Thrombophilia Profile, Plasma and Whole Blood

Coag, Hypercoagulability; Thrombophilia Profile; Thrombosis; Clotting

Useful for:

• Evaluating patients with thrombosis or hypercoagulability states


• Detecting a lupus-like anticoagulant; dysfibrinogenemia; disseminated intravascular coagulation/intravascular coagulation and fibrinolysis


• Detecting a deficiency of antithrombin, protein C, or protein S


• Detecting activated protein C resistance (and the factor V R506Q [Leiden] mutation if indicated)


• Detecting the prothrombin G20210A mutation

Whole Blood and Plasma both required.

Whole Blood

• Preferred: Yellow Top (ACD)


• Acceptable: Lavender Top (EDTA)


• Acceptable: Light-Blue Top (3.2% Sodium Citrate)

Platelet-poor Plasma

• Light-Blue Top (3.2% Sodium Citrate)

Collection Instructions:

1. Specimen must be collected prior to factor replacement therapy.


2. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing in Special Instructions.


3. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.


4. Aliquot plasma (1-2 mL per aliquot) into 5 separate plastic vials leaving 0.25 mL in the bottom of centrifuged vial.


5. Freeze plasma immediately (no longer than 4 hours after collection) at -20 degrees C or, ideally, ≤ -40 degrees C.

Additional Information:

Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.

Plasma (Sodium Citrate) 

• Frozen: 14 days

Whole Blood

• Ambient (preferred): 7 days


• Refrigerated: 14 days

• Gross Hemolysis


• Gross Lipemia


• Gross Icterus

• To obtain the most useful information, this testing is best performed in medically-stable patients who are not receiving oral vitamin K inhibitor (eg, warfarin, Coumadin), heparin, low-molecular-weight heparin, hirudin (Refludan), fibrinolytic agents (eg, streptokinase, tissue plasminogen activator), or platelet GPIIbIIIa (alpha IIb beta3) inhibitors (abxicimab [ReoPro], tirofiban, aggrastat)


• Patient should not be receiving direct thrombin inhibitors (argatroban, dabigatran), or direct factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban)


• If patient has been recently transfused, it is best to perform this study pretransfusion, if possible


• Useful information may be obtained in patients receiving anticoagulation therapy

• Optical Clot-Based: Prothrombin Time, APTT, DRVVT, Thrombin Time, Activated Protein Resistance V


• Clauss:  Fibrinogen


• Latex Immunoassay (LIA):  D-Dimer, Free Protein-S Antigen


• Chromogenic Assay: Antithrombin Activity, Protein-C Activity


• Direct Mutation Analysis: Prothrombin G20210A Mutation, B

4-7 days

Monday-Friday

The following assays comprise the profile core; see "Reflex Conditions" for list of additional assays associated with this profile.

• Prothrombin Time (PT)


• Activated Partial Thromboplastin Time (APTT)


• Dilute Russells Viper Venom Time (DRVVT)


• Thrombin Time


• Fibrinogen, Clauss


• D-Dimer


• Antithrombin Activity


• Protein C Activity


• Protein S Ag, Free


• Activated Protein Resistance V


• Prothrombin G20210A Mutation, B

• Plasma: 7 days


• Whole Blood: 1 month

81240, 85300, 85303, 85306, 85307, 85379, 85384, 85390, 85610, 85613, 85670, 85730

Test Definition: AATHR

Coagulation Profile Comparison

Thrombophilia Profile

Coagulation Patient Information

Informed Consent for Genetic Testing

Consentimiento informado para análisis genéticos

• Whole Blood: 3 mL


• Plasma: 5 mL in 5 polypropylene vials each containing 1 mL

An interpretive report will be provided.

Initial testing includes: prothrombin time (PT); activated partial thromboplastin time (APTT); dilute Russell viper venom time (DRVVT); thrombin time (bovine); fibrinogen; D-dimer; antithrombin activity; protein C activity; protein S antigen, free; prothrombin G20210A mutation; activated protein resistance V; and thrombophilia interpretation.

The following reflex-testing conditions are defined:

• PT > 13.9 seconds:  PT Mix (PTMSC) will be performed at an additional charge


• APTT  ≥ 38 seconds:  APTT Mix (APMSC) will be performed at an additional charge


• APTT Mix ≥ 38 seconds and Thrombin Time < 35.0 seconds (no evidence of heparin):  Platelet Neutralization Procedure (PNP) will be performed at an additional charge


• DRVVT Ratio ≥ 1.20:   DRVVT Mix (DRV2) and DRVVT Confirmation (DRV3) will be performed at an additional charge


• Thrombin Time ≥ 25.0 seconds:  Reptilase Time (RTSC) will be performed at an additional charge


• Fibrinogen <150 mg/dL (or clinically indicated):   PT-Fibrinogen (PTFIB) will be performed at an additional charge


• D-dimer > 500 ng/mL FEU:   Soluble Fibrin Monomer will be performed at an additional charge


• Free Protein-S Antigen < 65% for males or females ≥ 50 years of age: Total Protein-S Antigen (PST) will be performed at an additional charge


• Free Protein-S Antigen < 50% for females < 50 years of age:  Total Protein-S Antigen (PST) will be performed at an additional charge


• Protein-C Activity < 70% (with no evidence for an acquired decrease in protein-C activity): Protein-C Antigen (PCAG) may be performed at an additional charge


• Antithrombin Activity < 80% (with no evidence of an acquired decrease in antithrombin activity): Antithrombin Antigen (ATTI) will be performed at an additional charge.


• Activated Protein-C Resistance (APC) Ratio < 2.3:  Factor V Leiden (R506Q) Variant Analysis (F5DNA) will be performed at an additional charge.


• Baseline APC APTT is prolonged:  Factor V Leiden (R506Q) Variant Analysis (F5DNA) will be performed at an additional charge.


• If appropriate, Protein-S Activity (S_FX), coagulation factor assays (F_2, FACTV, F_7, F8A, F_9, F_10, F_11, F_12), or Staclot LA (STACL) will be performed at an additional charge to clarify significant abnormalities in the screen test results.

Mayo

3255-7, 9049-5, 18771-6, 15359-3, 24475-6, 14979-9, 5902-2, 46717-5, 48067-3, 27811-9, 27818-4, 27821-8, 13590-5, 48591-2, 6301-6, 69049-5, 18771-6