Waveform analysis of clotting test optical profiles in the diagnosis and management of disseminated intravascular coagulation (DIC)

Abstract

Transmittance waveform charts the changes in light transmittance on standard coagulation assays, such as the prothrombin time (PT) and activated partial thromboplastin time (APTT). Analysis and characterization of these data on photo-optical coagulation analysers provides additional qualitative and quantitative information to that obtained using the clotting time alone. The most thoroughly evaluated clinical application is that of the biphasic APTT waveform with disseminated intravascular coagulation (DIC). The degree of waveform abnormality correlates directly with the severity of haemostatic dysfunction and allows for both the prediction and monitoring from non-overt to overt DIC. As its performance is simple and rapid, this provides the means for targeting therapeutic intervention to an earlier stage of DIC. The recent identification that the mechanism underlying the biphasic waveform is a complex that exists in vivo between C reactive protein with very low density lipoprotein, provides potentially important insights into the molecular pathogenesis of DIC. Thus, in addition to the immediate clinical utility in diagnostic practice, it has important applications as a research tool. Preliminary experience in the application of this technology to the diagnosis and management of the haemophilias and the lupus anticoagulant syndrome has also provided evidence of the power and utility of waveform analysis in essentially simple clotting assays.

Mannose-binding lectin and its associated proteases (MASPs) mediate coagulation and its deficiency is a risk factor in developing complications from infection, including disseminated intravascular coagulation

“…This observation is supported by a report that anti-IL-6 antibody treatment reduced coagulation activation during sepsis (van der Poll, et al, 1994). We diagnosed DIC using the abnormal biphasic aPTT waveform, which is sensitive and can be detected prior to development of a prolonged PT and aPTT (Toh and Giles, 2002). The cause of the negative slope (slope_1) in the aPTT waveform during DIC (Figure 4) has been identified as calcium-mediated precipitation of C-reactive protein (CRP) complexed with very-low-density lipoprotein (Toh, et al, 2002).…”

Activated partial thromboplastin time waveform analysis: A new tool to detect infection?*

“…The aPTT was performed with the MDA II analyzer (bioMérieux, Marcy L'Etoile, France), using the MDA Platelin LS reagent (bioMérieux), as previously described (13)(14)(15)24). In the aPTT assay, the slope of the initial phase of the light transmission profile (slope_1, %T/s) quantifies an abnormal BPW (Fig.…”

Biphasic Activated Partial Thromboplastin Time Waveform and Adverse Events in Non–Intensive Care Unit Patients

“…[1][2][3] The MDA Coagulation Analyzer (bioMérieux, Durham, NC) uses waveform analysis technology to automatically flag for the presence of this abnormal waveform while running routine aPTT tests. 3 The waveform represents the change in light transmittance through a plasma specimen as the aPTT reaction takes place. With a normal aPTT waveform, the first phase (precoagulation phase) is a plateau that shows no change in light transmittance from baseline (100% transmittance [T]).…”