Laboratory results that predict arterial thrombosis.

This focus section reviews the laboratory markets now available for predicting the risk of cardiovascular disease. The three most often ordered are: fibrinogen, described by David Golec of Esoterix Coagulation; homocysteine, reviewed by Paige Macy of Esoterix Coagulation; and high-sensitivity C-reactive protein, reviewed by George Fritsma of the University of Alabama at Birmingham coagulation service. Following is a brief review of cardiovascular disease.

High sensitivity C-reactive protein.

Though there is no apparent relationship between CRP and cardiovascular disease, the hsCRP may be the most effective single marker of disease among otherwise healthy adults, and is certainly an effective marker when employed in combination with other proven markers such as fibrinogen, homocysteine, and lipid assays. The hsCRP test may not be particularly useful among inpatients, however, as it is typically elevated in acute inflammatory disease. In addition to its apparent ability to predict the risk of cardiovascular disease, the hsCRP test points the way to further identification of risk markers.

Hematologic effects of thrombophilia.

The hematologic effects of thrombophilia are subtle, and when recognized may provide clues for the diagnosis of hypercoagulation in patients. This article identifies aberrant, routine test results associated with the diagnosis of thrombophilia. The future expansion of laboratory testing for thrombophilia detection is presented in summation.

Educators' responsibilities in implementing the ADA.

The Americans with Disabilities Act (ADA) prohibits educational programs from discriminating against academically qualified applicants with disabilities and requires each academic program to develop a list of essential requirements for the program. This article describes how the ADA affects educational programs. It also presents a sample list of essential requirements for radiologic science education programs that supports ADA requirements. Documenting the essential requirements is in the best interests of the program and its students, providing a defensible basis for student admissions and the measurement of academic progress.

Essential requirements for clinical laboratory science.

OBJECTIVE: To present a sample list of essential requirements for clinical laboratory science (CLS) education that support the requirements of the Americans with Disabilities Act (ADA). The essential requirements provide a basis for student admission and academic progress measurement. DATA SOURCES: Over 700 articles have appeared in various professional and trade journals on the impact of the ADA since it was signed in 1990. DATA EXTRACTION: Literature review. DATA SYNTHESIS: The ADA prohibits discrimination against academically qualified program applicants with disabilities, and requires a list of essential requirements, distinct from academic requirements and distinct from essential functions of jobs, for each academic program. Essential requirements, also called technical standards or functional expectations, are task and attribute-based criteria that define their educational program. Applicants and students must possess or be able to achieve the essential requirements directly or through reasonable accommodations. CONCLUSION: By July 1994, all educators must have been prepared with defensible essential and academic requirements that reflect the needs of their programs, and with appropriate processes for managing applications, academic progress, and program completion that promote equal educational opportunity for qualified individuals with disabilities.

Detection of anticardiolipin antibody in patients with cocaine abuse.

Anticardiolipin antibody, an immunoglobulin that binds negatively charged phospholipids, is considered to be an in vitro inhibitor of clot-based coagulation procedures. We adapted an enzyme immunoassay using stationary cardiolipin antigen to compare anticardiolipin antibody activity in the plasma of 44 cocaine abusers with its activity in the serum of 72 blood donors and a sample of 203 random specimens from healthy volunteers. Activity of 20 of the 44 abusers and 43 of 203 random specimens exceeded the donor control reference range. Patients using intravenous cocaine were more likely to have elevated activity than those who inhaled (P less than 0.05). Of 7 patients who had seizures or thromboembolic disorders, 5 were anticardiolipin antibody positive. Enzyme immunoassay may have predictive value for ischemic disease in cocaine abusers.

Lupus-like anticoagulants and lower extremity arterial occlusive disease.

