Test Id : DRV1
Dilute Russell's Viper Venom Time (DRVVT), Plasma
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting and confirming or helping to exclude the presence of lupus anticoagulants (LA)
Identifying LA that do not prolong the activated partial thromboplastin time (APTT)
Evaluating unexplained prolongation of the APTT or prothrombin time clotting tests
Distinguishing LA from a specific coagulation factor inhibitor or coagulation factor deficiencies
Reflex Tests
Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| DRV2 | DRVVT Mix | No | No |
| DRV3 | DRVVT Confirmation | No | No |
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
If dilute Russell's viper venom time (DRVVT) ratio is > or =1.20, then DRVVT mix and DRVVT confirmation will be performed at an additional charge.
Method Name
A short description of the method used to perform the test
Only orderable as part of a profile or reflex. For more information see:
ALUPP / Lupus Anticoagulant Profile), Plasma
AATHR / Thrombophilia Profile), Plasma and Whole Blood
APROL / Prolonged Clot Time Profile, Plasma
ALBLD / Bleeding Diathesis Profile, Limited, Plasma
ADIC / Disseminated Intravascular Coagulation/Intravascular Coagulation and Fibrinolysis (DIC/ICF) Profile, Plasma
Optical Clot-Based
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Dilute Russell's Viper Venom Time, Plasma
dRVVT (Dilute Russell's Viper Venom Time)
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
If dilute Russell's viper venom time (DRVVT) ratio is > or =1.20, then DRVVT mix and DRVVT confirmation will be performed at an additional charge.
Specimen Type
Describes the specimen type validated for testing
Plasma Na Cit
Additional Testing Requirements
Serum anticardiolipin antibody testing (CLPMG / Phospholipid [Cardiolipin] Antibodies, IgG and IgM, Serum) and anti-beta-2 glycoprotein I (B2GMG / Beta-2 Glycoprotein 1 Antibodies, IgG and IgM, Serum) antibody testing should also be performed in conjunction with coagulation-based testing for lupus anticoagulant to enhance detection of different types of antiphospholipid antibodies.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Only orderable as part of a profile or reflex. For more information see:
ALUPP / Lupus Anticoagulant Profile, Plasma
AATHR / Thrombophilia Profile, Plasma and Whole Blood
APROL / Prolonged Clot Time Profile, Plasma
ALBLD / Bleeding Diathesis Profile, Limited, Plasma
ADIC / Disseminated Intravascular Coagulation/Intravascular Coagulation and Fibrinolysis (DIC/ICF) Profile, Plasma
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
See Specimen Required
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma Na Cit | Frozen | 14 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting and confirming or helping to exclude the presence of lupus anticoagulants (LA)
Identifying LA that do not prolong the activated partial thromboplastin time (APTT)
Evaluating unexplained prolongation of the APTT or prothrombin time clotting tests
Distinguishing LA from a specific coagulation factor inhibitor or coagulation factor deficiencies
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
If dilute Russell's viper venom time (DRVVT) ratio is > or =1.20, then DRVVT mix and DRVVT confirmation will be performed at an additional charge.
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Lupus anticoagulants (LA) are immunoglobulins (IgG, IgM, IgA, or a combination of these) of autoimmune type that are specifically directed against antigenic complexes of negatively charged phospholipids (such as phosphatidylserine or phosphatidylethanolamine) and coagulation-related proteins (such as beta-2-glycoprotein I) or clotting factors (including prothrombin [factor II] or factor X), and which cause prolongation of phospholipid-dependent clotting time tests due to inhibition.
LA are functionally and clinically distinct members of a broader group of antiphospholipid autoantibodies that includes immunologically detectable anticardiolipin antibodies or antibodies against other phospholipid-protein complexes. LA interfere with specific coagulation factor-phospholipid interactions, typically causing prolongation of 1 or more phospholipid-dependent clotting time tests (eg, activated partial thromboplastin time: APTT, dilute Russell's viper venom time: DRVVT) due to inhibition. This characteristic in vitro inhibition can be overcome by addition of excess phospholipid.
Because of the heterogeneous nature of LA antibodies, no single coagulation test can identify or exclude all LA. Currently, the International Society on Thrombosis and Haemostasis and the Clinical and Laboratory Standards Institute (CLSI) recommend testing for LA with at least 2 phospholipid-dependent clotting time assays based on different coagulation pathways and principles (eg, lupus-sensitive APTT and DRVVT).
In addition, given the potential for false-positive results in patients on anticoagulants, a profile or panel of coagulation tests is performed, including the prothrombin time (PT), APTT, thrombin time (TT), and DRVVT. If the PT, APTT, and/or DRVVT are prolonged, additional testing may include mixing tests with normal plasma (to evaluate for inhibition) and the use of excess phospholipid in appropriate assay systems to evaluate for phospholipid-dependent inhibition. Additional reflexive testing helps determine presence or absence of anticoagulants and/or inhibitors to other factors.
The diagnosis of LA requires performance and interpretation of complex coagulation testing, as well as correlation with available clinical information, including evidence of persistence of LA over time (> or =12 weeks).
