Effect of anticoagulant adjustment on prothrombin time test using two different PT reagents in patients with elevated hematocrit

Abstract

The recommendations for adjustment of citrate volume in sample tubes with high hematocrit (Ht) are based on indirect studies of underfilled tubes or artificially constructed Ht values. The aim of this study was to evaluate the effect of citrate volume adjustment in sample tubes from patients with hematocrit >55% using two different prothrombin time (PT) tests. Methods Paired citrate-adjusted and unadjusted blood specimens were obtained from 181 patients from the pulmonary hypertension ambulatory with high Ht values and on warfarin therapy. The samples were tested using recombinant human tissue factor (RTF) and reagents extracted from rabbit brain (HS Plus). The results are expressed as the international normalized ratio (INR). The correlation and percent change (% change) between sample pairs were calculated. Results INR-RTF results from adjusted and unadjusted citrate blood specimens showed a strong correlation ( R2 ​= ​0.8226, p ​< ​0.0001). The INR median was 2.25 (95% CI 2.10 to 2.41) for citrate-adjusted samples and was 2.22 (95% CI 2.06 to 2.38) for citrate-unadjusted samples. For samples with Ht >62%, the % change between sample pairs was >10%. Results using HS Plus showed a moderate correlation between citrate-adjusted and unadjusted samples ( R2 ​= ​0.4267, p ​< ​0.0001). The INR median was 2.51 (95% CI 2.35 to 2.68) for citrate-adjusted samples and 3.45 (95% CI 3.11 to 3.80) for citrate-unadjusted samples. For samples with Ht>55%, the % change between sample pairs was higher than 10%. Conclusion Our data demonstrate that in patients with polycythemia on warfarin therapy, INR-RTF does not require anticoagulant adjustment for assessment of samples with Ht <62%.

Anticoagulation Monitoring in the Intensive Care Unit

“…The HCT determines the percentage of RBCs within a patient's sample 22. An elevated HCT value would indicate low plasma volume, which can produce falsely elevated INR times; therefore, it is important to adjust for elevated HCT values into laboratory assessment with correction factors so as not to overestimate the effects of anticoagulants being measured 27…”