Emmanuel FavaloroInstitute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital · Haematology
Emmanuel Favaloro
BSc (Hons), PhD, FFSc (RCPA)
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905
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Introduction
Additional affiliations
October 2022 - December 2022
March 2020 - present
January 1981 - present
Publications
Publications (905)
Sticky platelet syndrome (SPS) is a plausible but often disputed condition that is said to reflect hereditary platelet hyperreactivity that can potentially lead to a prothrombotic risk. SPS is strongly believed in by a small cohort of some very active research teams, but is met with general skepticism by the majority of mainstream thrombosis resear...
ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13), also called von Willebrand factor (VWF) cleaving protease, acts as a moderator of VWF activity. ADAMTS13 cleaves VWF multimers, thereby reducing VWF activity in blood. When ADAMTS13 is absent (e.g., in patients with TTP [thrombotic thrombocytopenia purpura...
We accessed five of the most widely used, freely available generative artificial intelligence tools available on the Web on July 29, 2024, formulating the specific question: ‘Which are the leading risk factors for venous thrombosis?’ (the term ‘venous thrombosis’ was preferred to ‘venous thromboembolism’ as it is likely more familiar to patients)....
Hemostasis describes the process of blood clotting homeostasis. Hemostasis reflects a balance of procoagulant and anticoagulant mechanisms that aim to prevent both bleeding and thrombosis. If hemostasis is disrupted, and bleeding or thrombosis occur, then laboratory testing may ensue to either diagnose the reason for bleeding or thrombosis, or to m...
Background: The use of laboratory resources has seen a substantial increase in recent years, driven by automation and emerging technologies. However, inappropriate use of laboratory testing, encompassing both overuse and underuse, poses significant challenges.
Content: This review explores the complex interplay between patient safety, economic, an...
Although further studies are needed, preliminary findings suggest the possible clinical efficacy of heparin in improving post-traumatic stress disorders (PTSD) symptoms, and potentially averting subsequent thrombotic sequalae. Regardless of the mechanistic relationship between heparin and the pathogenesis of PTSD, there are some plausible biologica...
Objectives
Our objective was to maintain low interlaboratory variation and bias in international normalized ratio (INR) results following a network change in instrumentation and reagents, using a process of ongoing standardization and harmonization.
Methods
Network-wide standardization to new common instrument and reagent platforms followed by net...
The healthcare systems are a prime target for cyber-attacks due to the sensitive nature of the information combined with the essential need for continuity of care. Medical laboratories are particularly vulnerable to cyber-attacks for a number of reasons, including the high level of information technology (IT), computerization and digitization. Base...
The risk of developing venous thromboembolism is considerably high during an acute SARS-CoV-2 infection, tends to decrease over time, but remains higher than in people without COVID-19 for months afterwards. Nevertheless, recent clinical studies have convincingly shown that this trend could be at least partially reversed. In particular, the risk of...
The Task Force Preparation of Labs for Emergencies (TF-PLE) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has conducted a specific survey to determine the current state-of-the art on cyber-attacks of laboratory medicine in Europe. The first three questions concerned respondents' familiarity with malware, cyber-atta...
Coronavirus disease 2019 (COVID-19) occurs as a result of infection by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) virus. COVID-19 shows high morbidity and mortality rates, in part determined by various factors and the presence of other comorbidities. To reduce infection rates, help prevent COVID-19, and reduce COVID-19 related m...
Viscoelastic testing is increasingly being used in clinical and research settings to assess hemostasis. Indeed, there are potential situations in which viscoelastic testing is reportedly superior to standard routine laboratory testing for hemostasis. We report the current testing platforms and terminology, as well as providing a concise narrative r...
This first and perhaps most important aspect is that the occasional finding of a prolonged APTT, especially in hospitalized patients, cannot necessarily be attributed to preanalytical problems, whereas APTT values may instead reflect a real ex vivo (sometimes prothrombotic) state. In this context, the question also arises whether we should use the...
