Test Details
Methodology
Nephelometry
Result Turnaround Time
3 - 5 days
Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.
Use
This test is used for the measurement of plasminogen in plasma and may be useful in the distinction between type 1 and type 2 plasminogen deficiency.
Custom Additional Information
Plasminogen is a proenzyme (inactive precursor enzyme) that is primarily synthesized by the liver.1 Plasminogen is activated by fibrin. When fibrin is formed, it exposes lysine binding sites, which binds to plasminogen and leads to its unfolding.2 This unfolding enables plasminogen’s cleavage by tissue-plasminogen activator (tPA) and urokinase-plasminogen activator (uPA) into the activated two-chain serine protease plasmin.3 Plasminogen deficiency can be defined as type I (hypoplasminogenemia), with low plasminogen antigen and activity levels, or type II (dysplasminogenemia), with normal plasminogen antigen but low activity levels.4-7
In type I plasminogen deficiency, plasminogen antigen levels are less than 10 ng/dL.5 Homozygous and compound heterozygous individuals primarily present with ligneous conjunctivitis, along with ligneous gingivitis (that can lead to loss of all teeth) and obstructive hydrocephalus, with a median age of 1 year for onset.4,8-12 Other mucosal manifestations involve the respiratory tract (ligneous laryngitis)13 and female genital tract (ligneous vaginitis). Plasminogen deficiency is not associated with an increase in the rate of thrombosis.2 Heterozygous plasminogen deficiency is not associated with ligneous conjunctivitis.14,15
Specimen Requirements
Specimen
Plasma, frozen
Volume
1.0 mL
Container
Blue-top (sodium citrate) tube
Collection Instructions
Citrated plasma samples should be collected by double centrifugation. Blood should be collected in a blue-top tube containing 3.2% buffered sodium citrate.16 Evacuated collection tubes must be filled to completion to ensure a proper blood to anticoagulant ratio.17,18 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 (i.e., "butterfly"), in which case a discard tube should be used.19,20 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 for 10 minutes and carefully remove 2/3 of the plasma using a plastic transfer pipette, being careful not to disturb the cells. Deliver to a plastic transport 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 No. 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.
Stability Requirements
| Temperature | Period |
| Room temperature | Not stable |
| Refrigerated | 2°C to 8°C up to 8 days |
| Frozen | -20°C up to 1 year if frozen within 24 hours of collection |
| Freeze/thaw cycles | Stable x3 |
Reference Range
6.0–25.0 mg/dL
Storage Instructions
Freeze.
Footnotes
1. Raum D, Marcus D, Alper CA, Levey R, Taylor PD, Starzl TE. Synthesis of human plasminogen by the liver. Science. 1980 May 30;208(4447):1036-1037. PubMed 6990488
2. Keragala CB, Medcalf RL. Plasminogen: an enigmatic zymogen. Blood. 2021 May 27;137(21):2881-2889. PubMed 33735914
3. Yuan H, Vance KM, Junge CE, et al. The serine protease plasmin cleaves the amino-terminal domain of the NR2A subunit to relieve zinc inhibition of the N-methyl-D-aspartate receptors. J Biol Chem. 2009;284(19):12862-12873. PubMed 19240037
4. Mehta R, Shapiro AD. Plasminogen deficiency. Haemophilia. 2008 Nov;14(6):1261-1268. PubMed 19141167
5. Schuster V, Hügle B, Tefs K. Plasminogen deficiency. J Thromb Haemost. 2007 Dec;5(12):2315-2322. PubMed 17900274
6. Sarioglu A, Ugurlu K, Karaman M, Karakaya T, Kurtiloglu T, Zengin AZ. Ligneous periodontitis: A molecularly confirmed case of type I plasminogen deficiency. J Clin Exp Dent. 2025 Jun 1;17(6):e752-e755. PubMed 40621135
7. Celkan T. Plasminogen deficiency. J Thromb Thrombolysis. 2017 Jan;43(1):132-138. PubMed 27629020
8. Brito-Robinson T, Ayinuola YA, Ploplis VA, Castellino FJ. Plasminogen missense variants and their involvement in cardiovascular and inflammatory disease. Front Cardiovasc Med. 2024 Jun 25;11:1406953. PubMed 38984351
9. Klammt J, Kobelt L, Aktas D, et al. Identification of three novel plasminogen (PLG) gene mutations in a series of 23 patients with low PLG activity. Thromb Haemost. 2011 Mar;105(3):454-460. PubMed 21174000
10. Nasiri A, Nassar M, Alzahrani H. Plasminogen Deficiency: A Case Report and Review. Cureus. 2023 Sep 21;15(9):e45676. PubMed 37745749
11. Stoopler ET, Alawi F. Gingival swelling associated with hypoplasminogenemia. Rev Bras Hematol Hemoter. 2016 Jul-Sep;38(3):274-275. PubMed 27521869
12. Cupp DG. A 6-week-old baby boy with discharge. Digit J Ophthalmol. 2011;17(3):46-48. PubMed 23362396
13. Nakar C, McDaniel H, Parker JM, Thibaudeau K, Thukral N, Shapiro AD. Case Report: Respiratory lesions successfully treated with intravenous plasminogen, human-tvmh, replacement therapy in four patients with plasminogen deficiency type 1. Front Pediatr. 2024 Sep 20;12:1465166. PubMed 39372655
14. Okamoto A, Sakata T, Mannami T, et al. Population-based distribution of plasminogen activity and estimated prevalence and relevance to thrombotic diseases of plasminogen deficiency in the Japanese: the Suita Study. J Thromb Haemost. 2003 Nov;1(11):2397-2403. PubMed 14629475
15. Tait RC, Walker ID, Conkie JA, Islam SI, McCall F. Isolated familial plasminogen deficiency may not be a risk factor for thrombosis. Thromb Haemost. 1996 Dec;76(6):1004-1008. PubMed 8972025
16. 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. PubMed 8980376
17. 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. PubMed 9620035
18. 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).
19. 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. PubMed 9169665
20. 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. PubMed 10539100
LOINC® Map
| Order Code | Order Code Name | Order Loinc | Result Code | Result Code Name | UofM | Result LOINC |
|---|---|---|---|---|---|---|
| 117340 | Plasminogen Antigen | 4668-0 | 117341 | Plasminogen Antigen | mg/dL | 4668-0 |
| Order Code | 117340 | |||||
| Order Code Name | Plasminogen Antigen | |||||
| Order Loinc | 4668-0 | |||||
| Result Code | 117341 | |||||
| Result Code Name | Plasminogen Antigen | |||||
| UofM | mg/dL | |||||
| Result LOINC | 4668-0 |