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Activator Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Activator and links to relevant pages within the course.

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Authentic and Spurious Causes of Thrombocytopenia
Disseminated Intravascular Coagulation (DIC)

DIC is a condition that is usually secondary to an underlying disease or condition. Some of the activators of DIC are sepsis, placenta abruptio, snake bites, toxin, trauma, graft vs. host disease, and burns.The mechanisms that are involved in DIC include a hyperactivated coagulation system, a hyperactivated fibrinolytic system, or both simultaneously. In most cases the coagulation factors are consumed as soon as they are made and platelets are also consumed in the coagulation process. Clots are made rapidly and then rapidly destroyed as the fibrinolytic system is hyperactivated.

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Dermal Puncture and Capillary Blood Collection
Order of Draw

The order of draw for a capillary blood collection is slightly different than the order of draw for a venous blood collection.If capillary blood gases are ordered, they are drawn first to avoid introduction of room air as much as possible. A specimen for blood count is collected before tubes containing other anticoagulants and additives. This is to ensure that the blood will not begin to clot before this specimen is collected; clots will affect the accuracy of the blood count. The following order of draw is commonly used: ContainerAdditiveUseLavender topEDTAFor hematology blood countsGreen top Lithium heparinTests that require a heparinized plasma sample__Other tubes containing anticoagulantsVariedRed or gold topClot activatorTests that require a serum sampleRed top No additiveTests that require a serum sample but clot activator and/or gel may affect test

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Fundamentals of Hemostasis
Collecting Blood Specimens for Coagulation Testing

Venous blood specimens for coagulation assays should be collected into a tube containing 3.2% buffered sodium citrate tube (blue top tube), yielding a whole blood sample with a 9:1 blood to anticoagulant ratio. Inadequate filling of the collection tube will decrease this ratio, and may affect test results.A blue top tube used for coagulation testing should be drawn before any other tubes containing additives. This includes tubes containing other anticoagulants and/or plastic serum tubes containing clot activators. A serum tube that does not contain an additive can be collected before the blue top tube.If a winged blood collection set is used in drawing a specimen for coagulation testing, a discard tube should be drawn first. The discard tube must be used to fill the blood collection tubing dead space to assure that the proper anticoagulant/blood ratio is maintained, but the discard tube does not need to be completely filled. The discard tube should be a nonadditive or a coagulation tube.If a blood specimen used for coagulation testing must be collected from an indwelling line that may contain heparin, the line should be flushed with 5 mL of saline, and the first 5 mL of blood, or 6 times the line volume (dead space volume of the catheter), be drawn off and discarded before the coagulation tube is filled.

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Coagulation Disorders

This course began with a discussion on homeostasis, the body's desire to maintain a status of physiological equilibrium. Our inborn system of chemical checks and balances, activators and inhibitors, can be disrupted by numerous factors, two of the more common being acquired disease states and disorders passed on to offspring via inheritance. In regard to coagulation, both disease status and genetics can adversely affect the functionality of many hemostatic processes. Impaired hemostatic mechanisms, whether acquired or inherited, may cause either hemorrhage or thrombosis.Hemorrhage (bleeding external to the vasculature) most often stems from physical vessel trauma, but may also arise from a wide variety of disease states.Thrombosis does not require physical trauma, and is the activation of hemostatic processes at an inappropriate time in an inappropriate place, and may arise from a number of inherited or acquired disease states. The following pages are intended to serve as an introduction to some of the more commonly encountered coagulation disorders.

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Metabolic Syndrome
Adipokines Significant to Metabolic Syndrome

The adipokines that will be discussed on the following pages include: Tumor necrosis factor-alpha (TNF-a) Interleukin 6 (IL-6) Plasminogen activator inhibitor-1 (PAI-1) Adiponectin Angiotensinogen Leptin Resistin

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PAI-1

PAI-1 is a cytokine responsible for much of the prothrombotic state associated with metabolic syndrome. PAI-1 regulates the formation of thrombi by promoting formation of thrombin, platelet aggregation, and fibrin. PAI-1 inhibits fibrinolysis by blocking the activity of tissue-type plasminogen activator. PAI-1 is synthesized and released from the liver and adipocytes.PAI-1 is increased in obesity, is associated with insulin resistance, and is an early inflammatory predictor of type 2 diabetes.

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Risk Factors

According to the American Heart Association, the risk factors for metabolic syndrome include:Abdominal obesity (excessive fat tissue in and around the abdomen) Atherogenic dyslipidemia (blood fat disorders – high triglycerides, low HDL cholesterol and high LDL cholesterol – that foster plaque buildups in artery walls) Elevated blood pressure Insulin resistance or glucose intolerance (the body can't properly use insulin or blood sugar) Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood) Proinflammatory state (e.g., elevated high sensitivity C-reactive protein in the blood) Reference: Metabolic syndrome.The American Heart Association website. Available at:http://www.heart.org/HEARTORG/Conditions/More/MetabolicSyndrome/Metabolic-Syndrome_UCM_002080_SubHomePage.jsp#. Accessed December 5, 2011.

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Routine Venipuncture
Order of Draw

Blood collection tubes must be filled in a specific order to avoid specimen contamination from the additive in the preceding tube. The following order of draw is an accepted laboratory standard. 1. Tubes or bottles for blood cultures 2. Light-blue top tubes (sodium citrate) 3. Serum tubes (with or without clot activator) 4. Green top tubes (sodium or lithium heparin) 5. Lavender or pink top tubes (Potassium EDTA) 6. Gray (Sodium fluoride and sodium or potassium oxalate)

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Blood Collection Tubes

Most blood collection tubes contain an additive that either accelerates clotting of the blood (clot activator) or prevents the blood from clotting (anticoagulant). A tube that contains a clot activator will produce a serum sample when the blood is separated by centrifugation and a tube that contains an anticoagulant will produce a plasma sample after centrifugation. Some tests require the use of serum, some require plasma, and other tests require anticoagulated whole blood. The table below lists the most commonly used blood collection tubes.Tube cap colorAdditiveFunction of AdditiveCommon laboratory testsLight-blue3.2% Sodium citratePrevents blood from clotting by binding calciumCoagulationRed or gold (mottled or "tiger" top used with some tubes is not shown)Serum tube with or without clot activator or gelClot activator promotes blood clotting with glass or silica particles. Gel separates serum from cells.Chemistry, serology, immunologyGreenSodium or lithium heparin with or without gelPrevents clotting by inhibiting thrombin and thromboplastinStat and routine chemistryLavender or pinkPotassium EDTAPrevents clotting by binding calciumHematology and blood bank GraySodium fluoride, and sodium or potassium oxalateFluoride inhibits glycolysis, and oxalate prevents clotting by precipitating calcium.Glucose (especially when testing will be delayed), blood alcohol, lactic acid

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