	Red BLOOD CELLS
	Red blood cell count
	Hematocrit
	Red cell indices
	Erythrocyte sedimentation rate
	Reticulocyte count
	Osmotic fragility
	HEMOGLOBIN
	Total hemoglobin
	Fetal hemoglobin
	Hemoglobin electrophoresis
	Sickle cell test
	Unstable hemoglobin
	Heinz bodies
	Iron and total iron-binding capacity
	Ferritin
	Methemoglobin
	WHITE BLOOD CELLS
	White blood cell count
	White blood cell differential
	PLATELET ACTIVITY
	Bleeding time
	Platelet count
	Capillary fragility
	Platelet aggregation
	COAGULATION
	Activated partial thromboplastin time
	Prothrombin time
	Activated clotting time
	One-stage factor assay:Extrinsic coagulation system
	One-stage factor assay:Intrinsic coagulation system
	Plasma thrombin time
	Plasma fibrinogen
	Fibrin split products
	Plasma plasminogen
	Protein C
	Euglobulin lysis time
	D-Dimer
	International normalized ratio

International Normalized Ratio

The international normalized ratio (INR) system is viewed as the best means of standardizing measurement of prothrombin time to monitor oral anticoagulant therapy. It isn't used as a screening test for coagulopathies.

Purpose

To evaluate effectiveness of oral anticoagulant therapy.

Patient preparation

Explain to the patient that this test is used to determine the effectiveness of his oral anticoagulant therapy.
Tell the patient that a blood sample will be taken. Explain who will perform the venipuncture and when.
Reassure him that drawing a blood sample will take less than 3 minutes.

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Explain that he may feel slight discomfort from the tourniquet pressure and the needle puncture.

Procedure and posttest care

Perform a venipuncture, and collect the sample in a 7-ml blue-top tube.
If a hematoma develops at the venipuncture site, apply warm soaks.

Precautions

Completely fill the collection tube; otherwise, an excess of citrate appears in the sample.
Gently invert the tube several times to thoroughly mix the sample and the anticoagulant.
To prevent hemolysis, avoid excessive probing during venipuncture and handle the sample gently.
Put the sample on ice, and send it to the laboratory promptly.

Reference values

Normal INR for those receiving warfarin therapy is 2.0 to 3.0. For those with mechanical prosthetic heart valves, an INR of2.5 to 3.5 is suggested.

Abnormal findings

Increased INR values may indicate disseminated intravascular coagulation, cirrhosis, hepatitis, vitamin K deficiency, salicylate intoxication, uncontrolled oral anticoagulation, or massive blood transfusion.

Interfering factors

Failure to fill the collection tube completely, to adequately mix the sample and the anticoagulant, or to send the sample to the laboratory immediately.
Hemolysis due to excessive probing at the venipuncture site or to rough handling of the sample.

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