Abstract:
A point-of-test diagnostic chip that is capable of simultaneous evaluation of blood coagulation time (INR Value) and hematocrit level. A finger prick volume of blood is placed at the inlet of the device, and the residual vacuum contained within the device provides a pressure gradient to drive the flow of whole blood. The INR value is determined by the distance the blood traverses down the channel before it coagulates. The channel is primed with tissue factor and phospholipids to induce coagulation. A control channel is primed with anticoagulants for use as a way to normalize initial loading times. The hematocrit level is determined by sedimentation of blood cells into a trench and the interface between blood cells that have overfilled the trench and plasma provide a visual readout.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a 35 U.S.C. §111(a) continuation of PCT international application number PCT/US2013/057663 filed on Aug. 30, 2013, incorporated herein by reference in its entirety, which claims priority to, and the benefit of, U.S. provisional patent application Ser. No. 61/695,932 filed on Aug. 31, 2012, incorporated herein by reference in its entirety. Priority is claimed to each of the foregoing applications. 
         [0002]    The above-referenced PCT international application was published as PCT International Publication No. WO 2014/036484 on Mar. 6, 2014, which publication is incorporated herein by reference in its entirety. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0003]    Not Applicable 
       INCORPORATION-BY-REFERENCE OF MATERIAL SUBMITTED ON A COMPACT DISC 
       [0004]    Not Applicable 
       NOTICE OF MATERIAL SUBJECT TO COPYRIGHT PROTECTION 
       [0005]    A portion of the material in this patent document is subject to copyright protection under the copyright laws of the United States and of other countries. The owner of the copyright rights has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the United States Patent and Trademark Office publicly available file or records, but otherwise reserves all copyright rights whatsoever. The copyright owner does not hereby waive any of its rights to have this patent document maintained in secrecy, including without limitation its rights pursuant to 37 C.F.R. §1.14. 
       BACKGROUND OF THE INVENTION 
       [0006]    1. Field of the Invention 
         [0007]    This invention pertains generally to blood sensing, and more particularly to blood coagulation time and hematocrit level sensing. 
         [0008]    2. Description of Related Art 
         [0009]    The administration of anticoagulants has become a routine healthcare tool to prevent and combat a number of patient health problems. The prescription of oral anticoagulants (e.g. coumarins, direct thrombin inhibitors, etc.) is typically used as a long-term prophylaxis to prevent thrombosis in a number of “chronic” situations. For example, this includes patients with long-term health concerns such as atrial fibrillation, past episodes of embolism or stroke, inherited/acquired thrombophilic disorders, and surgeries such as those involving prosthetic heart valve replacement, coronary artery stent implantation, or orthopedic surgery (e.g. knee or hip replacements). 
         [0010]    As a result of the widespread use of anticoagulants, 2.5 million Americans now rely on blood thinners annually. However, the most commonly used oral anticoagulants, coumarins, have a number of adverse side effects that require continual blood monitoring and alteration of the drug dosage administered to the patient. The activity of coumarins, which are vitamin K antagonists, responds to a number of factors such as diet (foods high in vitamin K, cranberries, green vegetables), liver, kidney, and thyroid dysfunction, alcohol, several herbs and spices, and many commonly used drugs such as aspirin and certain antibiotics. Consequently, in  2005  the International Self-Monitoring Association for Oral Anticoagulation reviewed and advocates for the increased practice of patient self-testing as a means to counter the variability in initial dose selection and stabilization, as well as long-term difficulties in maintaining anticoagulant stability. Among the benefits of self-monitoring were improved quality of life, greater cost-effectiveness, patient education, and a decreased risk of death from hemorrhage. 
         [0011]    Unfortunately, the self-management of coagulation has not become a commonplace phenomenon as it has been with the use of glucose monitors to manage diabetes. A number of self-monitors are available on the market, such as the Roche CoaguChek and the HemoSense INRatio, yet these devices cost between $500-$2,000. In contrast, glucose monitors cost two orders of magnitude less and can generally be purchased for less than $20. A number of variables are at fault for this price differential. One aspect is that some coagulation monitors rely on more expensive technology like the CoaguChek, which detects the proteolytic cleavage of a fluorescent peptide. However, other monitors such as the INRatio, which electrochemically measures a change in impedance due to clot formation, are much cheaper and similar technologies to a glucose monitor, but still cost ˜$500. 
