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    Evaluation of analytical quality of coagulation parameters by sigmametric methodology
    (Kare Publishing, 2023) Aksit M.; Colak A.; Basok B.I.; Aksit M.Z.; Fidan M.; Kazar M.; Altan T.K.
    Objectives: The total testing process in the laboratory is divided into pre-analytical, analytical, and post-analytical phases. Evaluating the quality of these phases and carrying out improvement studies will increase the quality of the healthcare system. In this study, we aimed to evaluate the analytical phase of the coagulation tests using the six-sigma methodology, which is a quality management tool that aims at zero error. Methods: The coefficient of variation (CV%) values were calculated from the two-level internal quality control (IQC) data between January and June 2022 of the coagulation tests (prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer). External quality control (EQC) data were retrieved from the EQC program of external quality assurance services and used in the calculation of bias %. Total allowable error (TEa) data were obtained from the database of international organizations. The sigma value for each parameter was calculated according to the formula “(TEa%–Bias %)/ CV%.” Results: Level 1 and level 2 sigma values were calculated as 4.41 and 2.93 for PT; 5.27 and 4.31 for aPTT; 2.72 and 2.73 for fibrinogen, and 4.36 and 4.08 for D-dimer. Conclusion: Among coagulation tests in which we evaluated their analytical performances using the six sigma methodology, PT (level 2) and fibrinogen (level 1 and 2) showed poor performance (sigma value <3). We decided to follow the tests with 13s /22s /R4s /41s /8x Westgard control rules. Using these tests improvement can be achieved in the analytical process, and the overall testing process may improve by performing pre-analytical, post-analytical, and analytical assessments. © 2023, Kare Publishing. All rights reserved.
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    Evaluation of coagulation parameters according to serum CRP levels in early stage COVID-19 patients
    (Kare Publishing, 2023) Kardesler S.; Bozdemir A.E.; Karakoyun I.; Arslan F.D.; Parildar H.; Yilmaz N.; Basok B.I.
    Objectives: An increase in the levels of inflammatory biomarkers is observed in coronavirus disease (COVID-19). Coagulopathy occurring during the course of the disease has also been associated with inflammation. In our study, we aimed to evaluate the coagulation parameters according to the severity of inflammation in patients with early stage COVID-19 disease. Methods: The study was carried out retrospectively in a third-level hospital between April 8 and August 20, 2020. The patients were divided into two groups according to polymerase chain reaction (PCR) results. Non-COVID-19 group consisted of 72 patients with negative, and COVID-19 group consisted of 247 patients with positive PCR results. According to the serum C-reactive protein (CRP) levels the COVID-19 patients were divided into three groups as follows: Group1 (CRP<10 mg/L; n=105), Group 2 (CRP 10-50 mg/L; n=72), and Group 3 (CRP >50 mg/L; n=70). Age, CRP, and coagulation parameters including fibrinogen, D-dimer, aPTT, and PT were compared between the groups. Results: There were significant differences between the non-COVID-19 and COVID-19 patients in terms of age, CRP and coagulation parameters. Likewise, there was a significant difference among 3 groups regarding coagulation parameters. In the multinomial logistic regression analysis, only level of D-dimer was an independent risk factor among all groups, while PT was an independent risk factor between Groups 1, and 3. Conclusion: Our findings suggest that coagulopathy occurs in the early stage in relation to the severity of inflammation. For the diagnosis of COVID-19 disease and the detection of thrombotic complications; it is important to monitor results of the coagulation tests along with markers of inflammation from the early stages of the disease. © 2023, Kare Publishing. All rights reserved.
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    The use of new generation small-volume blood collection tubes for complete blood count
    (Kare Publishing, 2023) Bozdemir A.E.; Arslan F.D.; Basok B.I.; Copur S.; Yilmaz N.O.; Akar H.
    Objectives: Newborns and especially patients with malignancy develop frequently iatrogenic anemia based on phle-botomy. The use of blood collection tubes with small-volume may reduce the need for blood transfusion and the associated risks due to frequent phlebotomy. Therefore, we evaluated the reliability and accuracy of the complete blood count (CBC) using new generation small-volume blood collection tubes (SV-BCT) instead of large-volume blood collection tubes (LV-BCT). Methods: Venous blood samples were taken from 40 adult in-patients and collected to SV-BCT/LV-BCT pairs of three different brand (Microtainer®MAP-0.5 ml/Vacutainer®-2.0 ml; Becton, Dickinson and Company, USA) ([Microvette®-0.5 mL/S-Monovette®-2.6 ml; Sarstedt Ag and Co. KG, Germany]) ([MiniCollect®Complete-0.5 ml/Vacuette®-2.0 ml; Greiner Bio-One GmbH, Austria]). All tubes contained K2EDTA except Microvette®. Sixteen parameters of CBC were analyzed using a DxH 800 (Beckman Coulter Inc., USA). CBC results in tube pairs were compared in terms of statistical and clinical (bias%) significance. Results: There were statistically significant differences between the results of SV-BCT and LV-BCT pairs of the same brands for some parameters. However, bias% between tubes for 16 parameters was within the desirable limits, the differences were not clinically significant. Conclusion: Health personnel and phlebotomists can safely prefer SV-BCT which is a new generation and technically useful for CBC, especially in patients requiring frequent phlebotomy. Thus, the volume of blood sampling may be reduced to prevent iatrogenic blood loss. © 2023, Kare Publishing. All rights reserved.