Despite the small sample size of these studies and the lack of randomized clinical trials specifically addressing the risk of developing VTE in the prone versus supine position during mechanical ventilation, preliminary results suggest that prone positioning may contribute to increase an already elevated risk of developing venous thrombosis in COVI...
Introduction
Direct oral anticoagulants (DOACs) reflect anticoagulation agents given to treat or prevent thrombosis, having largely replaced vitamin K antagonists (VKAs) such as warfarin. DOACs are given in fixed daily doses and generally do not need monitoring. However, there may be a variety of reasons that justify measurement of plasma DOAC leve...
Supplementary material to Algorithm for DOAC Disptick in Emergency Care
We once again thank all the authors to this latest issue of “Editorial Compilations” for their original and comprehensive contributions, and we hope our readership enjoys this latest installment in this series.
D-dimers represent the breakdown products of fibrin. Thus, elevated plasma D-dimers will arise following a thrombotic event, such as a deep vein thrombosis or a pulmonary embolism, and therefore, a nonelevated D-dimer is used to effectively exclude such events. D-dimers are also elevated in a range of other conditions, for example, during dissemina...
Lupus anticoagulant (LA) represents 1 of the laboratory criteria for classification of patients as having definite antiphospholipid syndrome (APS). The other 2 laboratory criteria are anticardiolipin antibodies and anti–beta2-glycoprotein I antibodies. At least 1 of these antiphospholipid antibody (aPL) tests need to be positive, with evidence of p...
Due to their widespread use, testing for direct oral anticoagulants (DOACs) has become urgent in certain clinical situations. Screening based on widely available, rapid, and simple hemostasis assays such as prothrombin time, activated partial thromboplastin time, or even diluted Russel Viper venom time may provide sufficient evidence of “overcoagul...
Unfractionated heparin (UFH) reflects a commonly used anticoagulant. UFH is widely utilised for a variety of reasons, including (i) to anticoagulate patients and help treat and/or prevent thrombosis, (ii) to maintain patency in artificial blood circuits, and (iii) to anticoagulate select blood samples collected for laboratory testing (typically for...
Coronavirus disease 2019 (COVID-19) is frequently associated with thrombo inflammation, which can predispose to developing of life-threatening conditions in children such as the multisystem inflammatory syndrome (MIS-C) and Kawasaki disease. Because of the consistent overlap in pathogenesis and symptoms, identifying laboratory tests that may aid in...
Objectives:
There is limited information on the influence of collecting small amounts of blood on the quality of blood gas analysis. Therefore, the purpose of this study was to investigate the effects of different degrees of underfilling of syringes on test results of venous blood gas analysis.
Methods:
Venous blood was collected by venipuncture...
Direct oral anticoagulants (DOACs) cause unwanted interference in various hemostasis assays, including lupus anticoagulant (LA) testing, where false positive and false negative identification may occur. DOAC Stop (DS) is an activated charcoal (AC) product used to specifically and effectively adsorb DOACs from test plasma. This process normally requ...
One of the hallmarks of coronavirus disease 2019 (COVID-19), particularly in complicated cases (i.e., requiring hospitalization or intensive care support), is persistent hemostasis activation, which may be associated with a vast array of thrombotic episodes involving both the arterial and venous systems. The renewed emphasis on the relationship bet...
A State of the Art lecture titled “D-dimer Diagnostics: Can I use any D-dimer assay? Bridging the Knowledge-to-Action gap” was presented at the International Society on Thrombosis and Haemostasis Congress in 2023, included in the session on the clinical impact of variability in commonly used coagulation assays. Here, we review the role of D-dimer,...
Offers detailed assistance in the diagnosis and management of bleeding disorders
Includes extensive coverage of rare disorders and the challenges that they pose
Provides up-to-date guidance on use of the latest treatment options and new products
von Willebrand disease (VWD) is the most common congenital bleeding disorder with a potential incidence of 1% of the general population. The disorder is classified into three main types: type 1 and type 3 as (respectively, partial and complete) quantitative deficiency of von Willebrand factor (VWF) and type 2 (with qualitative VWF defects). The ble...