         [0012]    It is suspected that slow user adoption has not created a sustainable market that can survive upon small profit margins, thus the exorbitantly inflated price of blood monitors. To compound this issue, patient self-testing occurs on a monthly to weekly basis. This is a stark contrast to diabetics who test on a daily basis, perhaps as many as 3-10 times per day, thus using more consumables. In order for the self-monitoring of blood coagulation to become widespread, a cheap and more basic product that emulates a pregnancy lateral flow assay may drastically improve adoption. Even though pregnancy tests are used infrequently, their simplicity and robustness enable widespread accessibility. 
         [0013]    Accordingly, an object of the present invention is a blood coagulation chip with attributes that are more similar to a lateral flow assay than to a glucose monitor. 
       BRIEF SUMMARY OF THE INVENTION 
       [0014]    One aspect of the present invention is a point-of-test diagnostic chip to simultaneously determine blood coagulation time (INR Value) and hematocrit level. The chip is configured to be a simple, disposable device that can be cheaply mass fabricated using hot embossing or injection molding techniques. 
         [0015]    In one embodiment, a finger prick volume of blood is placed at the inlet of the device, and the residual vacuum contained within the device provides a pressure gradient to drive the flow of whole blood. The INR value is determined by the distance the blood traverses down the channel before it coagulates. The channel is primed with tissue factor and phospholipids to induce coagulation. A control channel is primed with anticoagulants for use as a way to normalize initial loading times. The hematocrit level is determined by sedimentation of blood cells into a trench and the interface between blood cells that have overfilled the trench and plasma provide a visual readout. 
         [0016]    Another aspect of the invention is to provide a self-management tool for people with chronic bleeding disorders or those who use oral anticoagulants as a long-term prophylaxis. The device may also be beneficial to physicians in the developing world and resource-limited areas. 
         [0017]    Further aspects of the invention will be brought out in the following portions of the specification, wherein the detailed description is for the purpose of fully disclosing preferred embodiments of the invention without placing limitations thereon. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING(S) 
         [0018]    The invention will be more fully understood by reference to the following drawings which are for illustrative purposes only: 
           [0019]      FIG. 1  is a schematic diagram of a self-loading, polymeric blood coagulation chip configured to simultaneously measure hematocrit and prothrombin time (INR value). 
           [0020]      FIG. 2  is an image demonstrating a top view of the self-powered plasma skimming trench in accordance of the present invention. 
           [0021]      FIG. 3  is a schematic diagram of the trench of  FIG. 2 . 
           [0022]      FIG. 4A  is a schematic diagram of the interface between transparent plasma and blood as a result of the plasma skimming trench during partial fractionalization. 
           [0023]      FIG. 4B  is a schematic diagram of the plasma skimming trench to yield the hemocrit level. 
           [0024]      FIG. 5  is a schematic view of the back side of the polymeric blood coagulation chip of  FIG. 1 . 
           [0025]      FIG. 6  is a top view schematic diagram of an exemplary self-loading, polymeric blood coagulation chip comprising a two-layer device with one of the layers comprising trenches for blood cell sedimentation and large vacuum reservoirs. 
           [0026]      FIG. 7  is a side view schematic diagram of the self-loading, polymeric blood coagulation chip of  FIG. 6 . 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0027]      FIG. 1  shows a schematic diagram of a self-powered, disposable blood coagulation chip  10  that is configured to simultaneously monitor both coagulation time and hematocrit. Prothrombin time (PT) measures the clotting tendency of blood by way of the extrinsic coagulation pathway, and is the most common technique used to determine the International Normalized Ratio (INR). The dosage level of anticoagulant that is administered to a patient is determined with the INR, with lower values indicating a risk of unwanted clotting. 
