Thrombotic Risk Reflexive Panel

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Informed Consent for Genetic Testing (required for NY patients)

Ordering Recommendation

Panel to evaluate for inherited and acquired thrombophilias.

Mnemonic

THROMRISKR

Methodology

Chromogenic Assay/Electromagnetic Mechanical Clot Detection/Quantitative Enzymatic Assay/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): Frozen.

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: 7 days; Refrigerated: 1 week; Frozen: 1 month
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
  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 yeas 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

  Hexagonal Phospholipid Neutral Reflex Negative
  PTT-D Heparin Neutralized 32-48 seconds
  Protein C Functional
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

  Platelet Neutralization (PTT-D, Confirm) Negative
  dRVVT Confirmation Negative
  APC Resistance 2.00 or greater
  PTT-LA Screen (PTT-D) 32-48 seconds
  Prothrombin Time 12.0-15.5 seconds
  Thrombin Time 14.7-19.5 seconds
  Reptilase Time Less than 22.0 seconds
  PTT-D 1:1 Mix 32-48 seconds
  dRVVT Screen 33-44 seconds
  dRVVT 1:1 Mix 33-44 seconds
  B2Glycoprotein 1, IgG Antibody <=20 SGU
  B2Glycoprotein 1, IgM Antibody <=20 SMU
  Cardiolipin Antibody IgG 14 GPL or less
  Cardiolipin Antibody IgM 12 MPL or less
  Homocysteine, Total 0-15 µmol/L, for both male and female

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

If APC resistance is normal, then Factor V Leiden by PCR will not be added. If APC resistance is low, or if a valid result cannot be obtained for the APC portion of the profile, then Factor V Leiden by PCR will be added. Additional charges apply. False elevations of plasma or serum homocysteine may occur if the plasma or serum is not promptly separated from the cells at the time of collection.

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
04/04/2022
X
11/15/2021
X
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 48767-8
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