A A Comparison of the Optical Method with the Mechanical Method in Routine Coagulation Tests
A Comparison of the Optical Method
Abstract
Background:This study aimed to compare the prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) values obtained using the photo-optical method and to assess these values according to the reference method which was the mechanical method .
Methods:Plasma samples from 340 patients, submitted to our hospital’s biochemistry laboratory for PT, INR, and aPTT analyses, were assayed using the mechanical coagulometric measurement method in a Stago Compact Max3 automated coagulation analyzer, which served as the reference device. The same samples were also analyzed using the Sunbio UP5500 automated analyzer with a simultaneous optical method. Turbid samples were analyzed in both devices without exclusion from the study. Correlation coefficient analysis was carried out using SPSS to assess intervariable correlations, and Passing-Bablok regression analysis was performed in R software version 3.6.0 for the comparison of PT, INR, and aPTT values between the two devices. Bland-Altman plots were used to analyze agreement.
Results:A good level of statistically significant agreement was found between the PT and INR values measured by the Stago Compact Max3 and Sunbio UP 5500 devices (intraclass coefficient [ICC]: 0.627, p=0.001; p<0.01 and ICC: 0.653, p=0.001; p<0.01, respectively). Additionally, there was an excellent level of statistically significant agreement for the aPTT values (ICC: 0.902, p=0.001, p<0.01). The Bland- Altman analysis revealed the mean 95% limits of agreement values as 2.46 (lower limit: -2.44, upper limit: 7.37) for PT, 0.07 (lower limit: -0.32, upper limit: 0.46) for INR, and 2.45 (lower limit: -1.67, upper limit: 6.58) for aPTT. The Passing-Bablok regression results indicated a systematic difference for PT measurement, but no proportional difference. No systematic or proportional differences were found for the measured INR and aPTT values between the Stago Compact Max3 and Sunbio UP 5500 devices. The intra-assay and inter-assay coefficient of variation (CV) values from level 1 and level 2 controls of the optical method were below 5%.
Conclusions:The results from the optical method were found to be consistent and reliable when compared to the mechanical method. PT and INR results showed statistically good agreement, while aPTT results demonstrated excellent agreement.
References
J. Thromb. Thrombolysis,2016:41(1)165–186 (PMID: 26780745).
2. Kaserer A., Casutt M., Sprengel K., Seifert B., Spahn D. R., Stein P., “Comparison of two different coagulation algorithmson the use of allogenic blood products and coagulation factors in severely injured trauma patients: A retrospective, multicentre,observational study,” Scand. J. Trauma. Resusc. Emerg. Med.,2018:26(1)1–9 ( PMID: 29310686).
3.A. Mina, E. J. Favaloro, J. Koutts, “Relationship between short activated partial thromboplastin times, thrombin generation, procoagulant factors and procoagulant phospholipid activity,” Blood Coagul. Fibrinolysis, 2012:23(3):203–207 .(PMID: 22322136).
4. Rathod N., Nair S., Mammen J., Singh S., “A comparison study of routine coagulation screening tests (PT and APTT) by three automated coagulation analyzers,” Int. J. Med. Sci. Public Heal.,2016(5)8:1563. https://www.cabidigitallibrary.org/doi/full/10.5555/20163297066
5. Ricos C, Alvareq V, Cava F, et al. Desirable specifications for total error, imprecision, and bias, derived from intra- and inter-individual biological variation, http://www.westgard.com/biodatabase 2014-update.htm.
6. Quehenberger P, Kapiotis S, Handler S, Ruzicka K, Speiser W. Evaluation of the automated coagulation analyzer SYSMEX CA 6000. Thromb Res. 1999;96:65–71 (PMID: 10554086).
7. Dorn-Beineke A, Demfle CE, Bertsch T, Wisser H. Evaluation of the automated coagulation analyzer Sysmex CA-7000. Thromb Res. 2005;116:171–179 (PMID: 15907533).
8. Fischer F, Appert-Flory A, Jambou D, Toulon P. Evaluation of the automated coagulation analyzer Sysmex CA-7000. Thromb Res. 2006;117:721–729 (PMID: 16098565).
9. D’Angelo A, Seveso MP, D’Angelo SV et al. Comparison of two automated coagulometer and the manual tilt tube method for the determination of prothrombin time. Am J Clin Pathol. 1989;92:321–328 (PMID: 2773851).
10. Fernandes B, Giles A. An abnormal activated partial thromboplastin time clotting waveform is associated with high mortality and a procoagulant state. Lab Hematol.2003;9:138–142 (PMID: 14521320).
11. Nesheim M, Samis J, Walker J et al. Lipoprotein-complexed C- reactive protein and the bipha- sic transmittance waveform in critically ill patients. Blood Rev. 2002;16(Suppl 1):S15–S22 ( PMID: 12918783).
12. Toh CH, Ticknor LO, Downey C, Giles AR, Paton RC, Wenstone R. Early identification of sepsis and mortality risks through simple, rapid clot waveform analysis. Implications of lipoprotein-complexed C reactive protein formation. Intensive Care Med 2003;29:55–61. (PMID: 12528023).
13.Chris Gardiner, FIBMS, MSc, PhD Dorothy M. Adcock, MD Leonthena R. Carrington, MBA
et al.H57-A Guideline Implementation of Coagulometers; Approved guideline. https://clsi.org/media/1389/h57a_sample.pd
14. Bilic-Zulle L. Comparison of methods: Passing and Bablok regression. Biochem Med.(Zagreb) 2011:49-52 (PMID: 22141206).
15. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307-310 (PMID: 2868172).
16. Avcı E , Ercan M, Özen Ş , Bahçeci O. Koagülasyon testlerinde optik ve mekanik pıhtı yöntemlerinin karşılaştırılması.Harran Üniversitesi Tıp Fakültesi Dergisi (Journal of Harran University Medical Faculty)2019;16(1):13-16. https://openurl.ebsco.com/EPDB%3Agcd%3A1%3A7565153/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A137137633&crl=c&link_origin=scholar.google.com.
17. Tekkesin N.,Kilinc C., “Optical and Mechanical Clot Detection Methodologies: A Comparison Study for Routine Coagulation Testing,” J. Clin. Lab. Anal., 2012:(26)3: 125–129 (PMID: 22628225).
18. Bai B., Christie D. J., Gorman R. T., and Wu J. R., “Comparison of optical and mechanical clot detection for routine coagulation testing in a large volume clinical laboratory,” Blood Coagul. Fibrinolysis, 2008:19(6)569–576 (PMID: 18685440).
19. Zengi O,Kucuk SH.Evaluation of the Succeeder SF-8200 fully automated coagulation analyzer. Clin. Lab., 2021:67(10) (PMID: 34655207).
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