Pre-analytical practices on routine coagulation testing

Dear Colleague, thanks for taking your time to fill in this questionnaire.

This questionnaire should be filled in by the person in charge of the routine coagulation analyses APTT, PT/INR and/or Fibrinogen. Please answer only questions applicable for your laboratory. Please, do not include answers about point-of-care (POCT) instruments.

If you complete the questionnaire and provide your email address, you will receive a feeback report with the results from this survey and an overview of the recommendations in this field.

By pressing the "Done" button (at the end of the questionnaire), your data will be saved. Be aware that you can go back and update your answers until the survey is closed. However, you have to use the same computer every time. When you are completely done, you should right-click on the mouse, click on preview and print your answers. The feedback report will include a summary of the results from all participants, however, your own results will not be specified/visible. Therefore, it will be helpful for you to keep your own answers for comparison when you receive the feedback report.

Best regards,

On behalf of the project group
Gunn BB Kristensen
Norwegian Clinical Chemistry EQA Program (NKK)

Part I: Information about the responding laboratory.

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* 1. Please fill in your e-mail address here to receive a feedback report

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* 2. In which country is your laboratory situated?


Country	Country menu

Other (please specify)

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* 3. Which type of laboratory do you work in?

Non-private hospital laboratory

Non-private outpatient (ambulatory care) laboratory

Private hospital laboratory

Private outpatient (ambulatory care) laboratory

Other

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* 4. Please tick off the coagulation analyses you perform in your laboratory (not POCT) (you may tick off several boxes):

Only PT/INR

Routine coagulation analyses (e.g. PT/INR and/or APTT and/or fibrinogen and/or thrombin time)

More specialized coagulation analyses (e.g. coagulation factors and/or thrombophilia tests and/or anti Xa assay)

Platelet function tests (e.g. platelet function analysers (PFA), platelet aggregometry)

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* 5. How many "internal" analyses do you perform per year (approximately)?
"Internal" analyses are defined as samples received from "in-house" (from departments or polyclinics inside the hospital or from inside the private laboratory).

APTT

INR

Protrombin time (PT)

Fibrinogen

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* 6. How many "external" analyses do you perform per year (approximately)?
"External" analyses are defined as samples received from outside the hospital/private laboratory, i.e. transferred from physicians' offices or laboratories, or other hospitals.

APTT

INR

Protrombin time (PT)

Fibrinogen

Part II: External samples:

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* 7. Which type of external samples (from primary care or other hospitals) do you accept in your laboratory? (You may tick off several boxes)

	Citrated Whole blood	Aliquoted fresh plasma (secondary tube)	Aliquoted frozen plasma (secondary tube)
APTT	APTT Citrated Whole blood	APTT Aliquoted fresh plasma (secondary tube)	APTT Aliquoted frozen plasma (secondary tube)
INR	INR Citrated Whole blood	INR Aliquoted fresh plasma (secondary tube)	INR Aliquoted frozen plasma (secondary tube)
Protrombin time (PT)	Protrombin time (PT) Citrated Whole blood	Protrombin time (PT) Aliquoted fresh plasma (secondary tube)	Protrombin time (PT) Aliquoted frozen plasma (secondary tube)
Fibrinogen	Fibrinogen Citrated Whole blood	Fibrinogen Aliquoted fresh plasma (secondary tube)	Fibrinogen Aliquoted frozen plasma (secondary tube)

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* 8. If you receive external samples as aliquoted plasma (fresh or frozen) – do you have routines for checking if this actually is citrated plasma and not another sample material (e.g. serum, heparin, EDTA plasma)?

We have no routines to check if this is citrated plasma

We always check that “citrated plasma” is stated on the tube

We perform a check only if we get unexpected results

We perform a check on all plasmas received from outside the hospital

Other

If "Other", please specify:

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* 9. If you check that external samples are citrated plasma - how do you do it? (You may tick off several boxes)

We check that “citrated plasma” is specified on the secondary tube

We measure different analytes in plasma

We follow a specific algorithm

Please specify analytes measured or algorithm followed

Part III: Blood sampling, tube filling volume and centrifugation

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* 10. Which type of citrate tubes do you accept for coagulation analyses?

Sodium Citrate (Na-citrate) 3.2% (105 or 109 mmol/L)

Sodium Citrate (Na-citrate) 3.8% (129 mmol/L)

Both 3.2% and 3.8% are accepted

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* 11. Which requirements (written procedures) do you have for tube filling volume (in percent)?