         [0028]    Additionally, blood coagulation chip  10  comprises an integrated sensor for measurement of hematocrit, which is an important indicator of homeostasis in blood. Hemorrhage is the most common side affect of anticoagulants as doctors tend to favor prescribing a higher dosage and an abnormal hematocrit level, as measured on our blood chip, would indicate the presence of internal bleeding. As many as 6% of patients taking anticoagulants report annual incidents of major hemorrhage and the additional monitoring of hematocrit would act as a valuable tool to help alert to any unknown internal bleeding. 
         [0029]    In the embodiment shown in  FIG. 1 , the inventive self-powered blood chip  10  is fabricated out of a transparent, nanoporous polymer base or substrate  12 . In a prototype embodiment, the polymer polydimethylsiloxane (PDMS) was used for the substrate  12 . However, it is envisioned other polymers that are known in the art and particularly suitable for mass fabrication, may be employed. 
         [0030]    The chip  10  is preferably vacuum packaged (not shown) so that the polymer  12  nanopores retain the vacuum for a period of time (e.g. up to 15 minutes or more) after the packaging is opened. Chip  10  comprises an on board lancet  14  (which may be retractably housed within substrate  12  with spring  16 ) that is configured to pierce the skin  28  to create a blood droplet for sampling. The blood sample may then be placed on orifice  15  that is coupled to individual dead-end channels and may be employed  22 ,  24 , and  26  via an inlet or feeding channel  18 , all of which are disposed inside the chip  10 . A pressure gradient between the atmosphere and the residual vacuum inside the chip  10  drives blood flow into the inlet channel  18  and up channel  22  to measure the PT/INR, channel  26  to measure hematocrit, and channel  24  to act as a control. 
         [0031]    Referring also to  FIG. 2 , PT/INR is measured by the distance (shown as furthest extent  64 ) in which the blood flows down the length of the control channel  24  and PT/INR, channel  26 . This is based on the premise that blood with a lower INR value will travel a shorter distance. 
         [0032]    In a preferred embodiment, the extrinsic pathway of channel  22  is infused with one or more initiator agents or reagents  60  (e.g. tissue factor (III), phosphatidylcholine, and/or phosphatidylserine) that are physio-adsorbed onto the sidewalls of the channel  22  to initiate clotting. The initiator agents  60  may be loaded via sacrificial inlet ports (not shown) that are permanently sealed after chip preparation and subsequent lyophilization enables long-term storage. The reagents  60  are reconstituted upon blood flow into the channel  22 . 
         [0033]    Since the time the user waits before blood injection after opening the vacuum sealed packaging will impact the distance the blood will travel (e.g. via a decay in the vacuum within the chip  10 ), a control channel  24  is used as an end point reference. This control channel  24  contains an agent or reagent  66  (e.g. lyophilized anticoagulant) that is formulated to prevent clot formation. Indicia, markings  52  are positioned adjacent both the control channel  24  and INR channel  22  to quantify the values of the visible endpoint distances ( 62 ,  64 ) the blood travels down the control channel  24  and INR channel  22 , respectively. The two endpoint distances  62 ,  64  of the control channel  24  and INR channel  22  have a non-linear correlation with the actual INR value. Accordingly, a chart (e.g. a table in accompanying documents, or table  70  printed on the backside of the substrate  12  (see  FIG. 5 )) may enable determination of the actual INR value  76  based upon the values for the control  62  and INR  64  distances (shown in  FIG. 1  as having values of 1.5 and 1.3, respectively). 
         [0034]    Referring now to  FIG. 2  and  FIG. 3 , hematocrit is measured via a trench  20  that utilizes gravity-based sedimentation to skim plasma from the blood  30  flowing into the inlet channel  18  of the chip  10 . Hematocrit is determined by partially removing a known volume of cells from blood  30  and allowing the channel  26  to fully load. The interface  40  between transparent plasma  38  and blood  30 , measured from the end of the channel  26 , yields the hematocrit value. 
