Sysmex® CA-1500 System Coagulation Curve Errors Online Training

Welcome to the Sysmex® CA-1500 System Coagulation Curve Errors Online Training course. The coagulation curve is a visual display of the activity that occurs during a clotting assay. Each test analysis yields a characteristic pattern or “signature” coagulation curve. The Sysmex® CA-1500 System uses the percentage detection method to obtain clotting time measurements but also uses checking methods to evaluate the curve generation process. If certain criteria are not met, the system generates a coagulation curve error. Select Next to continue.   Upon successful completion of this course, you will be able to: Identify how the Sysmex® CA-1500 System obtains clotting time measurements and validates coagulation curves Describe how to view and print coagulation curve graphs and data Identify key coagulation curve error codes Describe how to evaluate and troubleshoot key coagulation curve errors Select Next to continue. Congratulations. You have completed the Sysmex® CA-1500 System Coagulation Curve Errors online training course. Listed below are the key points that have been presented. Take time to review the material before you proceed to the final quiz. Identify how the Sysmex® CA-1500 System obtains clotting time measurements and validates coagulation curves The Sysmex® CA-1500 System uses the percentage detection method to obtain clotting time measurements but also uses checking methods to evaluate the curve generation process. If certain criteria are not met, the system generates a coagulation curve error. Demonstrate how to view and print coagulation curve graphs and data On the Stored Data List screen, the system flags test results with an asterisk (*). On the Stored Data Graphic Display screen and Micro Analysis printout, the system displays coagulation curve error codes. Set the printer option to Service to obtain a Micro Analysis printout, which displays a coagulation curve graph as well as analysis data from the 2% point to the 80% point of the curve. Be sure to change the printer setting back to List when finished. Identify key coagulation curve error codes ERR 2: Slight Coagulation, ERR 4: Analysis Time Over, ERR 8: Coagulation Curve Error, ERR 16: Turbidity Level Over, ERR 32: No Coagulation, ERR 100: Range Over, and ERR 128: Early Reaction Error. Describe how to evaluate and troubleshoot key coagulation curve errors Rule out inhibitors, sampling, and reagent problems. Review the coagulation reaction on the Micro Analysis printout. Re-analyze the sample. If the repeat result is not flagged, report the results. If the error occurs again, report the mean of the repeat and initial results if the curves are acceptable and both results are equivalent at the 50% detection point. DO NOT report results without numeric values. Select Next to continue. For clotting assays, the Sysmex® CA-1500 System uses the percentage detection method to obtain clotting time measurements by taking a reading at the 50% point on coagulation curves—but how does the system know if the results were obtained from a valid coagulation curve? To validate the coagulation curve, the system builds algorithms into its software to check if the coagulation curve generated during each clotting assay meets certain criteria. If certain check-method criteria are not met, the system flags the test result and generates a coagulation curve error. Select Next to continue. If the system generates a coagulation curve error, the system flags test results with an asterisk (*) on the Stored Data List screen, and displays error codes on the Stored Data Graphic Display screen as well as Micro Analysis printout. Review the coagulation curve data to determine if you can report test results, or if you must troubleshoot a problem within the assay. To view coagulation curves with errors: From the Main Menu screen, press Stored Data. On the Stored Data List screen, select a sample, and then press Graph. Note: Press the arrow keys to scroll to the right to view the analysis results for a sample. On the Stored Data Graphic Display screen, press the ERR button to view a description of the error. View Coagulation Curve Errors Learn how to view coagulation curve errors. Instructions:If media does not automatically start, select the play arrow to begin.Flash File:/content/generator/Course_90013652/sim_CA1500_CoagCurveError_ViewingErrors2__2/sim_CA1500_CoagCurveError_ViewingErrors2__2.htmHTML5 File:/content/generator/Course_90013652/sim_CA1500_CoagCurveError_ViewingErrors2_HTML5_800x600/index.htmlPDF File: To print coagulation curve data, you have three printer setting options: Select List to print analysis data in a list format. The list format is used most often. Select Graph to print a graph of the coagulation curve. Select Service to print a graph of the coagulation curve in Micro Analysis format, which displays a graph of the coagulation curve as well as analysis data from the 2% point to the 80% point of the curve. Use this option to learn more about the activity that occurs throughout the coagulation reaction. To set printing options: From the Main Menu screen, press Settings. On the Settings submenu, press I/O Settings. On the I/O Settings submenu, press GP. On the Graphic Printer Settings screen, press List, Graph, or Service. Press Set to update the print format settings. Select Next to continue. After changing the printing option to the Graph or Service setting, you can print a coagulation curve that shows the clotting reaction for a specific test result. To print coagulation curve data: From the