	Tube filling volume for your most used citrate tubes	Tube filling volume for pediatric tubes
APTT	APTT Tube filling volume for your most used citrate tubes menu	APTT Tube filling volume for pediatric tubes menu
INR	INR Tube filling volume for your most used citrate tubes menu	INR Tube filling volume for pediatric tubes menu
Protrombin time (PT)	Protrombin time (PT) Tube filling volume for your most used citrate tubes menu	Protrombin time (PT) Tube filling volume for pediatric tubes menu
Fibrinogen	Fibrinogen Tube filling volume for your most used citrate tubes menu	Fibrinogen Tube filling volume for pediatric tubes menu

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* 12. What is the source of your tube filling requirements in question 11? (You may tick off several boxes)

Own experience

Local studies

Published studies

National guidelines

International guidelines (CLSI etc.)

Written expert opinions

Please specify the name of the guideline or study if available

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* 13. When underfilled tubes are received; what do you do?

The results are reported without a comment.

The results are reported with a comment.

The results are reported without a comment if they are within the reference interval.

The results are reported without a comment if they are requested as urgent (STAT samples).

The sample is rejected – we ask for a new sample.

Other

If "Other", please specify:

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* 14. Which conditions do you use for centrifugation for samples where APTT, PT/INR and/or Fibrinogen are requested?

Most frequent used centrifugation force conditions (g)

Most frequent used duration in minutes

Most frequent used temperature (degree Celsius)

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* 15. If you have any alternative centrifugation conditions, please state the conditions used

Centrifugation force conditions (g)

Duration in minutes

Temperature (degree Celsius)

Part IV. Transport and Storage of the samples for routine coagulation

In the questions below (16-21), please provide the maximum accepted time interval after blood sampling your laboratory would allow to still analyse the samples. Please answer only if you have written procedures, and skip the situations not applicable to your laboratory. If your laboratory do not accept the conditions described in the question, please write 0 hours. If you do not have any requierements, please do not give any answer.

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* 16. Which requirements for sample stability do you have for "Citrated whole blood" at room temperature (hours):

APTT

APTT (unfractionated heparin)

INR and/or PT

INR (warfarin treatment)

Fibrinogen

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* 17. Which requirements for sample stability do you have for "Citrated whole blood" in refrigerator (hours):

APTT

APTT (unfractionated heparin)

INR and/or PT

INR (warfarin treatment)

Fibrinogen

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* 18. Which requirements for sample stability do you have for "Plasma on cells" (primary tube after centrifugation) at room temperature (hours):

APTT

APTT (unfractionated heparin)

INR and/or PT

INR (warfarin treatment)

Fibrinogen

Question Title

* 19. Which requirements for sample stability do you have for "Plasma on cells" (primary tube after centrifugation) in refrigerator (hours):

APTT

APTT (unfractionated heparin)

INR and/or PT

INR (warfarin treatment)

Fibrinogen

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* 20. Which requirements for sample stability do you have for "Aliquoted plasma" (transferred to a secondary tube) at room temperature (hours):

APTT

APTT (unfractionated heparin)

INR and/or PT

INR (warfarin treatment)

Fibrinogen

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* 21. Which requirements for sample stability do you have for "Aliquoted plasma" (transferred to a secondary tube) in refrigerator (hours):

APTT

APTT (unfractionated heparin)

INR and/or PT

INR (warfarin treatment)

Fibrinogen

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* 22. Do you have any comments on question 16 to 21?

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* 23. What do you do if the requirements you stated above (Q16-21) are not fulfilled?

The results are reported without a comment.

The results are reported with a comment

The results are reported without a comment if they are within the reference interval

The results are reported without a comment if they are urgent requests (STAT samples)

The sample is rejected – ask for a new sample

Other

If "Other", please specify:

Question Title

* 24. What is the source of your stability requirements in question 16-21? (You may tick off several boxes)

Own experience

Local studies

Published studies

National guidelines

International guidelines (CLSI etc.)

Written expert opinions

Please specify the name of the guideline or study if available:

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* 25. Do you store samples in primary tubes for potensial further extra requests for the routine coagulation tests PT/INR, APTT and/or fibrinogen?

Yes

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* 26. If yes, how do you store the samples?

Capped

Covered (e.g. with a plastic film or cardboard)

Uncapped and uncovered

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* 27. How do you usually store your samples?

At room temperature (18-23 degree Celcius)

In the refrigerator (2-8 degree Celcius)

In the freezer (-20 degree Celcius)

In the freezer (-80 degree Celcius)

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* 28. Do you have a system for temperature control?