         [0035]      FIG. 2  shows an image demonstrating a top view of an exemplary self-powered plasma skimming trench  20  in accordance of the present invention. Blood  30  from inlet  18  enters trench  20 , where the trench  20  is configured to overflow, thus creating an observable interface  40  between blood  30  and the transparent plasma  38 .  FIG. 3  shows a schematic diagram of the trench  20  of  FIG. 2  with the plasma  38  interface with air. 
         [0036]      FIG. 4A  shows a schematic diagram of the interface between transparent plasma  38  and blood  30  as a result of the plasma skimming trench during partial fractionalization. White blood cells  32  and red blood cells  34  are separated from the platelets  36  in the plasma  38 .  FIG. 4B  shows a schematic diagram of the plasma skimming trench  20  illustrating the blood  30  and plasma  38  interface  40  to yield the hemocrit level in channel  26 . 
         [0037]    The known trench  20  volume can be compared to the plasma  38  volume, as measured from the end of the dead-end channel  26 . Thus, the distance in which this interface  40  travels downstream within channel  26  generally corresponds to the hematocrit level. Markers/indicia  50  printed on the substrate  12  facilitate the user making a reading of the hemocrit value. 
         [0038]      FIG. 6  and  FIG. 7  illustrate top and side view schematic diagrams of an exemplary self-loading, polymeric blood coagulation chip  80  in accordance with the present invention. Chip  80  is shown as a two-layer substrate  82 , which may be both approximately 100 μm in height. The first layer  92  may comprise trenches (channels)  84 ,  86  and  88  for INR, control, and hemocrit measurements, respectively, that are enclosed by layer  90 . Referring to the side view of  FIG. 7 , trench  20  for blood cell sedimentation, large vacuum reservoirs comprising inlet channel  18  and channels  84 ,  86  and  88 , as well as inlet port  15  are shown. 
         [0039]    The self-loading, polymeric blood coagulation chip  10 / 80  described above and illustrated in  FIG. 1  through  FIG. 7  is robust. It&#39;s porous polymeric substrate  12  can ideally withhold vacuum for years and all reagents  60 ,  62  are lyophilized, reconstituted by the blood introduced into the device. Different storage and packaging techniques may be used to generate the internal vacuum and maximize shelf life. The differential loading pressure between the atmosphere and the residual vacuum in the chip  10 / 80  may also be dependent upon atmospheric conditions and altitude. Such loading may be assessed in various conditions, and variations of the chip  10 / 80  may be used according to variable applications at altitude levels above (or below) sea level. 
         [0040]    While the chip  10 / 80  is preferably shown above as a hybrid sensor for simultaneously measuring blood characteristics such as INR and hematocrit via an inlet channel that is bifurcated into separate channels  22 ,  24  and  26 , it is appreciated that separate chips may be employed to individually measure specific characteristics. E.g. a first chip (not shown) may simply comprise channel  26  and trench  20  coupled to inlet channel  18  and opening  15  to measure hemocrit, and a second chip (not shown) may merely comprise control channel  24  and INR channel  22  coupled to inlet channel  18  and opening  15  to measure INR. Furthermore, the hybrid sensor chip  10 / 80  illustrated in  FIG. 1  through  FIG. 7  above may also incorporate additional channels to include measurements of other physiological characteristics of the sample blood  30 . 
         [0041]    In summary, the present invention provides a solution to the adoption of self-management for individuals who chronically rely on orally administered anticoagulants. The self-loading, polymeric blood coagulation chip  10 / 80  of the present invention augments self-testing through the development of a cheap, disposable tool to simultaneously measure INR and hematocrit values. We aim to decrease hospital visitation and laboratory diagnostic costs, increase patient education through self-monitoring, and aid in the adoption and practice of self-management for oral anticoagulants. 
         [0042]    Although the description herein contains many details, these should not be construed as limiting the scope of the invention but as merely providing illustrations of some of the presently preferred embodiments of this invention. Therefore, it will be appreciated that the scope of the present invention fully encompasses other embodiments which may become obvious to those skilled in the art. 
