Impact of COVID-19 Pandemic on the Quality and Performance of Haemostasis Laboratories

R.A. Arisz¹, P. Meijer², N.CV Péquériaux³, S.J van de Leur⁴, M.V Lukens⁵, M.PM de Maat¹, M.J Hollestelle²

¹Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, ²ECAT Foundation (External quality Control for Assays and Tests), Voorschoten, Netherlands, ³Department of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 's Hertogenbosch, Netherlands, ⁴Department of Laboratory Medicine, Isala Hospital, Zwolle, Netherlands, ⁵Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands

Abstract Number: PB0205

Meeting: ISTH 2021 Congress

Theme: COVID and Coagulation » COVID and Coagulation, Clinical

Background: The high incidence of thrombotic events in patients with COVID-19 affects healthcare worldwide and results in an increased workload in haemostasis laboratories. Especially D-dimer, haemostatic parameters and anti-Xa tests are expected to be analysed more frequently. However, the impact of this increase in assay requests on the quality of performance in haemostasis laboratories remains unclear.

Aims: To evaluate the impact of the COVID-19 pandemic on the quality performance and management of haemostasis laboratories.

Methods: The impact on the quality of performance was studied using external quality assessment (EQA) data from 2019 and 2020 derived from ECAT surveys. A questionnaire was sent to Dutch haemostasis laboratories to identify challenges and management strategies during the COVID-19 pandemic with focus on D-dimer, anti-Xa, factor VIII and fibrinogen. Furthermore, the number of assays performed in 2019 and 2020 was collected from four Dutch hospitals, located in regions with different disease incidence.

Results: No differences in response rate nor the quality of the measurements were observed between the EQA surveys in 2019 and 2020 (Table 1). Fifty-five percent of the laboratories observed a more than 25% increase in test requests for anti-Xa and D-dimer assays in 2020 compared to 2019. Twenty-seven percent also experienced this increase in requested fibrinogen assays. Additionally, 84% of the respondents indicated to experience increased work pressure and increased absenteeism in 71% of the participating laboratories was observed. Evaluation of the number of assays performed over the year showed extreme peaks in anti-Xa assays (144 – 772%) in all four hospitals and D-dimer assays (368%, 670%) in the two hospitals that are located in areas with high disease incidence.

	CV (%)
	Pre-COVID19	COVID19
	Mean ± SD	Mean ± SD	p value
Fibrinogen (g/L)	6.8 ± 1.3	8.1 ± 1.4	n.s.
D-dimer (mg/L)	10.0 ± 3.0	9.4 ± 2.3	n.s.
Factor VIII (%)	8.1 ± 1.4	10.5 ± 4.3	n.s.
Anti-Xa (UFH) (IU/mL)	6.5 ± 1.5	7.3 ± 3.9	n.s.
Anti-Xa (LMWH) (IU/mL)	10.2 ± 4.2	10.0 ± 3.9	n.s.
CV, between participants coefficient of variation of two similar samples derived from two different surveys n.s., not significant difference between pre-COVID19 and COVID19

Comparison of international external quality data of haemostasis variables

Conclusions: The enormous increase in work pressure and test requests, especially for D-dimer assays and anti-Xa activity, did not affect the quality of performance within haemostatic laboratories during the COVID-19 pandemic.

To cite this abstract in AMA style:

Arisz RA, Meijer P, CV Péquériaux N, J van de Leur S, V Lukens M, PM de Maat M, J Hollestelle M. Impact of COVID-19 Pandemic on the Quality and Performance of Haemostasis Laboratories [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/impact-of-covid-19-pandemic-on-the-quality-and-performance-of-haemostasis-laboratories/. Accessed September 21, 2023.

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