Main Menu screen, press Stored Data. On the Stored Data List screen, select the result that you want to print, and then press Output. On the Select Sample menu, press Current. On the Select Device Menu screen, press GP Graph to print the selected coagulation curve data. To print both the coagulation curve and data displayed in Micro Analysis format on the same printout, do the following: Set print format: Main Menu -> Settings -> I/O Settings -> GP -> Service. Print graph & data: Main Menu -> Stored Data -> Output -> Current -> GP Graph. Select Next to continue. The Sysmex® CA-1500 System uses the percentage detection method to obtain clotting time results using bH and dH measurements. The system monitors each clotting reaction to determine the bH (0% scattered light intensity) and dH (100% scattered light intensity) until the reaction is completed. The system calculates most of the clotting times at the 50% detection point—the point between the baseline and the endpoint of the reaction where the amount of light scattered per unit time shows the greatest change. The system validates test results by ensuring that the curve generation process meets certain criteria. If not—the system generates a coagulation curve error. Select Next to continue. Key coagulation curve errors include: ERR 2: Slight Coagulation ERR 4: Analysis Time Over ERR 8: Coagulation Curve Error ERR 16: Turbidity Level Over ERR 32: No Coagulation ERR 100: Range Over ERR 128: Early Reaction Error Select Next to continue. The system generates an ERR 2: Slight Coagulation (SC) error if the system detects a weak clot formation, i.e., the dH does not reach the threshold value. Initial Results: Numeric results will be flagged by an asterisk (*) on the Stored Data List screen ERR 2 code appears on Stored Data Graphic Display screen and Micro Analysis printout Possible Causes: Low fibrinogen, factor deficiencies, inhibitors Anticoagulant contamination Reagent problem ERR 2: Slight Coagulation Learn about actions to take with ERR 2. Actions to take: Check sample for anticoagulant contamination, hemolysis, lipemia, etc. Verify sample and reagent delivery. Review results on the Micro Analysis printout to check for evidence of weak clot formation. Note: Micro Analysis will not print if dH < 10. Re-analyze sample. If the repeat result is not flagged with an asterisk (*), report the result. For fibrinogen assays, run MDA Low. If the error occurs again, report the mean of the repeat and initial results as determined by your laboratory protocol if the curves are acceptable and both results are equivalent at the 50% detection point. When complete, select the X in the upper-right corner to close the window and continue. The system generates an ERR 4: Analysis Time Over error if the analysis is not completed within the normal detection time—the system detects that the sample reaction end angle is greater than the permitted angle at the pre-determined maximum detection time. Initial Results: Numeric results do NOT appear on Stored Data List screen—the system displays *** . * ERR 4 code appears on Stored Data Graphic Display screen and Micro Analysis printout Possible Causes: Coagulopathies or medications that cause prolonged clotting times Buffer onboard the instrument is cold—should be at room temperature ERR 4: Analysis Time Over Learn about actions to take for ERR 4. Actions to take: Check sample for anticoagulant contamination, hemolysis, lipemia, etc. Verify sample and reagent delivery. Set a longer maximum detection time (within the range of 100 to 600 sec) or run PTLong or PTX for PT Extended tests, and then re-analyze sample. If you obtain numeric results without an asterisk (*), report the results. If the error occurs again, the sample may not be capable of forming a firm clot. Follow your laboratory’'s alternative protocol. DO NOT report results without numeric values. When complete, select the X in the upper-right corner to close the window and continue. The system generates an ERR 8: Coagulation Curve Error (CCE) if unexpected curve fluctuations occur, such as a sudden rise or fall in light intensity. The system uses six checking methods to determine dH differences at specified points on the curve. On the coagulation curve shown here, the system detects a downward slanting section before the end of the reaction and generates ERR code 8. Initial Results: Numeric results do NOT appear on Stored Data List screen—the system displays *** . * ERR 8 code appears on Stored Data Graphic Display screen and Micro Analysis printout Possible Causes: Air bubble in reaction tube Samples with artifact, such as protein strands that remain after freezing and thawing plasma RBCs in the plasma, platelet clumps, or micro clots ERR 8 Learn about actions to take with ERR 8. Actions to take: Check sample for anticoagulant contamination, hemolysis, lipemia, etc. Verify sample and reagent delivery. Review results on the Micro Analysis printout. Re-analyze sample. If the repeat result is not flagged with an asterisk (*), report the result. For fibrinogen assays, run MDA Low. If the error occurs again, reprint the Micro Analysis printout and report the mean of the repeat and initial results at the 50% mark from both printouts as determined by your laboratory protocol if the curves are acceptable and both results are equivalent. DO NOT report results without numeric values. When complete, select the X in the upper-right corner to close the window and continue. The system generates an ERR 16: Turbidity Level Over error if the dH is greater than the threshold value at the maximum detection