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Curvas de reação em coagulómetros de deteção ótica: construção de manual de utilização e interpretação
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Abstract(s)
A automação chegou á área do diagnóstico laboratorial de hemostase de forma mais contida, comparativamente a outras áreas do laboratório clínico, como Química Clínica. Em 1997 surgiram equipamentos de deteção ótica, que permitiam avaliar curvas de coagulação do Tempo de Tromboplastina Parcial ativada (TTPa), para além do tempo de coagulação. Este tipo de avaliação foi ampliado a outros testes de hemostase, (coagulimétrica ou outra). Hoje dispomos da Avaliação das Curvas Reação em coagulómetros óticos, por transmitância ou absorvância, que se tornou imprescindível sobretudo em resultados indeterminados (ou failed). No entanto esta ferramenta tem suscitado muitas dúvidas e dificuldades de aplicação por parte de Técnicos e Análises clínicas (TACSP) e Patologistas Clínicos, em contexto de Urgência e Rotina, no SPC, da ULS S. José. O presente trabalho pretende contribuir para a resolução das referidas dificuldades, com base na evidência, dando resposta á seguinte questão: Quais os critérios adequados para utilizar e interpretar as curvas de reação em coagulómetros de deteção ótica? O objetivo deste trabalho é: Construir um manual de utilização e interpretação de Curvas de Reação, para testes de coagulação mais frequentes em coagulómetros de deteção ótica – Tempo de Protrombina (TP), TTPa, Fibrinogénio Clauss (Fib-C) e D-Dímero (DD). É um estudo descritivo, que decorreu na ULS S. José, SPC, área do Core- Hematologia, do HSJ. Foram verificadas as curvas de resultados dos testes de triagem em hemóstase (TP, TTPa, Fib-C e DD), em particular os indeterminados para avaliação da respetiva curva de reação, em 30000 amostras. De 1% (691 testes) em 30000 amostras, de resultados indeterminados, de acordo com a causa destacam-se dois Padrões: Qualidade de amostra e Alterações da coagulação por patologia ou terapêutica. A construção de um manual de utilização e interpretação de Curvas de reação é possível, organizado por capítulos. Iniciado com apresentação das características das curvas, capítulos por testes a preencher com os exemplos e no final com casos raros. O manual é uma ferramenta útil a todos os profissionais que validam testes de hemostase. Pois contribui para decisões de diagnóstico e terapêutica sustentadas na evidência, em situações de urgência ou emergência.
ABSTRACT: Automation has arrived in the area of laboratory diagnosis of hemostasis in a more contained way, compared to other areas of the clinical laboratory, such as Clinical Chemistry. In 1997, optical detection equipment appeared, which allowed the evaluation of coagulation curves of the activated Partial Thromboplastin Time (aPTT), in addition to the coagulation time. This type of evaluation has been extended to other tests of hemostasis (coagulimetric or other). And today we have the Evaluation of Reaction Curves in optical coagulometers, by transmittance or absorbance, which has become essential especially in indeterminate (or failled) results. However, this tool has raised many doubts and difficulties in application by Clinical Technicians and Analyses and Clinical Pathologists, and in the context of Urgency and Routine, in the Clinical Pathology (SPC) service of the S. José Local Health Unit. The present work aims to contribute to the resolution of these difficulties, based on the evidence, by answering the following question: What are the appropriate criteria to use and interpret the reaction curves in optical detection coagulometers? The objective of this work is: To build a manual for the use and interpretation of Reaction Curves, for the most frequent coagulation tests in optical detection coagulometers – TP, aPTT, Fib-C, and DD. It is a descriptive study, which took place at the ULS S. José, SPC, area of the Core-Hematology, of the hospital of S. José. The reaction curves of the screening tests in hemostasis (PT, aPTT, Fib-C, and DD) were verified, in particular, the indeterminate ones to evaluate the respective reaction curve, in 30000 samples. From 1% (691 tests) in 30000 samples, with indeterminate results, according to the cause, two Standards stand out: Sample quality and Coagulation alterations by pathology or therapy. The construction of a manual for the use and interpretation of Reaction Curves is possible, organized by chapters. It begins with a presentation of the characteristics of the curves, chapters by tests to be filled in with examples and at the end with rare cases. However, a reaction curve can be unique and unrepeatable, like a fingerprint of an indeterminate result. The manual is a useful tool for all professionals who validate hemostasis tests. Because it contributes to evidence-based diagnostic and therapeutic decisions, in urgent or emergency situations.
ABSTRACT: Automation has arrived in the area of laboratory diagnosis of hemostasis in a more contained way, compared to other areas of the clinical laboratory, such as Clinical Chemistry. In 1997, optical detection equipment appeared, which allowed the evaluation of coagulation curves of the activated Partial Thromboplastin Time (aPTT), in addition to the coagulation time. This type of evaluation has been extended to other tests of hemostasis (coagulimetric or other). And today we have the Evaluation of Reaction Curves in optical coagulometers, by transmittance or absorbance, which has become essential especially in indeterminate (or failled) results. However, this tool has raised many doubts and difficulties in application by Clinical Technicians and Analyses and Clinical Pathologists, and in the context of Urgency and Routine, in the Clinical Pathology (SPC) service of the S. José Local Health Unit. The present work aims to contribute to the resolution of these difficulties, based on the evidence, by answering the following question: What are the appropriate criteria to use and interpret the reaction curves in optical detection coagulometers? The objective of this work is: To build a manual for the use and interpretation of Reaction Curves, for the most frequent coagulation tests in optical detection coagulometers – TP, aPTT, Fib-C, and DD. It is a descriptive study, which took place at the ULS S. José, SPC, area of the Core-Hematology, of the hospital of S. José. The reaction curves of the screening tests in hemostasis (PT, aPTT, Fib-C, and DD) were verified, in particular, the indeterminate ones to evaluate the respective reaction curve, in 30000 samples. From 1% (691 tests) in 30000 samples, with indeterminate results, according to the cause, two Standards stand out: Sample quality and Coagulation alterations by pathology or therapy. The construction of a manual for the use and interpretation of Reaction Curves is possible, organized by chapters. It begins with a presentation of the characteristics of the curves, chapters by tests to be filled in with examples and at the end with rare cases. However, a reaction curve can be unique and unrepeatable, like a fingerprint of an indeterminate result. The manual is a useful tool for all professionals who validate hemostasis tests. Because it contributes to evidence-based diagnostic and therapeutic decisions, in urgent or emergency situations.
Description
Mestrado em Tecnologias Clínico-Laboratoriais
Keywords
Curvas de reação Tempo de protrombina Tempo de tromboplastina ativada Fibrinogénio Reaction curves Prothrombin time Activated thromboplastin time Fibrinogen MTCL
Citation
Gomes AP. Curvas de reação em coagulómetros de deteção ótica: construção de manual de utilização e interpretação [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa; 2024.
Publisher
Instituto Politécnico de Lisboa