         [0043]    From the discussion above it will be appreciated that the invention can be embodied in various ways, including the following: 
         [0044]    1. An apparatus for measuring one or more physiological characteristics of a blood sample, the apparatus comprising: a substrate; a hematocrit measurement channel disposed within the substrate; the hematocrit measurement channel comprising a first closed end and a second end coupled to an orifice for receiving the blood sample; and a plasma skimming trench between the second end of the hematocrit measurement channel and the orifice; wherein the plasma skimming trench is configured to skim plasma from the blood sample flowing into the hematocrit measurement channel to generate a visible interface between the skimmed plasma and the blood sample; and wherein the location of the interface when the blood sample is fully loaded in said hematocrit measurement channel is indicative of the hematocrit level of the blood sample. 
         [0045]    2. An apparatus as in any of the previous embodiments, further comprising: one or more markings on the substrate adjacent to the hematocrit measurement channel; wherein the location of the interface with respect to the one or more markings indicate a value corresponding to the hematocrit level of the blood sample. 
         [0046]    3. An apparatus as in any of the previous embodiments: wherein the trench is configured to generate gravity-based sedimentation to skim plasma from the blood sample; and wherein the hematocrit level is a function of sedimentation of blood cells into the trench and the interface between blood cells that have overfilled the trench and the plasma. 
         [0047]    4. An apparatus as in any of the previous embodiments, further comprising: an inlet channel in communication with the orifice and hematocrit measurement channel; wherein the substrate comprises a self-loading, porous polymeric chip configured to be sealed under vacuum to generate a vacuum within the inlet channel; and wherein a residual vacuum remains within the inlet channel such that the blood sample placed at the orifice is drawn into the hematocrit measurement channel by a pressure gradient between the atmosphere and the residual vacuum. 
         [0048]    5. An apparatus as in any of the previous embodiments: wherein the polymeric chip is configured to be packaged in a vacuum sealed container to maintain the vacuum within the inlet channel; and wherein when the polymeric chip is configured such that when the vacuum sealed container is opened, a residual vacuum is maintained within in the inlet channel and hematocrit measurement channel. 
         [0049]    6. An apparatus as in any of the previous embodiments, further comprising: a prothrombin time (PT) measurement channel disposed within the substrate; the PT measurement channel comprising a first closed end and a second end coupled to the inlet channel; wherein the residual vacuum is configured to draw the blood sample into the PT measurement channel to measure PT (INR value) associated with the blood sample. 
         [0050]    7. An apparatus as in any of the previous embodiments, wherein the self-loading, porous polymeric chip is configured to simultaneously measure hematocrit and PT (INR value). 
         [0051]    8. An apparatus as in any of the previous embodiments, wherein the PT measurement channel comprises one or more coagulant reagents configured to initiate clotting of the blood sample. 
         [0052]    9. An apparatus as in any of the previous embodiments, wherein INR value is determined by the distance the blood sample traverses down the PT measurement channel before it coagulates. 
         [0053]    10. An apparatus as in any of the previous embodiments, wherein the one or more coagulant reagents comprise one or more of the following agents that are physio-adsorbed into the PT channel: tissue factor (III), phosphatidylcholine, and phosphatidylserine. 
         [0054]    11. An apparatus as in any of the previous embodiments, further comprising: a control measurement channel coupled to the inlet channel; wherein the residual vacuum is configured to draw the blood sample into the control measurement channel to provide an end-point reference. 
         [0055]    12. An apparatus as in any of the previous embodiments, wherein the control channel comprises an anticoagulant reagent configured to prevent clotting of the blood sample. 
         [0056]    13. An apparatus as in any of the previous embodiments: wherein the one or more coagulant reagents and anticoagulant reagent are lyophilized prior to packaging; and wherein the reagents are reconstituted upon contact with the blood sample. 
         [0057]    14. An apparatus for measuring one or more physiological characteristics of a blood sample, the apparatus comprising: a substrate; a prothrombin time (PT) measurement channel disposed within the substrate; the PT measurement channel being configured to measure PT (INR value) associated with the blood sample; the PT measurement channel comprising a first closed end and a second end coupled to an orifice for receiving the blood sample; and wherein INR value is determined by the distance the blood sample traverses down the PT measurement channel before it coagulates. 