	Yes	No
In the room (roomtemperature)?	In the room (roomtemperature)? Yes	In the room (roomtemperature)? No
In the refrigerator?	In the refrigerator? Yes	In the refrigerator? No
In the freezer?	In the freezer? Yes	In the freezer? No
During transport of external samples?	During transport of external samples? Yes	During transport of external samples? No

Part V: Use of preanalytical guidelines/recommenations and additional comments

Question Title

* 29. Do you have any national guidelines for preanalytical issues in coagulation testing?

Yes, from national society/ies

Yes, from government/National healthcare service

Yes, from experts in the field

Other

Please state the name of the guideline/recommendation if available:

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* 30. Do you have any additional comments to the questionnaire or on a specific question?

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* 31. If you forgot to state your email address to receive the feedback report, please state it here

Thanks for your contribution!

Question Title

* 1. Please fill in your e-mail address here to receive a feedback report

Question Title

* 2. In which country is your laboratory situated?

Question Title

* 3. Which type of laboratory do you work in?

Question Title

* 4. Please tick off the coagulation analyses you perform in your laboratory (not POCT) (you may tick off several boxes):

Question Title

* 5. How many "internal" analyses do you perform per year (approximately)? "Internal" analyses are defined as samples received from "in-house" (from departments or polyclinics inside the hospital or from inside the private laboratory).

Question Title

* 6. How many "external" analyses do you perform per year (approximately)? "External" analyses are defined as samples received from outside the hospital/private laboratory, i.e. transferred from physicians' offices or laboratories, or other hospitals.

Question Title

* 7. Which type of external samples (from primary care or other hospitals) do you accept in your laboratory? (You may tick off several boxes)

Question Title

* 8. If you receive external samples as aliquoted plasma (fresh or frozen) – do you have routines for checking if this actually is citrated plasma and not another sample material (e.g. serum, heparin, EDTA plasma)?

Question Title

* 9. If you check that external samples are citrated plasma - how do you do it? (You may tick off several boxes)

Question Title

* 10. Which type of citrate tubes do you accept for coagulation analyses?

Question Title

* 11. Which requirements (written procedures) do you have for tube filling volume (in percent)?

Question Title

* 12. What is the source of your tube filling requirements in question 11? (You may tick off several boxes)

Question Title

* 13. When underfilled tubes are received; what do you do?

Question Title

* 14. Which conditions do you use for centrifugation for samples where APTT, PT/INR and/or Fibrinogen are requested?

Question Title

* 15. If you have any alternative centrifugation conditions, please state the conditions used

Question Title

* 16. Which requirements for sample stability do you have for "Citrated whole blood" at room temperature (hours):

Question Title

* 17. Which requirements for sample stability do you have for "Citrated whole blood" in refrigerator (hours):

Question Title

* 18. Which requirements for sample stability do you have for "Plasma on cells" (primary tube after centrifugation) at room temperature (hours):

Question Title

* 19. Which requirements for sample stability do you have for "Plasma on cells" (primary tube after centrifugation) in refrigerator (hours):

Question Title

* 20. Which requirements for sample stability do you have for "Aliquoted plasma" (transferred to a secondary tube) at room temperature (hours):

Question Title

* 21. Which requirements for sample stability do you have for "Aliquoted plasma" (transferred to a secondary tube) in refrigerator (hours):

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* 22. Do you have any comments on question 16 to 21?

Question Title

* 23. What do you do if the requirements you stated above (Q16-21) are not fulfilled?

Question Title

* 24. What is the source of your stability requirements in question 16-21? (You may tick off several boxes)

Question Title

* 25. Do you store samples in primary tubes for potensial further extra requests for the routine coagulation tests PT/INR, APTT and/or fibrinogen?

Question Title

* 26. If yes, how do you store the samples?

Question Title

* 27. How do you usually store your samples?

Question Title

* 28. Do you have a system for temperature control?

Question Title

* 29. Do you have any national guidelines for preanalytical issues in coagulation testing?

Question Title

* 30. Do you have any additional comments to the questionnaire or on a specific question?

Question Title

* 31. If you forgot to state your email address to receive the feedback report, please state it here

* 5. How many "internal" analyses do you perform per year (approximately)?
"Internal" analyses are defined as samples received from "in-house" (from departments or polyclinics inside the hospital or from inside the private laboratory).

* 6. How many "external" analyses do you perform per year (approximately)?
"External" analyses are defined as samples received from outside the hospital/private laboratory, i.e. transferred from physicians' offices or laboratories, or other hospitals.