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Pathologist Interpretation: Thrombophilia

Path Consult: Coagulation, Coagulation Consultation for Pathology, Thrombophilia/Hypercoagulability

Test Codes

EPIC: LAB1231248

Department

Coagulation

Instructions

• This test is available to Outpatients only. The patient must be off anticoagulants.
• The Thrombophilia/Hypercoagulability Panel includes a basic number of tests, however tests may be added or excluded at the pathologist’s discretion based on prior or concurrent laboratory results. For optimal results, patients should be off anticoagulant drugs. The basic panel includes:
  • Activated Partial Thromboplastin (aPTT)
  • Activated Protein C Resistance
  • Antiphospholipid Antibody Panel
  • Antithrombin III
  • DRVVT
  • Factor V Genotyping Analysis
  • Factor VIII Activity
  • Hexagonal Phase Phospholipid
  • Homocysteine
  • Protein C Activity
  • Protein S Activity
  • Prothrombin Genotyping for Thrombotic Risk Assessment
  • Protime (PT)
• It is expected that these panels will expedite work-up for complex coagulopathies or thrombotic risk factors. In addition, the pathologist will be able to order multiple tests on a single specimen, limiting the amount of blood to be drawn from the patient.
• Please note that platelet studies are not included in these panels due to the considerable difference in pre-analytical time necessary to do coagulation studies vs. platelet studies (4 hours). However, platelet studies may be ordered concurrently by the physician, or if the pathologist considers platelet studies necessary to complete the work-up, it will be mentioned in the interpretation.
• Also note that the Thrombophilia/Hypercoagulation Panel includes multiple tests that should not be ordered on patients with an acute thrombotic event, as they can be falsely decreased. Moreover, many of these tests do not influence the initial treatment or prophylaxis. Therefore, the Thrombophilia Panel should NOT be ordered on inpatients.

Specimen Collection Criteria

Collect: Five Light Blue-top 3.2% Sodium Citrate tubes, one 4.0 mL Lavender-top K₂EDTA tube, and one Gold-top SST tube.

• SODIUM CITRATE TUBES MUST BE FULL.
• A copy of the requisition must be sent with the specimen.

Physician Office/Draw Specimen Preparation

For optimal results, maintain whole blood Sodium Citrate specimens at room temperature (20-26°C or 68-78.8°F) prior to transport. Transport whole blood to the Laboratory within 4 hours of collection. If transport within 4 hours is not possible, the following procedure must be followed for accurate results:

1. Centrifuge the capped tube at 1500 x g for 15 minutes.
2. Transfer plasma with a plastic pipette into a plastic polypropylene centrifuge tube, cap and centrifuge an additional 15 minutes at 1500 x g to obtain platelet poor plasma (PPP) which has a platelet count less than 10 bil/L. Plasma with a platelet count of less than 10 bil/L is critical for accurate results.
3. Immediately remove only the top two-thirds of the PPP and transfer it into five screw cap, 5 ml, 75 x 13 mm, round base, polypropylene tubes.
4. Freeze (-20°C/-4°F or below) the PPP specimens immediately.
5. Transport frozen on DRY ICE. Specimen must remain frozen during transport.

Maintain K₂EDTA specimens refrigerated (2-8°C or 36-46°F) prior to transport. Let SST specimen clot 30-60 minutes then immediately centrifuge to separate serum from cells. Refrigerate (2-8°C or 36-46°F) the centrifuged collection tube or maintain at room temperature (20-26°C or 68-78.8°F). (Minimum Serum: 0.5 mL)

Preparation for Courier Transport

Transport: Whole blood at room temperature (20-25°C or 68-77°F), or plasma obtained through the process listed above, frozen (-20°C/-4°F or below), and whole blood in K₂EDTA and centrifuged Gold-top tube, refrigerated (2-8°C or 36-46°F).

Rejection Criteria

• Frozen K₂EDTA specimens.
• Glass tubes and 3.8% Sodium Citrate tubes.
• Inappropriate specimen volume.
• Specimens that are clotted or grossly hemolyzed.
• SST specimens that are heat-inactivated, hemolyzed, or grossly lipemic.
• Thawed or partially thawed specimens.

In-Lab Processing

Whole blood Sodium Citrate specimens must be processed as follows upon receipt in the Laboratory:

1. Centrifuge the capped tube at 1500 x g for 15 minutes.
2. Transfer plasma with a plastic pipette into a plastic polypropylene centrifuge tube, cap and centrifuge an additional 15 minutes at 1500 x g to obtain platelet poor plasma (PPP) which has a platelet count less than 10 bil/L. Plasma with a platelet count of less than 10 bil/L is critical for accurate results.
3. Immediately remove only the top two-thirds of the PPP and transfer it into five plastic tube.

4. Test or freeze specimen according to lab protocol.

Maintain K₂EDTA specimens refrigerated (2-8°C or 36-46°F) prior to testing. Let SST specimen clot 30-60 minutes then immediately centrifuge to separate serum from cells. (Minimum Serum: 0.5 mL)

Storage

Specimen Stability for Testing:

Whole Blood (Sodium Citrate)
Room Temperature (20-26°C or 68-78.8°F): 4 hours
Refrigerated (2-8°C or 36-46°F): Unacceptable
Frozen (-20°C/-4°F or below): Unacceptable

Platelet Poor Plasma (PPP)
Room Temperature (20-26°C or 68-78.8°F): Unacceptable
Refrigerated (2-8°C or 36-46°F): Unacceptable
Frozen (-20°C/-4°F or below): 30 days

Whole Blood (K₂EDTA)
Room Temperature (20-26°C or 68-78.8°F): 72 hours
Refrigerated (2-8°C or 36-46°F): 7 days
Frozen (-20°C/-4°F or below): Unacceptable

Centrifuged SST Tubes and Microtainers^® with Separator Gels
Room Temperature (20-26°C or 68-78.8°F): 2 hours
Refrigerated (2-8°C or 36-46°F): 7 days
Frozen (-20°C/-4°F or below): Unacceptable

Serum Specimens (Pour-Overs)
Room Temperature (20-26°C or 68-78.8°F): 2 hours
Refrigerated (2-8°C or 36-46°F): 7 days
Frozen (-20°C/-4°F or below): 3 months

Specimen Storage in Department Prior to Disposal:

Refrigerated (2-8°C or 36-46°F): 7 days

Laboratory

Royal Oak Coagulation Laboratory

Performed

Minimum once per week.
Results available in 3-5 days. Interpretation available within 5-7 business days. 

Reference Range

See individual tests listed for the appropriate reference ranges.

Activated Partial Thromboplastin (aPTT), Activated Protein C Resistance, Antiphospholipid Antibody Panel, Antithrombin III, DRVVT, Factor V Genotyping Analysis, Factor VIII Activity, Hexagonal Phase Phospholipid, Homocysteine, Protein C Activity, Protein S Activity, Prothrombin Genotyping for Thrombotic Risk Assessment, Protime (PT)

Interpretation

An interpretative report will be included with each testing panel.

Clinical Utility

This panel should facilitate investigation of thrombophilia or hypercoagulable state. Possible etiologies include anti-phospholipid antibodies, factor V Leiden gene mutation, prothrombin gene mutation, hyperhomocysteinemia and deficiencies of protein C, protein S or antithrombin, etc. As with most complex laboratory testing, correlation with the clinical findings is necessary.

CPT Codes

85390 (additional codes depending on tests chosen by pathologist).

Contacts

Last Updated

8/15/2024