Test Catalog

Test Id : APROL

Prolonged Clot Time Profile, Plasma

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

Determining the cause of prolongation of prothrombin time or activated partial thromboplastin time

 

Screening for prolonged clotting times and determining the presence of factor deficiencies or inhibitor (eg, factor-specific, lupus-like, or the presence of heparin)

Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.

Test Id Reporting Name Available Separately Always Performed
APRI Prolonged Clot Time Prof Interp No Yes
PTSC Prothrombin Time (PT), P Yes, (order PTTP) Yes
APTSC Activated Partial Thrombopl Time, P Yes, (order APTTP) Yes
DRV1 Dilute Russells Viper Venom Time, P Yes, (order DRVI1) Yes
TTSC Thrombin Time (Bovine), P Yes Yes
CLFIB Fibrinogen, Clauss, P Yes, (order FIBTP) Yes
DIMER D-Dimer, P Yes, (order DDITT) Yes

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
GBETH General Factor Bethesda Units, P No No
5BETH FV Bethesda Units, P No No
8BETH FVIII Bethesda Units, P No No
9BETH FIX Bethesda Units, P No No
F8IS Coag Factor VIII Assay Inhib Scrn,P No No
FACTV Coag Factor V Assay, P Yes No
F_7 Coag Factor VII Assay, P Yes No
F_9 Coag Factor IX Assay, P Yes No
F_10 Coag Factor X Assay, P Yes No
F_11 Coag Factor XI Assay, P Yes No
F_12 Coag Factor XII Assay, P Yes No
F8A Coag Factor VIII Activity Assay, P Yes No
RTSC Reptilase Time, P Yes No
F_2 Coag Factor II Assay, P Yes No
PNP Platelet Neutralization Procedure No No
PTMSC PT Mix 1:1 No No
APMSC APTT Mix 1:1 No No
DRV2 DRVVT Mix No No
DRV3 DRVVT Confirmation No No
STACL Staclot LA, P No No
F5_IS Factor V Inhib Scrn No No
F9_IS Factor IX Inhib Scrn No No
F2_IS Factor II Inhib Scrn No No
F7_IS Factor VII Inhib Scrn No No
10_IS Factor X Inhib Scrn No No
11_IS Factor XI Inhib Scrn No No
PTFIB PT-Fibrinogen, P No No
SOLFM Soluble Fibrin Monomer No No
CH9 Chromogenic FIX, P Yes No
CHF8 Chromogenic FVIII, P Yes No

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), dilute Russell viper venom time (DRVVT), thrombin time (bovine), fibrinogen, D-dimer, and prolonged clot time 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 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 DRVVT ratio is > or =1.20, then DRVVT mix and DRVVT confirmation 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 PT, APTT, or DRVVT is prolonged, then coagulation factor assays may be performed at an additional charge.

If factor assay 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.

If appropriate, Staclot lupus anticoagulant (LA) will be performed at an additional charge to clarify significant abnormalities in the screen test results.

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

Method Name
A short description of the method used to perform the test

PTSC, APTSC, DRV1, TTSC,: Optical Clot-Based

CLFIB: Clauss

DIMER: Latex Immunoassay (LIA)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Prolonged Clot Time Prof

Aliases
Lists additional common names for a test, as an aid in searching

Coag

Prolonged Clot Time Profile

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), dilute Russell viper venom time (DRVVT), thrombin time (bovine), fibrinogen, D-dimer, and prolonged clot time 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 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 DRVVT ratio is > or =1.20, then DRVVT mix and DRVVT confirmation 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 PT, APTT, or DRVVT is prolonged, then coagulation factor assays may be performed at an additional charge.

If factor assay 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.

If appropriate, Staclot lupus anticoagulant (LA) will be performed at an additional charge to clarify significant abnormalities in the screen test results.

Specimen Type
Describes the specimen type validated for testing

Plasma Na Cit

Ordering Guidance

Multiple coagulation profile tests are available. See Coagulation Profile Comparison in Special Instructions for testing that is performed with each profile.

Shipping Instructions

Send the 5 aliquots in the same shipping container.

Necessary Information

1. If priority specimen, mark request form, give reason, and request a call-back.

2. Note if patient is currently receiving heparin, Coumadin (warfarin) or any medication affecting coagulation.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Patient Preparation:

1. Patient should not be receiving warfarin (Coumadin) or heparin.

2. Patient should also not be receiving fibrinolytic agents (streptokinase, urokinase, tissue plasminogen activator: tPA).