         [0058]    15. An apparatus as in any of the previous embodiments, further comprising: one or more markings on the substrate adjacent to the PT measurement channel; the one or more markings indicative of the INR value. 
         [0059]    16. An apparatus as in any of the previous embodiments, further comprising: an inlet channel in communication with the orifice and PT measurement channel; wherein the substrate comprises a self-loading, porous polymeric chip configured to be sealed under vacuum to generate a vacuum within the inlet channel; and wherein a residual vacuum remains within the inlet channel such that the blood sample placed at the orifice is drawn into the PT measurement channel by a pressure gradient between the atmosphere and the residual vacuum. 
         [0060]    17. An apparatus as in any of the previous embodiments: wherein the polymeric chip is configured to be packaged in a vacuum sealed container to maintain the vacuum within the inlet channel; and wherein when the polymeric chip is configured such that when the vacuum sealed container is opened, a residual vacuum is maintained within the inlet channel and PT measurement channel. 
         [0061]    18. An apparatus as in any of the previous embodiments, wherein the PT measurement channel comprises one or more coagulant reagents configured to initiate clotting of the blood sample. 
         [0062]    19. An apparatus as in any of the previous embodiments, wherein the INR value is determined by the distance the blood sample traverses down the PT measurement channel before it coagulates. 
         [0063]    20. An apparatus as in any of the previous embodiments, wherein the one or more coagulant reagents comprise one or more of the following agents that are physio-adsorbed into the PT channel: tissue factor (III), phosphatidylcholine, and phosphatidylserine. 
         [0064]    21. An apparatus as in any of the previous embodiments, further comprising: a control measurement channel coupled to the inlet channel; wherein the residual vacuum is configured to draw the blood sample into the control measurement channel to provide an end-point reference. 
         [0065]    22. An apparatus as in any of the previous embodiments, wherein the control channel comprises an anticoagulant reagent configured to prevent clotting of the blood sample. 
         [0066]    23. An apparatus as in any of the previous embodiments: wherein the one or more coagulant reagents and anticoagulant reagent are lyophilized prior to packaging; and wherein the reagents are reconstituted upon contact with the blood sample. 
         [0067]    24. An apparatus as in any of the previous embodiments, further comprising: a hematocrit measurement channel disposed within the substrate; the hematocrit measurement channel comprising: a first closed end; and a second end coupled to the inlet channel; and a plasma skimming trench between the second end of the hematocrit measurement channel and the inlet; wherein the plasma skimming trench is configured to skim plasma from the blood sample flowing into the channel to generate a visible interface between the skimmed plasma and the blood sample; and wherein the location of the interface when the blood sample is fully loaded in said hematocrit measurement channel is indicative of the hematocrit level of the blood sample. 
         [0068]    25. An apparatus as in any of the previous embodiments: wherein the trench is configured to generate gravity-based sedimentation to skim plasma from the blood sample; and wherein the hematocrit level is a function of sedimentation of blood cells into the trench and the interface between blood cells that have overfilled the trench and the plasma. 
         [0069]    26. An apparatus as in any of the previous embodiments, wherein the self-loading, porous polymeric chip is configured to simultaneously measure hematocrit and PT (INR value). 
         [0070]    27. A method for measuring one or more physiological characteristics of a blood sample, the method comprising: providing a substrate having one or more measurement channels embedded within the substrate; establishing a vacuum within the one or more measurement channels; applying a blood sample to an orifice of the substrate; said orifice coupled to the one or more measurement channels; drawing the blood sample into the one or more measurement channels as a result of the pressure gradient between the atmosphere and a residual vacuum within the one or more measurement channels; and measuring a physiological characteristic associated with the blood sample as a function of the distance the blood sample travels within the one or more measurement channels. 
