Laboratory Services

Thrombophilia Profile, Plasma and Whole Blood

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Updated Test Information:

Test Description
Thrombophilia Profile, Plasma and Whole Blood
Synonym(s)

Coag, Hypercoagulability; Thrombophilia Profile; Thrombosis; Clotting

Test ID
AATHR
General Information

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

Specimen Type

Whole Blood and Plasma both required.

Specimen Requirements

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)


 


 

Specimen Collection / Processing Instructions

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.

Collection File View/Download File
Stability

Plasma (Sodium Citrate) 



  • Frozen: 14 days



Whole Blood



  • Ambient (preferred): 7 days

  • Refrigerated: 14 days

Unacceptable Specimen Conditions

  • Gross Hemolysis

  • Gross Lipemia

  • Gross Icterus

Limitations

  • 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

Methodology

  • 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

Estimated TAT

4-7 days

Testing Schedule

Monday-Friday

Test Includes

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


 


 

Retention

  • Plasma: 7 days

  • Whole Blood: 1 month

CPT Code(s)

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

Additional Information
Minimum Sample Volume

  • Whole Blood: 3 mL

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

Reference Range

An interpretive report will be provided.

Reflex Conditions

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.

Performing Lab

Mayo

LOINC Code(s)

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