3. If patient has been recently transfused, it is best to perform this study pretransfusion, if possible.

Specimen Type: Platelet-poor plasma

Collection Container/Tube: Light-blue top (3.2% sodium citrate)

Submission Container/Tube: Plastic vial

Specimen Volume: 5 mL in 5 plastic vials each containing 1 mL

Collection Instructions:

1. Specimen must be collected prior to factor replacement therapy.

2. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing in Special Instructions.

3. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.

4. Aliquot plasma (1-2 mL per aliquot) into 5 separate plastic vials leaving 0.25 mL in the bottom of centrifuged vial.

5. Freeze plasma immediately (no longer than 4 hours after collection) at -20 degrees C or, ideally, < or =-40 degrees C.

Additional Information:

1. Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.

2. Each coagulation assay requested should have its own vial.

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

Forms

1. Coagulation Patient Information (T675) in Special Instructions.

2. If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

4 mL in 4 plastic vials each containing 1 mL

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 (preferred) 14 days

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

Determining the cause of prolongation of prothrombin time or activated partial thromboplastin time

 

Screening for prolonged clotting times and determining the presence of factor deficiencies or inhibitor (eg, factor-specific, lupus-like, or the presence of heparin)

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), dilute Russell viper venom time (DRVVT), thrombin time (bovine), fibrinogen, D-dimer, and prolonged clot time 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 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 DRVVT ratio is > or =1.20, then DRVVT mix and DRVVT confirmation 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 PT, APTT, or DRVVT is prolonged, then coagulation factor assays may be performed at an additional charge.

If factor assay 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.

If appropriate, Staclot lupus anticoagulant (LA) will be performed at an additional charge to clarify significant abnormalities in the screen test results.

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

When coagulation screening tests are performed to verify normal function of the coagulation system (eg, preoperative, routine examination), they sometimes indicate an abnormality that may be unexplained (ie, prolonged clotting times). This consultation provides validation of the prolongation and as comprehensive a workup as needed to define the abnormality.

 

Possibilities for a cause of prolongation include:

-Artifactual due to high hematocrit (-dilution of specimen by anticoagulant if patient hematocrit is 55% or greater)

-Factor deficiencies, congenital or acquired

-Factor inhibitors e.g. factor VIII inhibitors (bleeding disorder)

-Lupus anticoagulant (risk for thrombosis or recurrent miscarriage)

-Anticoagulant drug effect eg, (including warfarin (Coumadin or Jantoven), oral anti-Xa inhibitors, oral direct thrombin inhibitors), heparin.

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

If the patient's hematocrit is 55% or greater, the volume of citrate anticoagulant should be adjusted prior to submitting the specimen for analysis to avoid dilution of plasma by anticoagulant (1).

 

For optimal results, the patient should not be receiving oral vitamin K inhibitor (eg, warfarin, Coumadin), heparin, low-molecular weight heparin, hirudin (Refludan), argatroban, or fibrinolytic agents (eg, streptokinase, tissue plasminogen activator). If necessary, testing may be performed on patients receiving these treatments. Medications affecting coagulation parameters must be noted on requisition for accurate interpretation of results. Treatment with heparin causes false-positive results of in vitro coagulation testing for lupus anticoagulant. Coumadin treatment may impair ability to detect the more subtle varieties of lupus-like anticoagulants.

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

1. CLSI: Collection, Transport, and Processing of Blood Specimens for Testing Plasma-Based Coagulation Assays and Molecular Hemostasis Assays; Approved Guideline-Fifth edition. CLSI document H21-A5. Clinical and Laboratory Standards Institute; 2008

2. Kamal AH, Tefferi A, Pruthi RK: MBBS. How to interpret and pursue an abnormal prothrombin time, activated partial thromboplastin time, and bleeding time in adults. Mayo Clin Proc 2007 Jul;82:864-873

3. Laboratory Hematology Practice. Edited by K Kottke-Marchant. Wiley Blackwell Publishing, 2012

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

Method Description
Describes how the test is performed and provides a method-specific reference

Prothrombin time: Optical clot-based

The prothrombin time (PT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is incubated and combined with a PT reagent containing recombinant human tissue factor, synthetic phospholipids, calcium chloride, polybrene, and buffer. The tissue thromboplastin-factor VII/VIIa complex activates factor X. Activated factor X (factor Xa) forms a complex with factor Va, calcium, and phospholipid to activate factor II (prothrombin) to thrombin. Thrombin then acts on fibrinogen (factor I) to form fibrin which clots, the time to clot formation is measured optically using a wavelength of 671 nm providing the assay endpoint (the "prothrombin time").(Package insert: HemosIL RecombiPlasTin 2G Instrumentation Laboratory Company, R0, 03/2019)