Several international guidelines provide recommendations around the use of D-dimer testing for exclusion of pulmonary embolism (PE), including the appropriate D-dimer threshold (or cutoff), but there is no consensus amongst them. We briefly discuss guideline variation, performance characteristics and limitations of commercially available D-dimer as...
According to the evidence emerged from our analysis of recent US data, we found that mortality for PE seems to peak in the cooler months (particularly December and January), followed by a considerable decline between February and September. April and June were found to be the months with lower PE-related deaths.
Lupus anticoagulant (LA) is one of three tests identified as laboratory criteria for definite antiphospholipid syndrome (APS). The other two tests are anticardiolipin antibody (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibody. The presence of LA is assessed using clot-based tests, while the presence of aCL and aβ2GPI is assessed by immunological a...
Classification criteria can be used to diagnose APS, but clinicians should not restrict the diagnosis of APS to only these Classification criteria. Indeed, we would recommend not using classification criteria for diagnosis of APS, unless that patient is planned for inclusion in a clinical trial. Instead, clinicians should be guided by other expert...
Background: The EFLM Task Force Preparation of Labs for Emergencies (TF-PLE) created a survey that has been distributed to its members for gathering information on the key hazards experienced by European medical laboratories during the COVID-19 pandemic.
Methods: The survey was distributed to over 12,000 potential contacts (laboratory workers) via...
We once again thank all the authors to this latest issue of “Editorial Compilations” for their original and comprehensive contributions, and we hope our readership enjoys this
latest instalment in this series.
The use of artificial intelligence (AI) has become widespread in many areas of science and medicine, including laboratory medicine. Although it seems obvious that the analytical and post-analytical phases could be the most important fields of application in laboratory medicine, a kaleidoscope of new opportunities has emerged to extend the benefits...
Antiphospholipid syndrome (APS) is a hypercoagulable state caused by antiphospholipid antibodies (aPL). APS clinically manifests with arterial or venous or microvascular thrombi and/or pregnancy complications. It is well-known that the development of aPL can be a transient phenomenon and thus the current diagnostic criterion for APS requires repeat...
Objectives:
Because there is little published evidence on the effects of incomplete filling of K2EDTA evacuated blood tubes on routine hematological testing, this original study aimed to provide updated information on this preanalytical aspect.
Methods:
The study population consisted of 17 ostensibly healthy volunteers. Blood was drawn by venipu...
This survey includes a series of questions about the nature, organization, and preparedness for emergencies, was created using Google forms, officially mailed to over 12,000 potential EFLM contacts with an official newsletter to collect responses between May 8 and June 8, 2023. Although obviously not representative of all European countries, the co...
Background: The EFLM Task Force Preparation of Labs for Emergencies (TF-PLE) created a survey that has been distributed to its members for gathering information on the key hazards experienced by European medical laboratories during the COVID-19 pandemic. Methods: The survey was distributed to over 12,000 potential contacts (laboratory workers) via...
Background. Because there is little published evidence on the effects of incomplete filling of K2EDTA evacuated blood tubes on routine hematological testing, this original study aimed to provide updated information on this preanalytical aspect.
Materials and Methods. The study population consisted of 17 ostensibly healthy volunteers. Blood was draw...
This year's Congress of the International Society of Thrombosis and Haemostasis (ISTH) took place in person in Montréal, Canada, from June 24-28, 2023. The conference, held annually, highlighted cutting-edge advances in basic, translational, population and clinical sciences relevant to the Society. As for all ISTH congresses, we offered a special,...
von Willebrand disease (VWD) is considered the most common bleeding disorder and arises from deficiency and/or defect in the adhesive plasma protein von Willebrand factor (VWF). Diagnosis of VWD requires clinical assessment and is facilitated by laboratory testing. Several guidelines for VWD diagnosis exist, with the latest American Society of Hema...
Platelets are central elements of hemostasis and also play a pivotal role in the pathogenesis of thrombosis in coronavirus disease 2019. This study was planned to investigate the effects of different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) recombinant spike protein variants on platelet morphology and activation. Citrated whole...
