Thrombotic Risk Reflexive Panel

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Abnormal
Normal

Ordering Recommendation

Panel to evaluate for inherited and acquired thrombophilias.

Mnemonic

THROMRISKR

Methodology

Chromogenic Assay/Electromagnetic Mechanical Clot Detection/Quantitative Enzymatic/Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Polymerase Chain Reaction/Fluorescence Monitoring/Microlatex Particle Mediated Immunoassay

Performed

Varies

Reported

2-7 days

New York DOH Approval Status

This test is New York DOH approved.

Specimen Required

Patient Preparation

Fasting preferred. Refer to Specimen Handling at aruplab.com for hemostasis/thrombosis specimen handling guidelines.

Collect

Four Light Blue (Sodium Citrate) AND two Lavender (EDTA) AND two Serum Separator Tubes (SST). Also acceptable in place of one of the Serum Separator Tubes (SST): Green (Sodium or Lithium Heparin) or EDTA (K2 or K3).

Specimen Preparation

One Serum Separator Tube (SST), Green (Sodium or Lithium Heparin) or EDTA (K2 or K3) must be centrifuged and serum or plasma separated within 1 hour of collection. Transfer 1 mL centrifuged serum or plasma to ARUP Standard Transport Tube and label centrifuged tube for homocysteine testing. (Min: 0.5 mL) AND Transfer 2 mL serum into 2 ARUP Standard Transport Tubes, label as serum. (Min: 0.5 mL/tube) AND Transfer 7.5 mL platelet poor plasma prepared from the sodium citrate tubes to 5 ARUP Standard Transport Tubes, label as sodium citrate. (Min: 1 mL/tube) AND Transfer 3 mL lavender whole blood to 2 ARUP Standard Transport Tubes. (Min: 1 mL/tube)

Storage/Transport Temperature

Light Blue (Sodium Citrate): CRITICAL FROZEN. Separate specimens must be submitted when multiple tests are ordered.
Lavender Whole Blood and Serum, Green (Sodium or Lithium Heparin) or EDTA (K2 or K3): Refrigerated.

Unacceptable Conditions

Specimens collected in any tube type not listed above.

Remarks
Stability

Light Blue (Sodium Citrate): Ambient: Unacceptable; Refrigerated: Unacceptable; Frozen: 2 weeks
Lavender Whole Blood: Ambient: 2 hours; Refrigerated: 1 week; Frozen: Unacceptable
Serum: Ambient: 2 hours; Refrigerated: 1 week; Frozen: 2 weeks
Green (Sodium or Lithium Heparin) or EDTA (K2 or K3): Ambient: 4 days; Refrigerated: 1 month; Frozen: 10 months

Reference Interval

Test Number
 Components
 Reference Interval
  Prothrombin Time 12.0-15.5 seconds
Dilute Russell Viper Venom Time (dRVVT) 33-44 seconds
Dilute Russell Viper Venom (dRVVT) 1:1 Mix (performed if dRVVT > 44 seconds) 33-44 seconds
Dilute Russell Viper Venom Time (dRVVT) Confirmation Test (performed if dRVVT 1:1 Mix > 44 seconds) Negative
Partial Thromboplastin Time 32-48 seconds
Thrombin Time 14.7-19.5 seconds
Reptilase Time Less than 22.0 seconds
PTT Heparin Neutralized 32-48 seconds
Partial Thromboplastin Time 1:1 Mix (performed if PTT > 48 seconds) 32-48 seconds
Platelet Neutralization Procedure (performed if PTT 1:1 Mix > 48 seconds) Negative
Hexagonal Phospholipid Neutralization Negative
0050901 Cardiolipin Antibody, IgG Effective August 18, 2014
0-14 GPL Negative
15-19 GPL Indeterminate
20-80 GPL Low to Moderately Positive
81 GPL or above High Positive

0050902 Cardiolipin Antibody, IgM Effective August 18, 2014
0-12 MPL Negative
13-19 MPL Indeterminate
20-80 MPL Low to Moderately Positive
81 MPL or above High Positive

Beta-2 Glycoprotein 1 Antibody, IgG Effective August 18, 2014
0-20 SGU
Beta-2 Glycoprotein 1 Antibody, IgM Effective August 18, 2014
0-20 SMU
0098894 Protein S Free, Antigen
Age Male Female
1-89 days 15-55% 15-55%
90-179 days 35-92% 35-92%
180-364 days 45-115% 45-115%
1-5 years 62-120% 62-120%
6-9 years 62-130% 62-130%
10-17 years 60-140% 60-140%
18 years and older 74-147% 55-123%

