Partial Thromboplastin Time
Partial Thromboplastin Time
Definition
Purpose
Precautions
Description
Preparation
Aftercare
Risks
Normal results
Abnormal results
Morbidity and mortality rates
Alternatives Resources
Precautions
Side effects
Definition
The partial thromboplastin time (PTT) test is a blood test that is done to investigate bleeding disorders and to monitor patients taking an anticlotting drug (heparin).
Purpose
Diagnosis
Blood clotting (coagulation) depends on the action of substances in the blood called clotting factors. Measuring the partial thromboplastin time helps to assess which specific clotting factors may be missing or defective.
Monitoring
Certain surgical procedures and diseases cause blood clots to form within blood vessels. Heparin is used to treat these clots. The PTT test can be used to monitor the effect of heparin on a patient’s coagulation system.
Precautions
Certain medications besides heparin can affect the results of the PPT test. These include antihistamines, vitamin C (ascorbic acid), aspirin, and chlorpromazine (Thorazine).
Description
When a body tissue is injured and begins to bleed, it starts a sequence of clotting factor activities called the coagulation cascade, which leads to the formation of a blood clot. The cascade has three pathways: extrinsic, intrinsic, and common. Many of the thirteen known clotting factors in human blood are shared by both pathways; several are found in only one. The PTT test evaluates the factors found in the intrinsic and common pathways. It is usually done in combination with other tests, such as the prothrombin test, which evaluate the factors of the extrinsic pathway. The combination of tests narrows the list of possible missing or defective factors.
Heparin prevents clotting by blocking certain factors in the intrinsic pathway. The PTT test allows a doctor to check that there is enough heparin in the blood to prevent clotting, but not so much as to cause bleeding. The test is done before the first dose of heparin or whenever the dosage level is changed; and again when the heparin has reached a constant level in the blood. The PTT test is repeated at scheduled intervals.
The PTT test uses blood to which a chemical has been added to prevent clotting before the test begins. About 5 mL of blood are drawn from a vein in the patient’s inner elbow region. Collection of the sample takes only a few minutes. The blood is spun in a centrifuge, which separates the pale yellow liquid part of blood (plasma) from the cells. Calcium and activating substances are added to the plasma to start the intrinsic pathway of the coagulation cascade. The partial thromboplastin time is the time it takes for a clot to form, measured in seconds.
The test can be done without activators, but they are usually added to shorten the clotting time, making the test more useful for monitoring heparin levels. When activators are used, the test is called activated partial thromboplastin time or APTT.
Test results can be obtained in less than one hour. The test is usually covered by insurance.
Preparation
The doctor should check to see if the patient is taking any of the medications that may influence the test results. If the patient is on heparin therapy, the blood sample is drawn one hour before the next dose of heparin.
Aftercare
Aftercare includes routine care of the puncture site. In addition, patients on heparin therapy must be watched for signs of spontaneous bleeding. The patient should not be left alone until the doctor or nurse is sure that bleeding has stopped. Patients should also be advised to watch for bleeding gums, bruising easily, and other signs of clotting problems; to avoid activities that might cause minor cuts or bruises; and to avoid using aspirin.
Risks
The patient may develop a bruise or swelling around the puncture site, which can be treated with moist warm compresses. People with coagulation problems may bleed for a longer period than normal.
Normal results
Normal results vary based on the method and activators used. Normal APTT results are usually between 25-40 seconds; PTT results are between 60–70 seconds. APTT results for a patient on heparin should be 1.5–2.5 times normal values. An APTT longer than 100 seconds indicates spontaneous bleeding.
Abnormal results
Increased levels in a person with a bleeding disorder indicate a clotting factor may be missing or defective. Further tests are done to identify the factor involved. Liver disease decreases production of factors, increasing the PTT.
Low levels in a patient on heparin indicate too little heparin is in the blood to prevent clots. High levels indicate too much heparin is present, placing the person at risk of excessive bleeding.