         [0071]    28. A method as in any of the previous embodiments: wherein the physiological characteristic comprises hematocrit; the one or more measurement channels comprising a hematocrit measurement channel disposed within the substrate; the hematocrit measurement channel comprising a first closed end and a second end coupled to the orifice for receiving the blood sample; skimming plasma from the blood sample flowing into the hematocrit measurement channel to generate a visible interface between the skimmed plasma and the blood sample; and locating of the interface when the blood sample is fully loaded in said hematocrit measurement channel to indicate the hematocrit level of the blood sample. 
         [0072]    29. A method as in any of the previous embodiments: wherein the hematocrit measurement channel comprises a plasma skimming trench between the second end of the hematocrit measurement channel and the orifice; wherein skimming plasma from the blood sample comprises generating gravity-based sedimentation to skim plasma from the blood sample; and wherein the hematocrit level is a function of sedimentation of blood cells into the trench and the interface between blood cells that have overfilled the trench and the plasma. 
         [0073]    30. A method as in any of the previous embodiments: wherein the substrate further comprises a polymeric chip with an inlet channel in communication with the orifice and hematocrit measurement channel; and wherein establishing a vacuum comprises sealing the polymeric chip under vacuum to generate a vacuum within the inlet channel. 
         [0074]    31. A method as in any of the previous embodiments: wherein sealing the polymeric chip comprises packaging the chip in a vacuum sealed container to maintain the vacuum within the inlet channel; and wherein when the polymeric chip is configured such that when the vacuum sealed container is opened a residual vacuum is maintained within in the inlet channel and hematocrit measurement channel. 
         [0075]    32. A method as in any of the previous embodiments, further comprising: measuring a prothrombin time (PT) via measurement channel disposed within the substrate; the PT measurement channel comprising a first closed end and a second end coupled to the inlet channel; wherein the residual vacuum is configured to draw the blood sample into the PT measurement channel to measure PT (INR value) associated with the blood sample. 
         [0076]    33. A method as in any of the previous embodiments, wherein the hematocrit and PT (INR value) are measured simultaneously. 
         [0077]    34. A method as in any of the previous embodiments, wherein the PT measurement channel comprises one or more coagulant reagents configured to initiate clotting of the blood sample. 
         [0078]    35. A method as in any of the previous embodiments, wherein INR value is determined by the distance the blood sample traverses down the PT measurement channel before it coagulates. 
         [0079]    36. A method as in any of the previous embodiments, wherein the one or more coagulant reagents comprise one or more of the following agents that are physio-adsorbed into the PT channel: tissue factor (III), phosphatidylcholine, and phosphatidylserine. 
         [0080]    37. A method as in any of the previous embodiments, further comprising: measuring a control value via a control measurement channel coupled to the inlet channel; wherein the residual vacuum is configured to draw the blood sample into the control measurement channel to provide an end-point reference. 
         [0081]    38. A method as in any of the previous embodiments, wherein the control channel comprises an anticoagulant reagent configured to prevent clotting of the blood sample. 
         [0082]    39. A method as in any of the previous embodiments, further comprising: lyophilizing the one or more coagulant reagents and anticoagulant reagent prior to packaging; and reconstituting the reagents upon contact with the blood sample. 
         [0083]    Although the description herein contains many details, these should not be construed as limiting the scope of the disclosure but as merely providing illustrations of some of the presently preferred embodiments. Therefore, it will be appreciated that the scope of the disclosure fully encompasses other embodiments which may become obvious to those skilled in the art. 
         [0084]    In the claims, reference to an element in the singular is not intended to mean “one and only one” unless explicitly so stated, but rather “one or more.” All structural, chemical, and functional equivalents to the elements of the disclosed embodiments that are known to those of ordinary skill in the art are expressly incorporated herein by reference and are intended to be encompassed by the present claims. Furthermore, no element, component, or method step in the present disclosure is intended to be dedicated to the public regardless of whether the element, component, or method step is explicitly recited in the claims. No claim element herein is to be construed as a “means plus function” element unless the element is expressly recited using the phrase “means for”. No claim element herein is to be construed as a “step plus function” element unless the element is expressly recited using the phrase “step for”.