Long-coronavirus disease 2019 (COVID-19) represents a heterogeneous clinical syndrome characterized by a pathologic continuum of signs, symptoms, and also
laboratory/radiologic abnormalities that may persist for a long time after recovering
from an acute severe acute respiratory syndrome-coronavirus disease 2 infection.
Among the various components...
There are typically three phases identified as contributing to the total testing process. The preanalytical phase starts with the clinician and the patient, when laboratory testing is being considered. This phase also includes decisions about which tests to order (or not), patient identification, blood collection, blood transport, sample processing...
Hemostasis laboratories play a crucial role in the diagnosis and treatment of individuals with bleeding or thrombotic disorders. Routine coagulation assays, including the prothrombin time (PT)/international normalized ratio (INR), and activated partial thromboplastin time (APTT), are used for various purposes. These include as a screen of hemostasi...
Thrombotic thrombocytopenic purpura (TTP) is a prothrombotic condition caused by a deficiency of ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13). In turn, ADAMTS13 (also called von Willebrand factor (VWF) cleaving protease (VWFCP)) acts to cleave VWF multimers and thus reduce plasma VWF activity. In the...
Thrombotic thrombocytopenic purpura (TTP) is a prothrombotic condition caused by a significant deficiency of the enzyme, ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13). In the absence of adequate levels of ADAMTS13 (i.e., in TTP), plasma VWF accumulates, in particular as "ultra-large" VWF multimers, and...
Heparin-induced thrombocytopenia (HIT) represents an autoimmune process whereby antibodies are formed against heparin in complex with platelet factor 4 (PF4) after heparin administration. These antibodies can be detected by a variety of immunological assays, including ELISA (enzyme-linked immunosorbent assay) and by chemiluminescence on the AcuStar...
Hemostasis is a complex but balanced process that permit normal blood flow, without adverse events. Disruption of the balance may lead to bleeding or thrombotic events, and clinical interventions may be required. Hemostasis laboratories typically offer an array of tests, including routine coagulation and specialized hemostasis assays used to guide...
Antiphospholipid (antibody) syndrome (APS) is a prothrombotic condition with increased risk for thrombosis and pregnancy-related morbidity. In addition to clinical criteria related to these risks, APS is characterized by the persistent presence of antiphospholipid antibodies (aPL), as detected in the laboratory using a potentially wide variety of a...
Activated protein C resistance (APCR) reflects a hemostatic state defined by a reduced ability of activated protein C (APC) to affect an anticoagulant response. This state of hemostatic imbalance is characterized by a heightened risk of venous thromboembolism. Protein C is an endogenous anticoagulant that is produced by the hepatocytes and undergoe...
Antiphospholipid antibodies (aPL) represent a group of autoantibodies directed against phospholipids. These antibodies may arise in a number of autoimmune conditions, of which the antiphospholipid (antibody) syndrome (APS) is best recognized. aPL can be detected by various laboratory assays, essentially comprising both solid-phase (immunological) a...
von Willebrand factor (VWF) is a large adhesive plasma protein that expresses several functional activities. One of these activities is to bind coagulation factor VIII (FVIII) and to protect it from degradation. Deficiency of, and/or defects in, VWF can give rise to a bleeding disorder called von Willebrand disease (VWD). The defect in VWF that aff...
von Willebrand disease (VWD) is the most commonly reported inherited bleeding disorder and may alternatively occur as an acquired von Willebrand syndrome (AVWS). VWD/AVWS develops from defects and/or deficiency in the adhesive plasma protein von Willebrand factor (VWF). VWD/AVWS diagnosis/exclusion remains challenging because of the heterogeneity o...
ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) is also called von Willebrand factor (VWF) cleaving protease (VWFCP). ADAMTS13 acts to cleave VWF multimers and thus reduce plasma VWF activity. In the absence of ADAMTS13 (i.e., in thrombotic thrombocytopenia purpura, TTP), plasma VWF can accumulate, in pa...
