Bleeding With Normal aPTT/PT

CPT: 85240; 85245; 85246; 85250; 85270; 85291; 85384; 85410; 85415
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Test Details

Use

Assist in the determination of a cause of bleeding in a patient with a normal aPTT and PT.

Methodology

See individual tests.

Specimen Requirements

Specimen

Plasma (3.2% citrated), frozen

Volume

6 mL frozen citrated plasma (2 mL into each of three tubes)

Minimum Volume

3 mL frozen citrated plasma (1 mL into each of three tubes)

Container

Blue-top (sodium citrate) tube

Patient Preparation

Do not draw from an arm with a heparin lock or heparinized catheter.

Collection

Citrated plasma samples should be collected by double centrifugation. Blood should be collected in a blue-top tube containing 3.2% buffered sodium citrate.1 Evacuated collection tubes must be filled to completion to ensure a proper blood to anticoagulant ratio.2,3 The sample should be mixed immediately by gentle inversion at least six times to ensure adequate mixing of the anticoagulant with the blood. A discard tube is not required prior to collection of coagulation samples, except when using a winged blood collection device (ie, "butterfly"), in which case a discard tube should be used.4,5 When noncitrate tubes are collected for other tests, collect sterile and nonadditive (red-top) tubes prior to citrate (blue-top) tubes. Any tube containing an alternate anticoagulant should be collected after the blue-top tubes. Gel-barrier tubes and serum tubes with clot initiators should also be collected after the citrate tubes. Centrifuge for 10 minutes and (using a plastic transfer pipette) carefully remove two-thirds of the plasma without disturbing the cells. Deliver to a plastic transfer tube, cap, and recentrifuge for 10 minutes. Use a second plastic pipette to remove the plasma, staying clear of the platelets at the bottom of the tube. Transfer the plasma into a LabCorp PP transpak frozen purple tube with screw cap (LabCorp N° 49482). The specimen should be frozen immediately and maintained frozen until tested. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.

Please print and use the Volume Guide for Coagulation Testing to ensure proper draw volume.

Storage Instructions

Freeze plasma, refrigerate serum, and maintain whole blood and buccal swab kit at room temperature or refrigerate.

Clinical Information

Footnotes

1. Adcock DM, Kressin DC, Marlar RA. Effect of 3.2% vs 3.8% sodium citrate concentration on routine coagulation testing. Am J Clin Pathol. 1997; 107(1):105-110. 8980376
2. Reneke J, Etzell J, Leslie S, et al. Prolonged prothrombin time and activated partial thromboplastin time due to underfilled specimen tubes with 109 mmol/L (3.2%) citrate anticoagulant. Am J Clin Pathol. 1998; 109(6):754-757. 9620035
3. National Committee for Clinical Laboratory Standardization. Collection, Transport, and Processing of Blood Specimens for Coagulation Testing and General Performance of Coagulation Assays; Approved Guideline. 5th ed. Villanova, Pa: NCCLS;2008. Document H21-A5:28(5).
4. Gottfried EL, Adachi MM. Prothrombin time and activated partial thromboplastin time can be performed on the first tube. Am J Clin Pathol. 1997; 107(6):681-683.9169665
5. McGlasson DL, More L, Best HA, et al. Drawing specimens for coagulation testing: Is a second tube necessary? Clin Lab Sci. 1999; 12(3):137-139. 10539100

References

Alving BM. The antiphospholipid syndrome: Clinical presentation, diagnosis, and patient management. In: Kitchens CS, Alving BM, Kessler CM, eds Consultative Hemostasis and Thrombosis. Philadelphia, Pa: WB Saunders Co;2002:181-196.
Schafer AI, Levine MN, Konkle BA, et al. Thrombotic disorders: Diagnosis and treatment. Hematology (Am Soc Hematol Educ Program). 2003; 520-539. 14633797
Triplett DA. Thrombophilia. In: McClatchey KD, ed. Clinical Laboratory Medicine. 2nd ed. Philadelphia, Pa: Lippincott Williams and Wilkins;2002:1033-1049.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
117700 Bleeding with Normal aPTT/PT 086264 Factor VIII Activity % 3209-4
117700 Bleeding with Normal aPTT/PT 086298 Factor IX Activity % 3187-2
117700 Bleeding with Normal aPTT/PT 086314 Factor XI Activity % 3226-8
117700 Bleeding with Normal aPTT/PT 086330 Factor XIII 3241-7
117700 Bleeding with Normal aPTT/PT 001702 Fibrinogen Activity mg/dL 3255-7
117700 Bleeding with Normal aPTT/PT 164509 vWF Activity % 6014-5
117700 Bleeding with Normal aPTT/PT 086280 von Willebrand Factor (vWF) Ag % 27816-8
117700 Bleeding with Normal aPTT/PT 117740 Alpha-2-Antiplasmin % 27810-1
117700 Bleeding with Normal aPTT/PT 146788 Plasminogen Act Inhibitor-1 IU/mL 5975-8
Reflex Table for Factor XIII
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 086331 Please Note: 086331 Please Note: N/A

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