 

Activated Partial Thromboplastin Time: Optical clot-based

The activated partial thromboplastin time (APTT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is combined and incubated with an APTT reagent containing phospholipid, a negatively charged contact factor activator, and buffer. After a specified incubation time, calcium is added to trigger the coagulation process in the mixture. Subsequently, the time to clot formation is measured optically using a wavelength of 671 nm. Mixing studies (see APMSC / Activated Partial Thromboplastin Time [APTT] Mix 1:1, Plasma) using normal pooled plasma are performed in the Special Coagulation Laboratory on samples with a prolonged APTT, to assist in discriminating between factor deficiency states and coagulation inhibitors, unless further testing is not indicated.(Package insert: HemosIL SynthASil. Instrumentation Laboratory Company, R11, 06/2017)

 

Dilute Russell’s Viper Venom Time:  Optical clot-based

The dilute Russell viper venom time (DRVVT) screening assay is performed on the Beckman Coulter 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).(Package insert: LA CHECK DRVVT Precision Biologic, Dartmouth, R14, 03/2012)

 

Thrombin Time: Optical clot-based

The thrombin time (TT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is combined with a bovine thrombin reagent containing bovine albumin, calcium chloride, and buffer immediately triggering the coagulation process in the mixture. Time to clot formation is measured optically using a wavelength of 671 nm.(Package insert: HemosIL Thrombin Time, Instrumentation Laboratory Company, R1 12/2018)

 

Fibrinogen: Clauss assay

The Clauss fibrinogen assay is performed using the HemosIL Fibrinogen-C kit on the Instrumentation Laboratory ACL TOP. Patient plasma, containing fibrinogen, is mixed with reagent containing excess thrombin. The excess thrombin converts the fibrinogen in the patient plasma to fibrin. The amount of time it takes to form a clot is inversely proportional to the amount of fibrinogen present in the patient plasma.(Package insert: HemosIL Fibrinogen-C. Instrumentation Laboratory Company, R7, 06/2017)

 

D-Dimer: Latex immunoassay

The D-dimer assay is performed using the HemosIL D-Dimer HS 500 kit on the Instrumentation Laboratory ACL TOP instrument. D-dimer is assayed in plasma by adding polystyrene latex particles coated with monoclonal antibodies specific for D-dimer domain. The latex particles agglutinate in the presence of soluble fibrin degradation products (FDP) containing the D-dimer domain. The degree of agglutination is directly proportional to the concentration of D-dimer in the sample and is determined by measuring the decrease of transmitted light caused by the aggregates (turbidimetric immunoassay).(Package insert: HemosIL D-Dimer HS 500. Instrumentation Laboratory Company, 04/2018)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

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.

3 to 7 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

7 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

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.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

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.

See Individual Test IDs

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.

85379-DIMER

85384-CLFIB

85390-26-APRI

85610-PTSC

85613-DRV1

85670-TTSC

85730-APTSC

85130-Chromogenic FVIII (if appropriate)

85130-Chromogenic FIX (if appropriate)

85210-Factor II (if appropriate)

85220-Factor V (if appropriate)

85230-Factor VII (if appropriate)

85240-Factor VIII (if appropriate)

85250-Factor IX (if appropriate)

85260-Factor X (if appropriate)

85270-Factor XI (if appropriate)

85280-Factor XII (if appropriate)

85335-Bethesda titer (if appropriate)

85335-Factor V inhibitor screen (if appropriate)

85335-Factor VIII inhibitor screen (if appropriate)

85335-Factor IX inhibitor screen (if appropriate)

85366-Soluble fibrin monomer (if appropriate)

85385-PT-Fibrinogen (if appropriate)

85597-Platelet neutralization for lupus inhibitor (if appropriate)

85598-Staclot LA (if appropriate)

85611-PT mix 1:1 (if appropriate)

85613-DRVVT mix (if appropriate)

85613-DRVVT confirm (if appropriate)

85635-Reptilase time (if appropriate)

85732-APTT mix 1:1 (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
APROL Prolonged Clot Time Prof 98125-8
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.
APTSC Activated Partial Thrombopl Time, P 14979-9
CLFIB Fibrinogen, Clauss, P 48664-7
TTSC Thrombin Time (Bovine), P 46717-5
603324 Reviewed by 18771-6
603183 Prolonged Clot Time Prof Interp 69049-5
DIMER D-Dimer, P 48067-3
INRSC INR 6301-6
PTSEC Prothrombin Time (PT), P 5902-2
RVR1 DRVVT Screen Ratio 15359-3

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports