequatebileproductionandflow.
Anydiseasestatethataffectsthelivercanleadtoacoagulationabnormalityincluding:•Inflammation(hepatitis,cholangiohepatitis)•Neoplasia•Biliarystasis•Useofchronicmedications(NSAIDs,anesthetics,chemotherapeutics,etc.)
VitaminKdeficiencyorantagonismVitaminKisanessentialcofactorforcoagulationfactorsII,VII,IXandX.FactorVIIhastheshortesthalf-lifeandwilldepletetheearliest,therefore,PTisoftenprolongedfirst.9
SomecausesofVitaminKdeficiencyare:10
•Rodenticidetoxicity•Cholestaticliverdisease(reducedbileflowreducesabsorption)•LiverFailure•Malabsorptiondisorders•Medications
Otherdiseasestateswherecoagulationtestingisindicated:•Anypatientwithunexplainedbleeding,bruisingorpetechialhemorrhage•Snakebite •Infectiousdisease •Immune-mediateddisease•Shockorseveresystemicdisease;potentialforDIC(disseminatedintravascularcoagulopathy)•Activelybleedingpatients
-
VSproFibrinogenTest
Sample well for adding diluted platelet-poor plasma
Opticaldetectionwindows
Microfluidictechnology
Quick Reference Guide
TheVETSCANVSproFibrinogenTestcartridgeisusedinconjunctionwiththeVSproAnalyzertoevaluatethefibrinogenlevelinhorses,asensitiveandspecificmarkerforinflammation.Earlyrecognitionofsystemicinflammationisessentialfordiagnosisofdiseaseandformulatingatreatmentplan.Quantitativeserialtestingforfibrinogencanhelpeffectivelymonitortreatmentandtheresponsetotherapy.
Cartridge Storage:Refrigerateat2°Cto8°C(36°Fto46°F)
Cartridge Stability: Donotexposecartridgesinthefoilpouchtodirectsunlight,anddonotleavethem atroomtemperature(15-30°C,59-86°F)formorethan3hours.
Usecartridgeswithin10minutesofremovingfrompouch.
Equine
Reference Range:11, 12 Dynamic Range:11, 12
mg/dL
150-400
g/L
1.5-4.0
g/L
0-20
mg/dL
0-2000
-
Sample Preparation
Precautions before blood sample collection:
• Aswithanybloodtest,theaccuracyisdependentonthequalityofthebloodsample.Poorsamplequalitycanbecausedbyimpropercollectionandhandlingtechniques.
• Collectblooddirectlyfromthelargestaccessiblevein.
•Contaminationfromthromboplastin,alcoholandintravenoussolutionswillinterferewiththefibrinogenassay.
• Useofhemolyzedsamplesmayresultinlowerthanexpectedvalues.
•Ensureprecisionwhenmixingplatelet-poorplasmaanddiluent,andonlyusethepre-filledmicrotubesupplied.
•Theplatelet-poorplasmaanddiluentsolutionmustbemixedgently.Donotuseavortexmixer,anddonotshakethesample
•Thetubemustbefilledcompletelyforaccurateresults.
Fillanevacuatedsodiumcitratetubetothe“fill line”withwholeblood.Thebloodisdrawnintothetubeuntiltheflowstops.Forbloodcollectedintoaregularsyringe,theneedleshouldberemovedpriortoplacingbloodintothesodiumcitratetube.Donotplacesampleonarocker.NOTE:Under-filled or over-filled citrate tubes may alter results due to the improper anticoagulant-to-sample ratio.
Spinthecitratedwholebloodsampletoplatelet-poorplasmausingacentrifuge.Refertopackageinsertforcentrifugerequirements.
Useapipetteandoneofthesuppliedpipettetipstoextract100µLofplatelet-poorplasmafromthecentrifugedsampletube.Depositthe100µLofplatelet-poorplasmaintothepre-filleddiluenttubebypiercingthefoillidwiththepipettetip.
Gentlymixthediluentandsamplebyextractinganddepositingthemixtureusingthepipette.Thesampleisnowreadyfortesting.
Fillline
1
2
3
4
1 2
3 4
-
Test Procedure
VSpro
ResultsSticker
RemovetheFibrinogenTestCartridgefromrefrigeration10-15minutespriortoanalysistowarmuptoroomtemperature.Touchthe“Analyze”buttonintheHomemenuscreentostartthetest.
Insertanewtestcartridgewhenthemessage“Please insert new cartridge”isdisplayedonthescreen.
Enterthe9-digitcartridge codelocatedonthepouchlabelandtouch“Done”.
Touch“Confirm”toacknowledgethatthesamplehasbeenobtainedinasodiumcitratetube,spundowntoplatelet-poorplasmaanddilutedbyadding100µLoftheplasmatothesuppliedpre-filleddiluenttube.
Enter“Patient ID”and/or“Sample ID”.Touch“Done”toconfirmandthen“Next”tocontinue.The“Cartridge Warming Up”periodwillbegin.NOTE:Do not add sample while cartridge is warming up!
Whentheanalyzerbeepsandflashesthemessage“Add 100 µL sample and wait”,usepipetteanddisposablepipettetiptoadd100µLofsampletothewell.NOTE:Prior to adding sample, extract and re-deposit the sample in the tube to obtain a uniform mixture of plasma and diluent for testing. Do not introduce bubbles to the mixture.
Nextscreenshows“Test in progress”.Itlastsapproximately15minutesfromthetimethesampleisputintothewell.
Whenanalysisiscomplete,“Test Results”willappear.Usea“Results Sticker”(providedintheVSproStarterKitandcanbere-ordered:PN740-7041)toputtestresultsintoafile;printresultsifprinterisattached;orsaveresultstoacomputerthroughproperconnectivity.(SeetheVSpromanualformoreinformation).TheVSproautomaticallystoresupto1000testresults.Press“Done”toexitthetestresult
“Please remove cartridge”thathasbeenusedanddisposeofitandalltestmaterialappropriately,andplacethesealingcartridgeinthecartridgeslot.
1
2
3 1 2 3
4
5
6
4 5
6 7
8 9
7
8
9
###-###-###
-
Suggested Test Utilization
Fibrinogentestingside-by-sidewithcompletebloodcount(CBC)FibrinogenconcentrationsshouldbeincludedwhenperformingaCBCinthehorse.•Fibrinogenisanacutephaseproteinmadeintheliverthatdetectsinflammation.•Fibrinogenincreases24hoursafteraninflammatoryprocesshasstartedandpeaksbetween4and7days.•Fibrinogenmayindicateinflammationinthesubclinicalhorsewhentheleukogramiswithinnormallimits.•Fibrinogenlevelsareverysensitive,andevenamildincreaseshouldbeconsideredsignificant.
SystemicinflammatorymarkerEarlyrecognitionofsystemicinflammationusingfibrinogenisessentialforformulatinganeffectivetreatmentplan.Inflammationthatgoesunrecognizedcanimpairapatient’sgrowthandperformance.•Fibrinogenbloodlevelsaredirectlyrelatedtotheseverityoftheunderlyingcondition.•Fibrinogenisthepreferredinflammatorymarkerforearlydetection(subclinical)ofRhodococcusequipneumonia.13
•FibrinogenincreasesmorequicklyinsynovialfluidthanserumamyloidA(SAA)(byseveralhours)followingendotoxinadministrationintothejoint.14
•Whentestedserially,fibrinogenprovidesinformationregardingtreatmentefficacyandlength,prognosis,especiallyconsideringsuchinfectiousorinflammatoryconditionsas:R.equiinfections,strangles,pigeonfever,pleuropneumonia,abdominalabscess,septicarthritis,endometritis,clostridialmyonecrosis,andendocarditis.