Lupus-like anticoagulants (LLA), lupus anticoagulant and/or anticardiolipin antibody, are increasingly recognized in association with venous and arterial thrombotic events. We recently reviewed our experience with patients undergoing revascularization for lower-limb ischemia who were found to have LLA. Nine patients had LLA based on a prolongation of the partial thromboplastin time or by anticardiolipin assay by an enzyme-linked immunosorbent assay system. The ages of the patients ranged from 23 to 57 years. There were seven (78%) men, six (67%) blacks, two (22%) diabetic patients, and three (33%) hypertensive patients. One patient had systemic lupus erythematosus. All patients except one were cigarette smokers. Four patients had concurrent regulatory protein abnormalities: three protein C deficiencies, one protein S deficiency, and one plasminogen deficiency. The nine patients had 10 lower-extremity arterial reconstructions with two postoperative failures within 30 days. Patients were anticoagulated with heparin or aspirin after all but one operation. Patients at risk were identified on the basis of age (less than 51 years), unexplained early graft thrombosis, or history of venous or arterial thrombotic events. This group of patients is believed to be at risk for early postoperative thrombosis. Postoperative anticoagulation after revascularization for patients with LLA may be beneficial.

Vitamin E and autoxidation.

Vitamin E refers to a family of fat-soluble phenolic compounds called tocopherols, which have been established as essential nutrients in vertebrates. In animals the deficiency state has resulted in diminished reproductive capabilities, muscular dystrophy, exudative diathesis, megaloblastosis, gastrointestinal and pulmonary degeneration, and nephrosis. In humans with low vitamin E levels a subclinical diminished erythrocyte life-span has been demonstrated by hydrogen peroxide hemolysis test. This effect may have clinical significance among premature infants. The metabolic function of vitamin E appears to be as a scavenger of lipid peroxides and free oxygen radicals which enter into chain reactions to cause breakdown of lipids. Normal levels of the vitamin serve to prevent this cellular oxidative breakdown. Laboratory measurement of vitamin E is chromatographic, with HPLC presently used in both research and clinical applications. The association between vitamin E levels and hemolytic anemia in humans is currently under investigation.

Control mechanisms in platelet activation.

Those activation stages that are energy dependent rely upon a complex control mechanism involving the interaction of platelet thrombasthenin, free ionic calcium, cyclic AMP and the prostaglandins. This article describes the feedback mechanisms inherent in these controls, and the sources, activities and degradation of all control materials. Particular attention is paid to the prostaglandins and their activating enzymes, both within the dense tubular system of the platelet and the cytoplasm of endothelial cells. The implications of the prostaglandin pathway for both therapy and laboratory diagnosis are explored.

A review of platelet function and testing.

Platelet function testing is an area of recent growth and development in clinical laboratories. Additions to classical testing procedures include aggregation and retention tests and measurement of platelet release products. The necessity exists for understanding platelet structure and function. In this paper, the various platelet structures are demonstrated, their composition is described, and their individual contribution to platelet activation discussed. Platelet activation is described in four phases: adhesion, reversible contraction, aggregation, and release. Each is described in relationship to the others and laboratory test procedures marking each are described. The question of the relationship of measurement of platelet release markers to clinical condition is reviewed.

A career mobility option within a university integrated medical technology program.

Career mobility has become an increasingly important movement influencing the education of allied health professionals in recent years. With the advent of intermediate levels of professionals in several allied health fields, career mobility can facilitate the advancement of careers for many of these health professionals.

Determining continuing education interests of medical technologists: an initial step.

Continuing education is an ever-increasing need for medical technologists who want to maintain and upgrade their professional knowledge and skills. Professional groups strive to develop programs to meet a diversity of needs. Planning groups often encounter difficulty during the program development process as they identify topics and select effective educational strategies for presentation. In order to help identify topics of interest and desirable educational methods for the continuing education of laboratory personnel, a continuing medical technology education interest assessment tool was developed and used by a medical technology continuing education committee. Development and use of this assessment tool and resulting statistical survey results formed the basis for two continuing education courses, both considered highly successful.

Urinalysis by modular learning.

A self-instructional approach to the entry-level presentation of urinalysis in a written modular format was used by a class of medical laboratory technician students. The course consisted of 13 modules based upon behavioral objectives. The modules used no audio or visual media but required "hands-on" performance of laboratory procedures. The achievements of a test sample of 12 students were compared with those of a previous class in which the same material was presented in lectures. Evaluation by written tests given to both classes showed no statistical difference. The self-instructed students performed adequately in their practical laboratory work, but the overall learning time was increased by 50 percent when self-pacing was used. A measurement questionnaire revealed that the students preferred instructor-led courses to self-instructional units for a variety of reasons which lead to some further considerations.