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Laboratory hemostasis: from biology to the bench

  • Giuseppe Lippi ORCID logo EMAIL logo and Emmanuel J. Favaloro
Published/Copyright: February 19, 2018
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 56 Issue 7

Abstract

Physiological hemostasis is an intricate biological system, where procoagulant and anticoagulant forces interplay and preserves blood fluidity when blood vessels are intact, or trigger clot formation to prevent excessive bleeding when blood vessels are injured. The modern model of hemostasis is divided into two principal phases. The first, defined as primary hemostasis, involves the platelet-vessel interplay, whilst the second, defined as secondary hemostasis, mainly involves coagulation factors, damaged cells and platelet surfaces, where the so-called coagulation cascade rapidly develops. The activation and amplification of the coagulation cascade is finely modulated by the activity of several physiological inhibitors. Once bleeding has been efficiently stopped by blood clot formation, dissolution of the thrombus is essential to restore vessel permeability. This process, known as fibrinolysis, also develops through coordinate action of a vast array of proteins and enzymes. An accurate diagnosis of hemostasis disturbance entails a multifaceted approach, encompassing family and personal history of hemostatic disorders, accurate collection of clinical signs and symptoms, integrated with laboratory hemostasis testing. Regarding laboratory testing, a reasonable approach entails classifying hemostasis testing according to cost, complexity and available clinical information. Laboratory workout may hence initiate with some rapid and inexpensive “screening” tests, characterized by high negative predictive value, then followed by second- or third-line analyses, specifically aimed to clarify the nature and severity of bleeding or thrombotic phenotype. This article aims to provide a general overview of the hemostatic process, and to provide some general suggestions to optimally facilitate laboratory hemostasis testing.

Keywords: bleeding; blood coagulation; laboratory hemostasis; platelets; thrombosis
Corresponding author: Prof. Giuseppe Lippi, Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37100 – Verona, Italy, E-mail:

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2017-12-24
Accepted: 2018-1-19
Published Online: 2018-2-19
Published in Print: 2018-6-27

©2018 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2017-1205
Keywords for this article
bleeding; blood coagulation; laboratory hemostasis; platelets; thrombosis

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Free light chains in the cerebrospinal fluid. Do we still need oligoclonal IgG?
  4. Reviews
  5. Obese phenotype and natriuretic peptides in patients with heart failure with preserved ejection fraction
  6. Prognostic value of HE4 in patients with ovarian cancer
  7. Opinion Paper
  8. Laboratory hemostasis: from biology to the bench
  9. Genetics and Molecular Diagnostics
  10. Multicenter validation study for the certification of a CFTR gene scanning method using next generation sequencing technology
  11. General Clinical Chemistry and Laboratory Medicine
  12. IL8 and IL16 levels indicate serum and plasma quality
  13. “Send & hold” clinical decision support rules improvement to reduce unnecessary testing of vitamins A, E, K, B1, B2, B3, B6 and C
  14. CSF free light chain identification of demyelinating disease: comparison with oligoclonal banding and other CSF indexes
  15. Search for new biomarkers of pediatric multiple sclerosis: application of immunoglobulin free light chain analysis
  16. The importance of detecting anti-DFS70 in routine clinical practice: comparison of different care settings
  17. Higher D-lactate levels are associated with higher prevalence of small dense low-density lipoprotein in obese adolescents
  18. LC-MSMS assays of urinary cortisol, a comparison between four in-house assays
  19. Optimized angiotensin-converting enzyme activity assay for the accurate diagnosis of sarcoidosis
  20. Quantitative urine test strip reading for leukocyte esterase and hemoglobin peroxidase
  21. Performance evaluation of cobas HBV real-time PCR assay on Roche cobas 4800 System in comparison with COBAS AmpliPrep/COBAS TaqMan HBV Test
  22. Systematic comparison of routine laboratory measurements with in-hospital mortality: ICU-Labome, a large cohort study of critically ill patients
  23. Reference Values and Biological Variations
  24. Establishing reference intervals for sex hormones and SHBG in apparently healthy Chinese adult men based on a multicenter study
  25. Plasma midregional proadrenomedullin (MR-proADM) concentrations and their biological determinants in a reference population
  26. Cancer Diagnostics
  27. Analytical validation of the Hevylite assays for M-protein quantification
  28. Cardiovascular Diseases
  29. Assessing matrix, interferences and comparability between the Abbott Diagnostics and the Beckman Coulter high-sensitivity cardiac troponin I assays
  30. Infectious Diseases
  31. Evaluation of a novel prognostic score based on thrombosis and inflammation in patients with sepsis: a retrospective cohort study
  32. Letters to the Editor
  33. Independent evaluation using fresh patient samples under real clinical conditions is vital for confirming the suitability and marketability of any new HbA1c assay. An example
  34. Anti-streptavidin antibodies mimicking heterophilic antibodies in thyroid function tests
  35. Site-specific DNA methylation detection based on enzyme-linked immunosorbent assay using recombinant methyl-CpG binding protein
  36. 3q29 microduplication in a small family with complex metabolic phenotype from Southern Italy
  37. A D1424N mutation in the MYH9 gene results in macrothrombocytopenia and granulocytic inclusion bodies in a Chinese inherited macrothrombocytopenia pedigree
  38. Evaluation of analytical performance of a chemiluminescence enzyme immunoassay (CLEIA) for cTnI using the automated AIA-CL2400 platform
  39. Cellular markers of eryptosis are altered in type 2 diabetes
  40. Platelet serotonin is not elevated in patients with benign head and neck paragangliomas
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