Kaolin Clotting Time (KCT)

CPT: 85347
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Test Details

Use

The KCT is a sensitive screening test of lupus anticoagulants (LA) in patients with a history of thrombosis.6-10

Limitations

This test was developed, and its performance characteristics determined, by LabCorp. It has not been cleared or approved by the US Food and Drug Administration (FDA).

Methodology

In the kaolin clotting time (KCT) test, kaolin, a negatively-charged particulate activator, is incubated with test plasma to activate the contact factors and the intrinsic system.11 Calcium chloride is added and the mixture is timed until a clot forms.

Additional Information

The intrinsic mechanism requires the presence of all coagulation factors except factor VII and XIII. In the KCT, unlike TTIT, dRVVT, and aPTT, no reagent phospholipid is added, so plasma phospholipids are required for the reaction to proceed. For this reason, the KCT is sensitive to the presence of lupus anticoagulants, when if present, will generally prolong the KCT. All clot-based tests are potentially affected by factor deficiencies. The KCT is prolonged in any except factor VII or XIII deficiency. Lupus anticoagulants are nonspecific antibodies that extend the clotting time of phospholipid-dependent clotting assays such as the KCT.7,10 Unlike specific factor antibodies, LA are usually associated with venous thrombosis, pulmonary embolism, arterial thrombosis, and recurrent fetal loss.12 LA do not specifically inhibit coagulation factors; rather they neutralize anionic phospholipid-protein complexes that are involved in the coagulation process. Prolongation of clot-based assays is highly dependent on the sensitivity of the reagent employed. Reagents with reduced amounts of phospholipid, such as KCT, aPTT-LA, and dilute Russell viper venom (dRVVT), have enhanced sensitivity for LA.7 Testing for lupus anticoagulant (LA) and the antiphospholipid syndrome that is associated with these antibodies is described in more detail in the APS section. The KCT is sensitive to deficiency or inhibition of factors in the intrinsic pathway. These include the contact factors; high molecular weight kininogen (HMWK); prekallikrein; and factor XII along with procoagulant factors XI, IX, VIII, X, V, prothrombin, and fibrinogen.10,12-14 An extended KCT can be seen in acquired deficiencies of intrinsic factors II, IX, and X that result from vitamin K deficiency or the use of oral anticoagulants that block vitamin K-dependent production of procoagulant factors. These conditions also affect the level of factor VII, an extrinsic pathway factor. Since factor VII has a short half-life relative to the vitamin K-dependent factors of the intrinsic pathway, vitamin K-dependent factor deficiency can often result in an extended PT with a normal aPTT and KCT. Consumption coagulopathy, such as disseminated intravascular coagulation (DIC), can produce an extended KCT due to depletion of intrinsic factors. The KCT can also be extended in conditions that reduce the production of procoagulant factors (eg, severe liver disease or malnutrition). Inhibitors, both factor specific and nonspecific, can also prolong the KCT.

Specimen Requirements

Specimen

Plasma (platelet poor), frozen

Volume

2 mL

Minimum Volume

1 mL

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 tube. Gel-barrier tubes and serum tubes with clot initiators should also be collected after the citrate tubes. Centrifuge and carefully remove the plasma using a plastic transfer pipette, being careful not to disturb the cells. Transfer the plasma into a LabCorp PP transpak frozen purple tube with screw cap (LabCorp N° 49482). Freeze immediately and maintain 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. Stable at room temperature for four hours.

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 Jan; 107(1):105-110. 8980376
2. Reneke J, Etzell J, Leslie S, Ng VL, Gottfried EL. 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 Jun; 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 Jun; 107(6):681-683. 9169665
5. McGlasson DL, More L, Best HA, Norris WL, Doe RH, Ray H. Drawing specimens for coagulation testing: Is a second tube necessary? Clin Lab Sci. 1999 May-Jun; 12(3):137-139. 10539100
6. Van Cott EM, Laposata M. Coagulation. In: Jacobs DS, DeMott WR, Oxley DK eds. Laboratory Test Handbook With Key Word Index. Hudson, Ohio: Lexi-Comp; 2001: 327-358.
7. Brandt JT, Triplett DA, Alving B, Scharrer I. Criteria for the diagnosis of lupus anticoagulants: An update. On behalf of the Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardization Committee of the ISTH. Thromb Haemost. 1995 Oct; 74(4):1185-1190. 8560433
8. 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.
9. Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med. 2002 Mar 7; 346(10):752-763. 11882732
10. Triplett DA. Coagulation abnormalities. In: McClatchey KD, ed. Clinical Laboratory Medicine. 2nd ed. Philadelphia, Pa: Lippincott Williams and Wilkins;2002:1033-1049.
11. Adcock DM, Bethel MA, Macy PA. Coagulation Handbook. Aurora, Colo: Esoterix−Colorado Coagulation; 2006.
12. Bick RL. Antiphospholipid thrombosis syndromes. Clin Appl Thromb Hemost. 2001 Oct; 7(4):241-258. 11697705
13. Roberts HR, Escobar MA. Less common congenital disorders of hemostasis. In: Kitchens CS, Alving BM, Kessler CM, eds. Consultative Hemostasis and Thrombosis. Philadelphia, Pa: WB Saunders Co; 2002: 57-71.
14. Cohen AJ, Kessler CM. Hemophilia A and B. In: Kitchens CS, Alving BM, Kessler CM, eds. Consultative Hemostasis and Thrombosis. Philadelphia, Pa: WB Saunders Co; 2002:43-56.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
500128 KCT (Kaolin Clotting Time) 500129 KCT (Kaolin Clotting Time) KCT Units 13053-4
500128 KCT (Kaolin Clotting Time) 500985 KCT (Kaolin Clotting Time) N/A

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