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Technology And Trends Of Coagulation Analyzers

In the recent past with increase in screening tests and therapeutic monitoring of hemostasis, many new innovative techniques have been introduced for coagulation analyzers. Broadly, coagulation analyzers can be divided into clinical laboratory and PoC analyzers. On the basis of technology, the three basic divisions are mechanical, optical, and electrochemical. Presently, optical technology is the most preferred technology. The common tests ordered by clinicians in prothrombin time coagulation analyzers have advanced from small single-channel semi-automated to four-channel fully automated instruments. Automation has revolutionized the workflow with modern complex coagulometers having high-throughput, reliability, flexibility, easy-to-use advanced software with in-built LJ graphs and calibration curves, improved accuracy, and precision with minimum human error in measurement. Standard labs want mid to large volume analyzers that can transmit data, directly or indirectly into software, then into their HIS and ultimately into their EMR systems.

Most analyzers use reagents that are standardized across lines, have accessory software, providing automatic validation for patient results. Pre-analytical sample integrity check, advanced automated mixing studies, automated platelet aggregation, clot waveform analysis, automatic testing (re-run), and reflex testing are few advancements limited to few latest coagulometers. The expansive test menu includes assay for Protein C, Protein S, APC resistance, and various other factors. The principle utilized by a coagulometer may be clotting or chromogenic substrate factor assay. In addition, D-dimer can be tested on analyzers based on the immunoturbidimetric method or ELISA. Light transmission aggregometry (LTA) is regarded as the gold standard of platelet function testing. Platelet aggregometry is limited by hematocrit and platelet count range. It does not require sample preparation, a time consuming process, needed in LTA. PoC coagulation analyzers or coagulation monitoring devices for anticoagulation therapy are used to generate timely results like electrochemical testing, for example PT/INR. Activated clotting time (ACT) is a test used in cardiopulmonary bypass which is used to detect change in the optical density of fibrin. ROTEM (rotational thromboelastometry) and TEG (thromboelastography) are PoC technologies which provide real-time analysis of the viscoelastic properties of clot formation and thereby diagnosis and treatment of bleeding during cardiac surgery and other intraoperative procedures.

India is undergoing a paradigm shift in healthcare with quality and timely affordable service to all. This will bring a manifold increase in the usage of coagulometers. The next-generation coagulation analyzers are likely to be more compact and smartly designed with added parameters according to new anticoagulants and more specialty tests according to the need of the hour. Future PoC coagulation devices are likely to be electrochemical microfluidic multiplexed biosensor platforms.

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