time. Initial Results: Numeric results do NOT appear on Stored Data List screen—the system displays *** . * ERR 16 code appears on Stored Data Graphic Display screen and Micro Analysis printout Possible Causes: Turbid or lipemic sample ERR 16: Turbidity Level Over Learn about actions to take for ERR 16. Actions to take: Check sample for anticoagulant contamination, hemolysis, lipemia, etc. Verify sample and reagent delivery. Re-analyze the sample. For Fbg and factor assays, dilute using Owren's veronal buffer. If the repeat result is not flagged with an asterisk (*), report the result. If the error occurs again, the sample may not be capable of forming a firm clot. Follow your laboratory’'s alternative protocol, such as ultracentrifugation to remove lipemia. DO NOT report results without numeric values. Note: Some alternative protocols may include using an ultracentrifuge to eliminate or reduce interferences such as lipemia in samples. Siemens Healthcare Diagnostics provides no data to support or contradict this approach. Results obtained from ultra-centrifuged samples must be validated by each laboratory. When complete, select the X in the upper-right corner to close the window and continue. The system generates an ERR 32: No Coagulation (NC) error if it is unable to detect a coagulation reaction. Initial Results: Numeric results do NOT appear on Stored Data List screen—the system displays *** . * ERR 32 code appears on Stored Data Graphic Display screen and Micro Analysis printout Possible Causes: Low fibrinogen, factor deficiencies, inhibitors Anticoagulant contamination, hemolysis, lipemia Reagent problem ERR 32: No Coagulation Learn about actions to take for ERR 32. Actions to take: Check sample for anticoagulant contamination, hemolysis, lipemia, etc. Verify sample and reagent delivery. Review previous patient history to determine acceptability of patient results. Re-analyze sample. If the repeat result is not flagged with an asterisk (*), report the result. For fibrinogen assays, run MDA Low. If the error occurs again, follow your laboratory’'s alternate protocol. DO NOT report results without numeric values. When complete, select the X in the upper-right corner to close the window and continue. The system generates an ERR 100: Range Over error if the clotting time at the 50% point is less than the minimum reportable time, i.e., the analysis result is outside the software-defined analysis range. Initial Results: Numeric results do NOT appear on Stored Data List screen—the system displays *** . * ERR 100 code appears on Stored Data Graphic Display screen and Micro Analysis printout Possible Causes: Lack of instrument maintenance Reagent contamination Fbg result less than or greater than laboratory-defined re-dilution limits, e.g., < 50 mg/dL or > 500 mg/dL PT or APTT results outside reportable ranges, e.g., PT <7 seconds or APTT <15 seconds ERR 100: Range Over Learn about actions to take for ERR 100. Actions to take: For fibrinogen assays, change the dilution ratio and re-analyze. For other assays, do the following: Verify sample and reagent delivery, and inspect instrument condition. Review results on the Micro Analysis printout to check for clot formation. Re-analyze sample. If the repeat result is not flagged with an asterisk (*), report the result. If the error occurs again, visually inspect reaction tube for clot formation or follow your laboratory's alternative protocol, such as using a manual tilt tube method. DO NOT report results without numeric values. Note: Remember the manual tilt tube method to visually detect clot formation? This tried-and-true method is still a valid option to confirm the early presence of a clot. When complete, select the X in the upper-right corner to close the window and continue. The system generates an ERR 128 Early Reaction Error (ERE) if a clotting reaction occurs too early—or too slowly! The system uses four checking methods to detect EREs, and generates an additional error code for each type of ERE detected: ERE 1, ERE 2, ERE 3, and ERE 4. In the ERR 128 ERE 4 example shown here, the system checked the angle of the reaction curve using dH measurements at 4 and 8 seconds and determined that difference between these two values exceeded a set limit, which means that the reaction occurred too early. Initial Results: The system will either flag a numeric result or display *** . * on the Stored Data List screen—it depends on the ERE code The system will display both ERR 128 and individual ERE codes on the Micro Analysis printout Possible Causes: Abnormal sample Reagent problem ERR 128: Early Reaction Error Learn about actions to take for ERR 128. Actions to take: Check sample for anticoagulant contamination, hemolysis, lipemia, etc. Verify sample and reagent delivery. Review results on the Micro Analysis printout to check for clot formation and determine the type of ERE code. Re-analyze sample. If the repeat result is not flagged with an asterisk (*), report the result, as determined by your laboratory protocol. If the error occurs again, review results on the Micro Analysis printout to check for clot formation and determine the ERE code. If ERE 4, report the result if the clotting time result correlates with the coagulation curve, and repeat results match initial results at the 50% detection point. If results do not correlate, redraw sample and/or follow laboratory protocol. If not ERE 4, redraw sample and/or follow laboratory protocol. DO NOT report results without numeric values. When complete, select the X in the upper-right corner to close the window and continue.