Establishing a direct laboratory access program.

Direct Laboratory Access (DLA) refers to a program whereby individuals who wish to have laboratory testing performed can avail themselves of such testing independently of a physician referral. DLA benefits both physicians and consumers. Physicians benefit by not having to invest time and office resources for consumers who do not seek medical intervention but rather who visit physicians for the sole purpose of obtaining permission to have laboratory tests performed.

Heparin anticoagulation during cardiopulmonary bypass in an antithrombin-III deficient patient. Implications relative to the etiology of heparin rebound.

A case of antithrombin-III (AT-III) deficiency was diagnosed on the basis of a diminished anticoagulant effect following the administration of heparin for cardiopulmonary bypass. The clinical evaluation and interpretation of a diminished response to heparin is discussed, as are considerations relative to the treatment of AT-III deficient persons whose disorder is not manifest until they are already anesthetized for cardiovascular bypass. The implications of AT-III deficiency relative to the mechanism of heparin rebound are also discussed.

Computer-assisted heparin monitoring.

Heparin monitoring during procedures involving cardiopulmonary bypass using the Bull protocol has been programmed using a microcomputer. The program displays the in-vivo heparin tolerance curve and the patient's effective plasma heparin level along this curve. It calculates the incremental dose of heparin necessary to achieve effective anticoagulation throughout the procedure.