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What the Neighbours Say

Ljungkvist et al. Haemophilia https://doi.org/10.1111/hae. 13640 While it is well appreciated that an optimal hemostatic response requires the coordinated interaction of the complete coagulation protein cascade, our clinical laboratory tests of hemostasis have tended to limit analysis to specific pathways or factors in the cascade. This practice has been prompted, at least in part, by the difficulties in standardizing global tests of hemostasis such as the thrombin generation assay. Efforts to introduce these global tests into the diagnostic laboratory are increasingly required with the introduction of therapies that cannot be monitored with standard assays. Ljungkvist et al. have now reported the results of a standardization protocol for thrombin generation using the calibrated automated thrombogram (TGA-CAT) and three reference plasmas to normalize results. The study involved six Nordic centers and the testing of three plasmas with hypo, normal and hypercoagulability. Prior to introduction of the normalization protocol the results showed inter-laboratory CVs of 10% or lower except for the endogenous thrombin potential (12%) and peak (14%) in the hypocoagulable plasma. With the incorporation of two of the three reference plasmas into their standardization protocol, the investigators were able to produce TGA-CAT results as robust as standard coagulation assays used in routine diagnostic laboratories.