Harmonization and standardization of laboratory tests and procedures carry a variety of benefits. For example, within a laboratory network, harmonization/standardization provides a common platform for test procedures and documentation across different laboratories. This enables staff to be deployed across several laboratories, if required, without...
Introduction: The coagulation cascade thrives as the haematological gatekeeper ensuring equilibrium between blood flow and thrombosis. Under pathological conditions, the positive-feedback loops compound upon one another, disrupting this equilibrium and increasing the risk of thrombosis and embolic events. Cardiac thromboembolism persists as the cul...
Introduction:
Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially fatal microangiopathy, with an untreated mortality rate of around 90%. TTP is caused by severe deficiency in ADAMTS13, which results in accumulation of ultra large von Willebrand factor multimers, triggering a consumptive thrombocytopenia, microangiopathic hemolytic...
Hemostasis can be defined as a homeostatic process in which the body attempts to minimize loss of blood by balancing out pro- and anti-procoagulant forces [...]
Background:
Anti-platelet factor 4 (PF4) antibodies in vaccine-induced immune thrombotic thrombocytopenia (VITT) appear to be transient, with discrepant persistence depending on the platform used for detection.
Objectives:
We aimed to report a longitudinal study of antibody persistence using 2 ELISA platforms and 2 platelet-activating functional...
The von Willebrand factor (VWF) collagen binding (VWF:CB) assay was first reported for use in von Willebrand diagnostics in 1986, by Brown and Bosak. Since then, the VWF:CB has continued to be used to help diagnose von Willebrand disease (VWD) (correctly) and also to help assign the correct subtype, as well as to assist in the monitoring of VWD the...
Welcome to the latest issue of Seminars in Thrombosis and Hemostasis (STH) published under the “banner” of “Editorial Compilation,” with this being the thirteenth such issue. Although Seminars in Thrombosis and Hemostasis is historically a theme-driven publication, ongoing opportunities emerge to disseminate wide-ranging contributions of current in...
There is no certainty in change, other than change is certain. As Seminars in Thrombosis and Hemostasis celebrates 50 years of publication, I felt it appropriate to reflect on my own 40-year plus scientific career. My career in the thrombosis and hemostasis field did not start until 1987, but the subsequent 35 years reflected a period of significan...
Heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombotic thrombocytopenia (VITT) are rare, iatrogenic immune-mediated conditions with high rates of thrombosis-related morbidity and mortality. HIT is a long-recognized reaction to the administration of the common parenterally administered anticoagulant heparin (or its derivatives)...
Introduction:
: Unfractionated heparin remains the most widely used agent in the prevention and acute treatment of thrombosis. Pharmacological complexities of this intriguing agent mandate frequent monitoring of its anticoagulant properties to maintain safe and effective hematological outcome. Although activated partial thromboplastin time has bee...
Welcome to another issue of Seminars in Thrombosis and Hemostasis (STH), published under the “banner” of “Maintaining hemostasis and preventing thrombosis in coronavirus disease 2019 (COVID-19),” this being Part IV, or the fourth such volume. The first three issues were, respectively, published in 2020, 2021, and 2022, and proved very popular with...
Hemostasis reflects a homeostatic mechanism that aims to balance out pro-coagulant and anti-coagulant forces to maintain blood flow within the circulation. Simplistically, a relative excess of procoagulant forces can lead to thrombosis, and a relative excess of anticoagulant forces can lead to bleeding. There are a wide variety of congenital disord...
Parenteral anticoagulants are a class of anticoagulants that need to be administered non-orally, usually by injection or infusion. There are a variety of such agents, but heparin reflects the most frequently used. Being alerted to an error in a prior publication in which the word 'parenteral' was inadvertently replaced by the word 'parental', it be...
For more than a decade, US laboratories have failed to implement solutions to help their clinicians in managing complex situations or patients on DOACs. The problem may find different origins among which the position of the Food and Drug Administration, which categorized these drugs as monitoring‐ and measurement‐free, while other regulatory bodies...