External quality assessment scheme for blood coagulation.

The aim of setting an External Quality Assessment Scheme (EQAS) for Blood Coagulation is to achieve a harmonization among the participating laboratories on blood coagulation testing. In Indonesia EQAS for blood coagulation is organized by the Department of Clinical Pathology, Faculty of Medicine, University of Indonesia which cooperates with the Indonesian Society of Clinical Pathologists, Jakarta Chapter. Currently coagulation tests in Indonesia are only performed in a limited number of laboratories especially in the hospital. Therefore only 65 laboratories participated in the first trial of EQAS. The control material for EQAS was provided by Organon Teknika and parameters involved in the first trial were PT, INR, APTT, and fibrinogen. Currently there are 7 brands of reagents for coagulation tests available in the market, i.e.: Behring, Biomerieux, Biopool, Human, Nycomed, Organon, and Ortho. In the evaluation, the results of each participant were compared to the median of participants who used the same reagent. If the number of participants using a given reagent was less than 10, then the result of each participant was compared to the median of overall participants. The result of a given parameter was classified as within consensus if it fell into the range of median +/- 15%. In the overall evaluation, the percentage of participants which was classified as within consensus for PT, INR, APTT, and fibrinogen were 68%, 64%, 63%, and 67%, respectively, but the CV for PT, INR, APTT, and fibrinogen were 19.84%, 17.89%, 20.21%, and 23.96% respectively. In the evaluation of participating laboratories using Behring's reagent, the percentages of participants classified as within consensus for PT, INR, APTT, and fibrinogen were 72%, 82%, 54%, and 74%, respectively. For Organon's product users, the percentages of those parameters were 84.6%-90%, 48%-75%, 86%, and 67%, respectively. It is concluded that around two-thirds of overall participating laboratories achieved harmonization in the results of coagulation test, but the variation of all parameters is still wide.

Country report: Clinical chemistry in Indonesia.

Seven hundred clinical laboratories in all over 27 provinces in Indonesia participated the Indonesian External Quality Assurance Scheme (Program Nasional Pemantapan Kualitas Laboratorium Kesehatan bidang Kimia Klinik). Among those laboratories, the government laboratory account for 288 (41%), and the rest 412 (59%) are private laboratories. Automatic analyzer was used by approximately 22% of the participating laboratories. Seventeen analytes were included in the program: bilirubin, cholesterol, creatinine, glucose, total protein, urea, uric acid, triglycerides, AST, ALT, calcium, albumin, alkaline phosphatase, gamma-GT, sodium, potassium, and chloride. Using WHO scoring system, median overall VIS of 128 was obtained. It means that the all over performance was fairly good . Bilirubin got the best median VIS (33). Sodium (median VIS 177), potassium (162) and chloride (209) got the worst VIS compared to the other parameters.

Country report: the Indonesian NEQAS on hematology. National External Quality Assessment Scheme.

Around six hundred clinical laboratories in all the province of Indonesia participated the Indonesian National External Quality Assessment Scheme (NEQAS) on Hematology (Program Nasional Pemantapan Kualitas Laboratorium Klinik bidang Hematologi). Automated analyzer gave better results compared to the manual method. For hemoglobin, the CV of automated analyzer and manual method were 2.8% and 9.1%, respectively. The CV of automated analyzer and manual method for leukocyte count were 8.3% and 32.3%; for erythrocyte count were 9.7% and 80.8%; and for thrombocyte count were 10.3% and 45.9%. We observe no significant improvement of the overall performance from 1986 to 1998. Quality control material for NEQAS on hematology is still a problem. The artificial particles seem not behave exactly like the human cells (leukocytes, thrombocytes).

PF3 activity in normal subjects and beta-thalassemia trait.

Platelet factor 3 (PF3) is a platelet membrane component that plays an important role in the activation of the coagulation mechanism. Whenever platelet activation occurred, PF3 is released and participates in thrombin formation. Erythrocyte membrane fraction has also some PF3 like activity, and in abnormal erythrocyte membrane disorders, eg thalassemia, some of the membrane fraction accelerates platelet activation by increasing the PF3 activity. Formerly it was difficult to measure the PF3 activity in plasma. Recently a sensitive chromogenic test to determine the PF3 activity, which could detect the changes in PF3 activity with time, was introduced. This study was done to observe the effect of abnormal erythrocyte on platelet activation. The results obtained using the chromogenic method are the following: whole blood taken from normal subjects showed OD 0.11 +/- 0.06 at 0 minutes after blood collection and then increased significantly (p < 0.01) to 0.21 +/- 0.10 after 90 minutes, while the platelet count did not differ significantly (p > 0.05). Those results showed that there were some platelet activation after 90 minutes as seen by the increased PF3 activity, with no significant change in platelet counts. In beta-thalassemic trait subjects the PF3 activity in whole blood at 0 minutes did not differ significantly compared to the normal subjects, but after 90 minutes it was significantly higher (p < 0.01), OD 0.52 +/- 0.35. However the PF3 in platelet rich plasma at 90 minutes did not increase. The platelet count after 90 minutes was significantly decreased (p < 0.01) This result suggest that the increase in PF3 activity was caused by the role of the abnormal erythrocytes.