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Fellowship Research Project Funded in 2007

Quality assurance of special coagulation laboratory practices

Dr. Elianna Saidenberg
Chief Resident in Hematology
McMaster University - Hamilton, Ontario
One year funding

It is a pleasure for me to have this opportunity to introduce myself to the hemophilia community of Canada. I am presently in my sixth postgraduate year of medical training and am enrolled in a transfusion medicine fellowship at the University of Ottawa. Concurrent with this training I am working in the coagulation laboratory and with the clinical hemophilia and bleeding disorders service. Given the necessity of treating many haemostatic defects with human and recombinant blood products, the connection between transfusion medicine and hemostasis medicine feels very natural.

This year I am the very fortunate and grateful recipient of the Novo-Nordisk- Canadian Hemophilia Society- Association of Hemophilia Clinic Directors of Canada Fellowship in Hemophilia. I aim to use the opportunities afforded to me by this fellowship to gain the skills needed to effectively manage a coagulation laboratory. Availability of prompt, precise and accurate measurements of hemostatic parameters is vitally important in the provision of medical care to patients with bleeding disorders. To further my knowledge and understanding of procedures and process in the coagulation lab I am planning several quality assurance projects.

The first project I have undertaken relates to creation of normal ranges for platelet aggregation and secretion tests done at our site. These tests are very important in the diagnosis of congenital and acquired disorders of platelet function as well as other disorders of coagulation such as von Willebrand disease. The testing machines used are called aggregometers. They provide a visual representation of the test results as a graph and also provide measurements of the slope and amplitude of the curve. Interpretation of these tests relies heavily on the interpreting physician’s reading of the curve. Thus, the results could vary based on the eye of the interpreter. To improve the accuracy of these test results it is recommended by the Clinical Laboratory Standards Institute that every laboratory calculate normal ranges for their own aggregometers. To comply with these recommendations I have begun the task of compiling data on aggregation test results done on healthy volunteers at our centre. This information will then be evaluated by a statistician who will apply the necessary mathematical processes to determine the normal ranges.

Subsequent projects I have planned will evaluate the quality of other tests done in the coagulation lab to help ensure their quality. Through assessment of these procedures I will gain vital skills in laboratory management which will hopefully help me ensure that I can provide the best possible care for my patients with bleeding disorders.