Understanding the “philosophy” of laboratory hemostasis
-
Giuseppe Lippi
,
Dorothy Adcock
Abstract
Unlike many other areas of laboratory medicine, laboratory hemostasis has some peculiarities, which makes it one of the most complex diagnostic domains in clinical medicine. The inherent complexity of the hemostasis process, the components of which have not yet been thoroughly unravelled, is mirrored by a large number of hemostasis disturbances, which can involve single or multiple components. Although laboratory diagnostics represents an unavoidable part of the diagnostic reasoning in patients with bleeding or thrombotic disorders, the basic concept beneath the assumption that in many human pathologies, one single test may be sufficient for the diagnosis, does not hold true in hemostasis. There are in fact many aspects that would lead us to conclude that laboratory hemostasis can be considered a very challenging arena for many clinicians and perhaps also for some laboratory professionals. The most challenging aspects typically include the following concepts; that hemostasis is an intricate and multifaceted process, that more than one test is typically needed to achieve a final diagnosis, that results of screening tests depend on many biological factors and do not allow making a final diagnosis, that harmonization of techniques is still an unmet target, and that the calculations used vary widely among laboratories. This article is hence aimed at discussing many of these aspects, with the hope of presenting a useful contribution to better understand the “philosophy” of laboratory hemostasis.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
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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©2019 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
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- Original Articles
- Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
- Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process
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- Case reports of diagnostic error: liposarcoma mistaken for hematoma in an obese female with concurrent ipsilateral thrombosis on rivaroxaban
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Artikel in diesem Heft
- Frontmatter
- Editorial
- The Model List of Essential In Vitro Diagnostics: nuisance or opportunity?
- Reviews
- Skeletal myopathies as a non-cardiac cause of elevations of cardiac troponin concentrations
- Histo-genomics: digital pathology at the forefront of precision medicine
- Opinion Papers
- Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety
- Understanding the “philosophy” of laboratory hemostasis
- Original Articles
- Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
- Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process
- Mortality and morbidity rounds (MMR) in pathology: relative contribution of cognitive bias vs. systems failures to diagnostic error
- Experienced physician descriptions of intuition in clinical reasoning: a typology
- A randomized experimental study to assess the effect of language on medical students’ anxiety due to uncertainty
- Development and application of a PCR-HRM molecular diagnostic method of SNPs linked with TNF inhibitor efficacy
- Acute rejection in kidney transplantation and the evaluation of associated polymorphisms (SNPs): the importance of sample size
- Letter to the Editor
- Physically damaged second victims by diagnostic delay in pulmonary tuberculosis of hospitalized patients. Cognitive errors with urgent need for prevention
- The physical examination, including point of care technology, is an important part of the diagnostic process and should be included in educational interventions to improve clinical reasoning
- Case Reports
- Case reports of diagnostic error: liposarcoma mistaken for hematoma in an obese female with concurrent ipsilateral thrombosis on rivaroxaban
- Macro-CK type 2 in metastatic prostate cancer