0099869 Homocysteine, Total Effective January 4, 2021:
0-15 µmol/L, for both male and female
0030010 Antithrombin, Enzymatic (Activity)
Age Reference Interval
1-4 days 39-87%
5-29 days 41-93%
30-89 days 48-108%
90-179 days 73-121%
180-364 days 84-124%
1-5 years 82-139%
6 years 90-131%
7-9 years 90-135%
10-11 years 90-134%
12-13 years 90-132%
14-15 years 90-131%
16-17 years 87-131%
18 years and older 76-128%

0030113 Protein C, Functional Effective November 17, 2014
Age Reference Interval
1-4 days 17-53%
5-29 days 20-64%
30-89 days 21-65%
90-179 days 28-80%
180-364 days 37-81%
1-6 years 40-92%
7-9 years 70-142%
10-11 years 68-143%
12-13 years 66-162%
14-15 years 69-170%
16-17 years 70-171%
18 years and older 83-168%

  APC Resistance Effective February 21, 2011

2.00 or greater
Test Number
 Components
 Reference Interval
0030127 APC Resistance Panel Refer to report
0097720 Factor V Leiden (F5) R506Q Mutation Refer to report

Factor V Leiden by PCR & Fluorescence Monitoring Negative: The sample is negative for factor V Leiden, R506Q mutation.
0056060 Prothrombin (F2) c.*97G>A (G20210A) Pathogenic Variant

Interpretive Data

Refer to individual components.

This test was developed and its performance characteristics determined by ARUP Laboratories. It has not been cleared or approved by the US Food and Drug Administration. This test was performed in a CLIA certified laboratory and is intended for clinical purposes.

Counseling and informed consent are recommended for genetic testing. Consent forms are available online.

Compliance Category

Laboratory Developed Test (LDT)

Note

Hotline History

View Hotline History

 

Hotline History

Date of Change
Test Name Change
Methodology
Performance/Reported Schedule
Specimen Requirements
Reference Interval
Interpretive Data
Note
CPT Code
Component Change
Other Interface Change
New Test
Inactive
01/04/2021
X
X
N/A

CPT Codes

86147 x2; 86146 x2; 85306; 83090; 85300; 85303; 85307; 85610; 81240; 85730; 85613.  If PTT is abnormal, add 85670. If Thrombin time is abnormal, add 85635, 85730 and 85525. If PTT Heparin Neutralization is abnormal, add 85732. If PTT 1:1 Mix is abnormal, add 85597.  If dRVVT is abnormal, add 85613.  If dRVVT 1:1 mix is abnormal, add 85613.  If PNP and dRVVT confirmation are normal, add 85598.  If APC resistance is low, add 81241.

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Components

Component Test Code* Component Chart Name LOINC
0030010 Antithrombin, Enzymatic (Activity) 27811-9
0030054 Thrombosis Interpretation - Risk
0030079 Lupus Anticoagulant Interpretation 75882-1
0030082 Hexagonal Phospholipid Neutral Reflex 33930-9
0030084 PTT-D Heparin Neutralized 52123-7
0030113 Protein C Functional 27819-2
0030184 Platelet Neutralization (PTT-D, Confirm) 15191-0
0030189 dRVVT Confirmation 50410-0
0030193 APC Resistance 13590-5
0030194 Factor V Leiden by PCR 21668-9
0030232 PTT-LA Screen (PTT-D) 34571-0
0030246 Prothrombin Time 5902-2
0030270 Thrombin Time 3243-3
0030296 Reptilase Time 6683-7
0030323 PTT-D 1:1 Mix 5946-9
0030352 dRVVT Screen 6303-2
0030353 dRVVT 1:1 Mix 75513-2
0050322 B2Glycoprotein 1, IgG Antibody 44448-9
0050323 B2Glycoprotein 1, IgM Antibody 44449-7
0050901 Cardiolipin Antibody IgG 3181-5
0050902 Cardiolipin Antibody IgM 3182-3
0056060 Prothrombin (F2) G20210A Variant 24475-6
0098894 Protein S Ag Free 27821-8
0099869 Homocysteine, Total 13965-9
2001308 FACV REF Specimen 31208-2
2001334 PT PCR Specimen 31208-2
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.

Aliases

Thrombotic Risk Reflexive Panel