The venom obtained from Russell's viper (Vipera russelli) contains enzymes that directly activate coagulation factors V and X, bypassing the activation of factors VII, VIII, IX, XI, and XII, and therefore, the effect of deficiencies or inhibitors of these factors. Diluting the phospholipid necessary for the clotting factor interactions increases the sensitivity to LA and the likelihood of identifying a phospholipid-dependent inhibitor that may not be detected by other coagulation tests with a higher phospholipid content (eg, LA-insensitive APTT reagents).
The DRVVT screen ratio test is one of several available in vitro tests that may be used to screen and confirm for presence of LA or to help exclude LA. DRVVT testing is used in conjunction with other appropriate coagulation tests (reflexive testing panels) to assist in detection and confirmation of LA, or help exclude their presence.
The DRVVT may be abnormally prolonged (DRVVT screen ratio > or =1.20) by LA as well as coagulation factor deficiencies, anticoagulant effects, or other types of coagulation factor inhibitors.
Specimens with abnormal results (DRVVT screen ratio > or =1.20) are subjected to reflexive testing (see Testing Algorithm). With the reflexive testing algorithm, the sensitivity of DRVVT testing for LA diagnosis is approximately 65% to 70% and the specificity is 95% or higher.
Although LA cause prolonged clotting times in vitro, there is a strong association with thrombosis risk. However, not all patients with persisting LA develop thrombosis.
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.
Only orderable as part of a profile or reflex. For more information see:
ALUPP / Lupus Anticoagulant Profile, Plasma
AATHR / Thrombophilia Profile, Plasma and Whole Blood
APROL / Prolonged Clot Time Profile, Plasma
ALBLD / Bleeding Diathesis Profile, Limited, Plasma
ADIC / Disseminated Intravascular Coagulation/Intravascular Coagulation and Fibrinolysis (DIC/ICF) Profile, Plasma
< 1.20
Normal ranges for children: not clearly established, but similar to normal ranges for adults, except for newborn infants whose results may not reach adult values until 3 to 6 months of age.
Interpretation
Provides information to assist in interpretation of the test results
Dilute Russell's viper venom time screen ratio (<1.20):
A normal dilute Russell's viper venom time (DRVVT) screen ratio (<1.20) indicates that lupus anticoagulant (LA) is not present or not detectable by this method (but might be detected with other methods).
An abnormal DRVVT screen ratio (DRVVT screen ratio > or =1.20) may suggest presence of LA, however, other possibilities include:
-Deficiencies or dysfunction of factors I (fibrinogen), II, V, or X, congenital or acquired
-Inhibitors of factor V, or occasionally by inhibitors of factor VIII, or other specific or nonspecific inhibitors
-Anticoagulation therapy effects (see Cautions)
Further evaluation consists of performing mixing studies with an equal volume of normal pooled plasma (DRVVT 1:1 mix) to investigate the possibility of coagulation factor deficiency (suggested by DRVVT mix ratio <1.20) and to evaluate inhibition (suggested by DRVVT mix ratio > or =1.20) and mixing patient plasma with DRVVT reagent enriched in phospholipid (DRVVT confirmatory reagent) (DRVVT mix and DRVVT confirmation ratios).
Possible combination of results include the following:
-DRVVT screen ratio > or =1.20, DRVVT mix ratio <1.20, and DRVVT confirmation ratio <1.20:
No evidence of LA. These data may reflect anticoagulation therapy effects or other (congenital or acquired) coagulopathy.
-DRVVT screen ratio > or =1.20, DRVVT mix ratio > or =1.20, and DRVVT confirmation ratio <1.20:
The prolonged and inhibited DRVVT (DRVVT screen and mix ratios) may reflect presence of a specific factor inhibitor (eg, factor V inhibitor), anticoagulation therapy effects or other nonspecific inhibitors as can be seen with monoclonal protein disorders, lymphoproliferative disease etc. Although LA cannot be conclusively excluded, the DRVVT confirmation ratio of < or =1.20 makes this less likely.
-DRVVT screen ratio > or =1.20, DRVVT mix ratio <1.20, and DRVVT confirmation ratio > or =1.20:
Although mixing study of the prolonged DRVVT screen and mix ratios provides no evidence of inhibition, additional phospholipid shortens the clotting time (DRVVT confirmation ratio), suggesting presence of LA
-DRVVT screen ratio > or =1.20, DRVVT mix ratio > or =1.20, and DRVVT confirmation ratio > or =1.20:
The data are consistent with presence of LA, provided anticoagulant effect can be excluded (see Cautions)
Additional tests to evaluate abnormal DRVVT results include activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time. Abnormalities observed with these tests may be further evaluated with normal plasma mixing studies, the platelet neutralization procedure (for APTT), and coagulation factor assays may sometimes be needed. All of these reflexive testing procedures, together with Coagulation Consultant interpretation, are included in Mayo Clinic's Coagulation Consultation test panels:
ALUPP / Lupus Anticoagulant Profile, Plasma
ALBLD / Bleeding Diathesis Profile, Limited, Plasma
AATHR / Thrombophilia Profile, Plasma and Whole Blood
APROL / Prolonged Clot Time Profile, Plasma
ADIC / Disseminated Intravascular Coagulation/Intravascular Coagulation and Fibrinolysis (DIC/ICF) Profile, Plasma
DRVVT assays ordered as a single, stand-alone test should be interpreted within patient clinical context and close attention to medication use by patient (see Cautions).
