Hemorrhage remains one of the leading causes of preventable death in trauma and critical illness, underscoring the need for immediate laboratory guidance for intervention. The challenge for today’s laboratories is to not only generate accurate results, but also deliver the right information quickly enough to guide care in real time. When a patient is actively bleeding, the clock is not just ticking — it’s accelerating. Yet many laboratories still operate within frameworks optimized for accuracy over speed, which leaves a critical gap in the care of actively bleeding patients.
To bridge this gap, we must change the mindset around coagulation testing in these scenarios, shifting our focus from precision to speed with a result “accurate enough” to guide management and change outcomes. Labs should also keep in mind that some of the most effective approaches are also the simplest — targeted testing strategies that employ outside-of-the-box approaches to prioritize speed, clinical relevance, and changes in sample workflow.
Utilizing common tests
The emergency hemorrhage panel at our institution provides information about hemostasis using four widely available tests: prothrombin time, hematocrit, fibrinogen, and platelet count. This panel provides swift answers to clinicians who are caring for actively bleeding patients and need to know promptly whether the hemostasis parameter is above or below the threshold for replacing the required component.
When implementing this panel, the lab should collaborate with clinicians to ensure that testing is limited to patients who are actively bleeding and that samples are delivered to the central laboratory in a timely manner. Evidence suggests that such streamlined approaches can achieve turnaround times well under 20 minutes when workflows are optimized and testing is prioritized appropriately (
1).
Another evolving area is the assessment of anticoagulant status in urgent scenarios. Direct oral anticoagulants (DOACs) are increasingly encountered in emergency settings, where their presence can dramatically influence clinical decisions. Although these medications do not require routine monitoring, the ability to rapidly detect them in urgent situations — such as active bleeding or emergency surgery — can be critical.
However, traditional quantitative assays for DOACs are not yet widely available. As an alternative, laboratories can use widely available tests such as thrombin time and anti-Xa to provide qualitative assessment of anticoagulant presence with a faster turnaround time (
2).
Striking a balance
It is critical that coagulation tests remain within the central laboratory, where trained staff can identify preanalytical issues, such as hemolysis or inadequate tube filling, that could falsely skew results. To that end, achieving a balance between accuracy and speed requires the laboratory director to serve as a key liaison between the clinical frontline and the laboratory bench. The director must ensure that laboratory staff understand the clinical context: that in an emergency, the goal is not a perfect analytical value, but a rapid, reliable result centered on the thresholds that drive immediate management changes.
Together, these challenges highlight a broader shift in laboratory medicine: moving toward testing strategies that are not only accurate, but also timely, targeted, and aligned with clinical need. This shift involves reexamining established workflows, challenging assumptions about testing priorities, and engaging more directly with clinical teams. It also calls for practical solutions — approaches that labs can implement in real-world settings without needing entirely new technologies and resources.
Innovation in laboratory medicine does not always require new tools. Sometimes, it just means using the available tools and reconfiguring their use while balancing speed, accuracy, and workflows. In the end, when minutes matter, strategy matters just as much.
Interested in learning more? Attend the ADLM 2026 roundtable, “All you need is blood: Strategic laboratory solutions to rapid assessment of hemostasis in emergency situations,” on Monday, July 27 in Anaheim, California. Find out more at meeting.myadlm.org.
References
- Chandler WL, Ferrell C, Trimble S, et al. Development of a rapid emergency hemorrhage panel. Transfusion 2010; doi: 10.1111/j.1537-2995.2010.02753.x.
- Wong S, Slingerland J, Dickerson JA, et al. Development of a rapid qualitative screen for anticoagulant presence. J Appl Lab Med 2024; doi: 10.1093/jalm/jfad081.
Cristina Figueroa Villalba, MD, is an assistant professor in the department of laboratory medicine and pathology at the University of Washington School of Medicine in Seattle. She also serves as the medical director of the apheresis program and the associate medical director of the transfusion medicine service at Seattle Children’s Hospital. +Email: [email protected]
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