Hemostasis practice: state-of-the-art
Hemostasis disorders are typically classified as either hemorrhagic or thrombotic. Irrespective of the nature and underlying causes, the diagnostic approach to patients with hemostasis disturbances is multifaceted and involves accurate collection of clinical history taking and physical examination, as also combined with results of an appropriate number and type of laboratory investigations, which can be arbitrarily classified as first-line (i.e., screening), second-line (i.e., for the etiological diagnosis) and third-line (i.e., for biochemical or even molecular characterization) analyses. This possible classification actually mirrors that of laboratory services, which are now increasingly organized in “spoke” (i.e., peripheral), “hub” (i.e., core) and reference facilities. Albeit many supranational initiatives are underway to improve quality throughout the total hemostasis testing process, several important issues still plague this important branch of laboratory medicine, including the relatively modest knowledge that many laboratory professionals have of hemostasis in health and disease, the unacceptable heterogeneity of available diagnostic algorithms for both diagnosis and therapeutic management of hemostatic diseases, the inaccurate definition of reference ranges, the identification and communication of critical values, as well as the still unsatisfactory harmonization of many preanalytical, analytical and postanalytical procedures.