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Residual platelets in frozen-thawed plasma can decrease sensitivity and specificity of lupus anticoagulants (LA) testing (false-negative results). Specimens that are to be frozen before testing must be centrifuged twice to remove as many of the platelets as possible before freezing.
Anticoagulation therapy effects such as warfarin (especially when the effect is supratherapeutic), excess heparin, direct thrombin inhibitors (eg, dabigatran [Pradaxa]), argatroban [Ancova], bivalirudin [Angiomax]), direct factor Xa inhibitors (eg, rivaroxaban [Xarelto], apixaban [Eliquis], edoxaban [Savaysa]) may result in a false-positive assay performance for LA. Clinical correlation and repeat testing remote (>1 week) from anticoagulation therapy is suggested.
Although the dilute Russell's viper venom time (DRVVT) reagents contain a heparin inhibitor (Polybrene) that is sufficient for neutralization of heparin (up to 1-2 U/mL), the results may not necessarily represent what would occur if no heparin were present in the specimen. Therefore, DRVVT results from heparinized plasma should be interpreted with caution.
Excess heparin or inhibitors of factors V or VIII may cause false-positive results of LA testing, depending on the types of coagulation testing performed.
LA diagnosis does not have definite predictive value for associated clinical complications such as thromboembolic problems or fetal loss.
The DRVVT test will not detect all LAs. Some LAs may only be detectable by other tests such as the Staclot LA, activated partial thromboplastin time, and platelet neutralization procedure, or other methods.
Persistence of LA over time (12 weeks or more between positive testing results) is a clinically important criterion for the antiphospholipid antibody syndrome diagnosis.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Proven A, Bartlett RP, Moder KG, et al. Clinical importance of positive test results for lupus anticoagulant and anticardiolipin antibodies. Mayo Clin Proc. 2004;79(4):467-475
2. Gastineau DA, Kazmier FJ, Nichols WL, Bowie EJ. Lupus anticoagulant: an analysis of the clinical and laboratory features of 219 cases. Am J Hematol. 1985;19(3):265-275
3. Brandt JT, Triplett DA, Alving B, Sharrer I. Criteria for the diagnosis of lupus anticoagulant: an update. On behalf of the Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the ISTH. Thromb Haemost. 1995;74(4);1185-1190
4. Arnout J, Vermylen J. Current status and implications of autoimmune antiphospholipid antibodies in relation to thrombotic disease. J Thromb Haemost. 2003;1(5):931-942
5. Pengo V, Tripodi A, Reber G, et al. Update of the guidelines for lupus anticoagulant detection. Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost. 2009;7:1737-1740. doi:10.1111/j.1538-7836.2009.03555.x
6. CLSI Laboratory Testing for Lupus Anticoagulant; Approved Guideline. CLSI document H60-A. Clinical and Laboratory Standards Institute; 2014
Method Description
Describes how the test is performed and provides a method-specific reference
The dilute Russell's viper venom time (DRVVT) screening assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is incubated for a specified time, then combined with a DRVVT screening reagent containing Russell's viper venom, phospholipids, heparin neutralizing agents, calcium, buffers and stabilizers to trigger the coagulation process. Subsequently, the time to clot formation is measured optically using a wavelength of 671 nm. The patient DRVVT screening clotting time is normalized by dividing the patient result by the mean DRVVT screening clotting time of normal pooled plasma to yield a ratio (DRVVT screen ratio).
Patient samples with a prolonged DRVVT (DRVVT screen ratio > or =1.20) are further studied by adding an equal volume of normal pooled plasma (platelet-depleted) and repeating the DRVVT test procedure, with mathematical normalization, to yield the DRVVT mix (1:1) ratio and the DRVVT test using DRVVT confirmatory reagent (enriched in phospholipid), and results are expressed as the quotient obtained from dividing the patient DRVVT screening clotting time by the patient DRVVT confirmatory clotting time (DRVVT confirm ratio).(Thiagarajan P, Pengo V, Shapiro SS. The use of the dilute Russell's viper venom time for the diagnosis of lupus anticoagulants. Blood. 1986;68(4):869-874; package insert: CRYOcheck LA CHECK dRVVT Screening Reagent. Precision BioLogic; 05/2023; package insert: CRYOcheck LA SURE dRVVT Confirmatory Reagent. Precision BioLogic; 05/2023)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
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Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
85613-DRVVT
85613-DRVVT mix (if appropriate)
85613-DRVVT confirmation (if appropriate)
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| DRV1 | Dilute Russells Viper Venom Time, P | 15359-3 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| RVR1 | DRVVT Screen Ratio | 15359-3 |