Test Catalog

Test ID: ALBLD    
Bleeding Diathesis Profile, Limited, Plasma

Useful For Suggests clinical disorders or settings where the test may be helpful

Detection of the more common potential causes of abnormal bleeding (eg, factor deficiencies/hemophilia, von Willebrand disease, factor-specific inhibitors) and a simple screen to evaluate for an inhibitor or severe deficiency of factor XIII (rare)


This test is not useful for assessing platelet function (eg, congenital or acquired disorders such as Glanzmann thrombasthenia, Bernard-Soulier syndrome, storage pool disease, myeloproliferative disease, associated platelet dysfunction), which requires fresh platelets

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Initial testing includes: prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (bovine), fibrinogen, D-dimer, coagulation factor VIII activity assay, coagulation factor IX assay, von Willebrand factor (VWF) antigen, VWF activity, factor XIII screen, and limited bleed profile interpretation.


If PT is >13.9 seconds, then PT mix will be performed at an additional charge.


If APTT is > or =38 seconds, then APTT mix and dilute Russell viper venom time (DRVVT) will be performed at an additional charge.


If DRVVT ratio is > or =1.20, then DRVVT mix and DRVVT confirm will be performed at an additional charge.


If thrombin time is > or =25.0 seconds, then reptilase time will be performed at an additional charge.


If fibrinogen is <150 mg/dL, or clinically indicated, then PT-fibrinogen will be performed at an additional charge.


If D-dimer is >500 ng/mL FEU, then soluble fibrin monomer will be performed at an additional charge.


If APTT mix is > or =38 seconds and thrombin time is <35.0 seconds (no evidence of heparin), then platelet neutralization procedure will be performed at an additional charge.


If VWF activity assay is <55% or VWF activity:VWF antigen ratio is abnormally increased, then VWF ristocetin cofactor activity assay will be performed at an additional charge. 


If VWF antigen is <55%, the VWF activity is <55%, or the VWF activity:VWF antigen ratio is abnormal, then VWF multimer analysis will be performed at an additional charge.


If appropriate, coagulation factor assays or Staclot lupus anticoagulant will be performed at an additional charge to clarify significant abnormalities in the screen test results.


If factor result is below the normal range, the appropriate factor inhibitor screen may be performed along with the Bethesda titering assay, at an additional charge, if inhibitor screen is positive.


See Hemophilia Testing Algorithm in Special Instructions.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Bleeding problems may be associated with a wide variety of coagulation abnormalities or may be due to problems not associated with coagulation (trauma and surgery as obvious examples). A partial listing of causes follows. 


-Deficiency or functional abnormality (congenital or acquired) of any of the following coagulation proteins: fibrinogen (factor I), factor II (prothrombin), factor V, factor VII, factor VIII (hemophilia A), factor IX (hemophilia B), factor X, factor XI (hemophilia C; bleeding severity not  always proportionate to factor level), factor XIII (fibrin-stabilizing factor), von Willebrand factor (VWF antigen and activity), and alpha-2 plasmin inhibitor and plasminogen activator inhibitor (PAI-I; severe deficiency in rare cases). Neither alpha-2 plasmin inhibitor nor PAI-I are included as a routine bleeding diathesis assay component, but either can be performed if indicated or requested.

-Deficiency (thrombocytopenia) or functional abnormality of platelets such as congenital (Glanzmann thrombasthenia, Bernard-Soulier syndrome, storage pool disorders, etc) and acquired (myeloproliferative disorders, uremia, drugs, etc) disorders. Platelet function abnormalities cannot be studied on mailed-in specimens.

-Specific factor inhibitors (most commonly directed against factor VIII); factor inhibitors occur in 10% to15% of the hemophilia population and are more commonly associated with severe deficiencies of factor VIII or IX (antigen <1%). The inhibitor appears in response to transfusion therapy with factor concentrates with no correlation of occurrence and amount of therapy. Factor VIII inhibitors may occur spontaneously in the postpartum patient, with certain malignancies, in association with autoimmune disorders (eg, rheumatoid arthritis, systemic lupus erythematosus), in the elderly, and for no apparent reason.

-Other acquired causes of increased bleeding include paraproteinemia; other factor-specific inhibitors, including those against factor V, factor XI; or virtually any of the coagulation proteins.

-Acute disseminated intravascular coagulation/intravascular coagulation and fibrinolysis (DIC/ICF), which is a fairly common cause of bleeding. Bleeding can also occur in patients with chronic ICF.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

An interpretive report will be provided.

Interpretation Provides information to assist in interpretation of the test results

An interpretive report will be provided.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

No significant cautionary statements

Clinical Reference Recommendations for in-depth reading of a clinical nature

Boender J, Kruip MJ, Leebeek FW: A Diagnostic Approach to Mild Bleeding Disorders. J Thromb Haemost 2016;Aug;14(8):1507-1516 doi: 10.1111/jth.13368.

Special Instructions Library of PDFs including pertinent information and forms related to the test