Fibrinogenspecificity•Plasmafibrinogenmayincreasewithdehydrationandmaydecreasewithseverehepaticdiseaseduetodecreasedproteinproduction.•IncasesofDIC,fibrinogenmaybedecreasedduetoincreasedutilization(maskingthehyperfibrinogenemiaassociatedwiththeinflammatoryprocess).
Patientmonitoringtool•Thedegreeofhyperfibrinogenemiaapproximatestheseverityofdisease.•Whenused,inconjunctionwiththeclinicalfindingsandotherlaboratorydata,themosteffectivetreatmentprotocolandprognosiscanbemonitoredclosely.•Fibrinogenlevelsmaybeusedaloneindeterminingresolutionoftheinflammatoryprocesswhentheleukogramisunchangedorhasreturnedtonormal.
Plasma Protein:Fibrinogen (PP:F) Ratio
Usefulintheinterpretationoffibrinogenconcentrationwhenhyperproteinemiaispresent.Thisratioiscalculatedas:
PP:FRatio=fibrinogenmg/dl
(plasmaTPmg/dl-fibrinogenmg/dl)
10-15Normal
>15Dehydration
-
1Dataonfile.StudyNo.TI-03294,ZoetisInc.2Dataonfile.StudyNo.TI-04203,ZoetisInc.3LippiG,PlebaniM,FavaloroE.Interferenceincoagulationtesting:focusonspurioushemolysis,icterus,andlipemia.SeminarsInThrombosisAndHemostasis.2013Apr;39(3):258-266.4LippiG,SalvagnoGL,MontagnanaM,Lima-OliveiraG,GuidiGC,FavaloroE.QualityStandardsforSampleCollectioninCoagulationTesting.SeminarsInThrombosisAndHemostasis.2012;38:565-575.5MontiP,ArcherJ.Qualityassuranceandinterpretationoflaboratorydata[Chapter2].BSAVAManualofCanineandFelineClinicalPathology.2016:12.6TopperMJ,WellesEG.Hemostatis[Chapter4].DuncanandPrasse’sVeterinaryLaboratoryMedicine:ClinicalPathology.2003:99-135.7TopperMJ,WellesEG.Hemostasis[Chapter4].DuncanandPrasse’sVeterinaryLaboratoryMedicine:ClinicalPathology,FifthEdition.2011:127.8BainPJ.Liver[Chapter7].DuncanandPrasse’sVeterinaryLaboratoryMedicine:ClinicalPathology,FifthEdition.2011:224.9TopperMJ,WellesEG.Hemostasis[Chapter4].DuncanandPrasse’sVeterinaryLaboratoryMedicine:ClinicalPathology,FifthEdition.2011:136.10Stokol,T.Disordersofhaemostasis[Chapter6].BSAVAManualofCanineandFelineClinicalPathology.2016:116.11Dataonfile.StudyNo.TI-03300,ZoetisInc.12EpsteinKL,BrainardBM.AnevaluationoftheAbaxisVSProforthemeasurementofequineplasmafibrinogenconcentrations.Equinevet.J.2012;44(4):449-452.13Passamonti,Fetal.Rhodococcusequipneumoniainfoals:anassessmentoftheearlydiagnosticvalueofserumamyloidAandplasmafibrinogenconcentrationsinequineclinicalpractice.VetJ.2015Feb;203(2):211-8.14Andreassen,Metal.Changesinconcentrationsofhaemostaticandinflammatorybiomarkersinsynovialfluidafterintra-articularinjectionoflipopolysaccharideinhorses.BMCVetRes.2017Jun19;13(1):182.15RobinsonNE,SprayberryK.CurrentTherapyinEquineMedicine,SixthEdition.2008:957.
VETSCANisaregisteredtrademarksofAbaxis,Inc.AlltrademarksarethepropertyofZoetisServicesLLCorarelatedcompanyoralicensorunlessotherwisenoted.©2019ZoetisServicesLLC.Allrightsreserved.ABX-00069R1
www.zoetisUS.com
10SylvanWayParsippany,NJ07054USATel+18889638471
3240WhippleRoadUnionCity,CA94587USATel+18008222947