Morbidity and mortality rates
Morbidity rates are excessively miniscule. The most common problems are minor bleeding and bruising. Since neither are reportable events, morbidity can only be estimated. Mortality is essentially zero.
KEY TERMS
Activated partial thromboplastin time— Partial thromboplastin time test that uses activators to shorten the clotting time, making it more useful for heparin monitoring.
Clotting factors— Substances in the blood that act in sequence to stop bleeding by forming a clot.
Coagulation— The process of blood clotting.
Coagulation cascade— The sequence of biochemical activities, involving clotting factors, that stop bleeding by forming a clot.
Common pathway— The pathway that results from the merging of the extrinsic and intrinsic pathways. The common pathway includes the final steps before a clot is formed.
Extrinsic pathway— One of three pathways in the coagulation cascade.
Heparin— A medication that prevents blood clots.
Intrinsic pathway— One of three pathways in the coagulation cascade.
Partial thromboplastin time— A test that checks the clotting factors of the intrinsic pathway.
Plasma— The fluid part of blood, as distinguished from blood cells.
Alternatives Resources
There are no alternatives to a partial thromboplastin time.
Precautions
The only precaution needed is to clean the venipuncture site with alcohol.
Side effects
The most common side effects of a partial thromboplastin time test are minor bleeding and bruising.
Resources
BOOKS
Fischbach, F. T. and M. B. Dunning. A Manual of Laboratory and Diagnostic Tests. 8th ed. Philadelphia: Lippincott Williams & Wilkins, 2008.
McGhee, M. A Guide to Laboratory Investigations. 5th ed. Oxford, UK: Radcliffe Publishing Ltd, 2008.
Price, C. P. Evidence-Based Laboratory Medicine: Principles, Practice, and Outcomes. 2nd ed. Washington, DC: AACC Press, 2007.
Scott, M.G., A. M. Gronowski, and C. S. Eby. Tietz’s Applied Laboratory Medicine. 2nd ed. New York: Wiley-Liss, 2007.
Springhouse, A. M.. Diagnostic Tests Made Incredibly Easy!. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2008.
PERIODICALS
Aksungar, F. B., A. E. Topkaya, Z. Yildiz, S. Sahin, and U. Turk. “Coagulation status and biochemical and inflammatory markers in multiple sclerosis.” Journal of Clinical Neuroscience 15, no. 4 (2008): 393–397.
Awan, M. S., M. Iqbal, and S. Z. Imam. “Epistaxis: when are coagulation studies justified?” Emergency Medicine Journal 25, no. 3 (2008): 156–157.
Mueck, W., B. I. Eriksson, K. A. Bauer et al. “Population pharmacokinetics and pharmacodynamics of rivaroxaban - an oral, direct factor Xa inhibitor - in patients undergoing major orthopaedic surgery.” Clinical Pharmacokinetics 47, no. 3 (2008): 203–216.
Rosenkrantz, A., M. Hinden, B. Leschmik, et al. “Calibrated automated thrombin generation in normal uncomplicated pregnancy.” Thrombosis and Hemostasis 99, no. 2 (2008): 331–337.
ORGANIZATIONS
American Association for Clinical Chemistry. http://www.aacc.org/AACC/.
American Society for Clinical Laboratory Science. http://www.ascls.org/.
American Society of Clinical Pathologists. http://www.ascp.org/.
College of American Pathologists. http://www.cap.org/apps/cap.portal.
OTHER
American Clinical Laboratory Association. Information about clinical chemistry. 2008 [cited February 24, 2008]. http://www.clinical-labs.org/
Clinical Laboratory Management Association. Information about clinical chemistry. 2008 [cited February 22, 2008]. http://www.clma.org/.
Lab Tests On Line. Information about lab tests. 2008[cited February 24, 2008]. http://www.labtestsonline.org/.
National Accreditation Agency for Clinical Laboratory Sciences. Information about laboratory tests. 2008 [cited February 25, 2008]. http://www.naacls.org/.
L. Fleming Fallon, Jr, MD, DrPH
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