Ordering Recommendation

Determine the cause for a prolonged prothrombin time or activated partial thromboplastin time. Condition-specific testing is preferred when the patient has a known coagulation disorder or a clear bleeding presentation.

Mnemonic
CLOT REF R
Methodology

Electromagnetic Mechanical Clot Detection/Qualitative Hemagglutination/Platelet Agglutination/Microlatex Particle-Mediated Immunoassay

Performed

Mon-Sun

Reported

1-8 days

New York DOH Approval Status
This test is New York DOH approved.
Specimen Required
Patient Preparation
Collect

At least five (5) Light Blue (Sodium Citrate) tubes. Refer to Specimen Handling at aruplab.com for hemostasis/thrombosis specimen handling guidelines.

Specimen Preparation

Transfer five 1 mL aliquots of platelet-poor plasma to five ARUP Standard Transport Tubes, label as sodium citrate. (Min: 1 mL/aliquot and 5 mL total)

Storage/Transport Temperature

CRITICAL FROZEN. Separate specimens must be submitted when additional test codes are ordered.

Unacceptable Conditions

Serum or EDTA plasma. Specimens containing anticoagulant medications. Clotted or hemolyzed specimens.

Remarks

Submit the Patient History Form for Prolonged Clot Reflex Panel.

Stability

Ambient: Unacceptable; Refrigerated: Unacceptable; Frozen: at -20°C: 3 months; Frozen at -70°C: 6 months

Reference Interval
Test Number
Components
Reference Interval
0030130 Fibrinogen 150-430 mg/dL
0030057 D-Dimer 0.0-0.4 µg/mL
0030181 Lupus Anticoagulant Reflexive Panel Effective August 21, 2017
Test Number
Components
Reference Interval
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
Prothrombin Time 12.0-15.5 seconds
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

PT, Inhibitor Screen, 1:1 Mix 12.0-15.5 seconds
0030126 Soluble Fibrin Monomer Negative
0030007 Factor II, Activity (Prothrombin)
Age Reference Interval Age Reference Interval
1-4 days 26-70% 7-9 years 78-125%
5-29 days 33-93% 10-11 years 78-120%
30-89 day 34-102% 12-13 years 72-123%
90-179 days 45-105% 14-15 years 75-135%
180-364 days 60-116% 16-17 years 77-130%
1-5 years 71-116% 18 years and older 86-150%
6 years 67-107%

0030075 Factor V, Activity
Age Reference Interval Age Reference Interval
1-4 days 36-108% 7-9 years 69-132%
5-29 days 45-145% 10-11 years 66-136%
30-89 days 62-134% 12-13 years 66-135%
90-179 days 48-132% 14-15 years 61-129%
180-364 days 55-127% 16-17 years 65-131%
1-5 years 79-127% 18 years and older 62-140%
6 years 63-116%

0030080 Factor VII, Activity
Age Reference Interval Age Reference Interval
1-4 days 28-104% 7-9 years 67-145%
5-29 days 35-143% 10-11 years 71-163%
30-89 days 42-138% 12-13 years 78-160%
90-179 days 39-143% 14-15 years 74-180%
180-364 days 47-127% 16-17 years 63-163%
1-5 years 55-116% 18 years and older 80-181%
6 years 52-120%

0030026 Factor VIII Activity with Reflex to Bethesda Quantitative, Factor VIII
Test Number
Components
Reference Interval
0030095 Factor VIII, Activity Refer to report
Bethesda Quantitative, Factor VIII Effective May 19, 2014
0.5 BU or less

0030032 Factor IX Activity with Reflex to Bethesda Quantitative, Factor IX
Test Number
Components
Reference Interval
0030100 Factor IX, Activity Refer to report
Bethesda Quantitative, Factor IX Effective May 19, 2014
0.4 BU or less

0030105 Factor X, Activity
Age Reference Interval Age Reference Interval
1-4 days 12-68% 7-9 years 74-130%
5-29 days 19-79% 10-11 years 70-134%
30-89 days 31-87% 12-13 years 69-133%
90-179 days 35-107% 14-15 years 63-146%
180-364 days 38-118% 16-17 years 74-146%
1-5 years 58-116% 18 years and older 81-157%
6 years 55-101%

0030110 Factor XI, Activity
Age Reference Interval Age Reference Interval
1-4 days 10-66% 7-9 years 70-138%
5-29 days 23-87% 10-11 years 66-137%
30-89 days 27-79% 12-13 years 68-138%
90-179 days 41-97% 14-15 years 57-129%
180-364 days 38-134% 16-17 years 65-159%
1-5 years 56-150% 18 years and older 56-153%
6 years 52-120%

0030115 Factor XII, Activity 58-166%
0030285 von Willebrand Factor Antigen
Age Reference Interval
0-6 years 52-214%
7-9 years 62-180%
10-11 years 63-189%
12-13 years 60-189%
14-15 years 57-199%
16-17 years 50-205%
18 years and older 52-214%

0030250 von Willebrand Factor Activity (Ristocetin Cofactor)
Age Reference Interval
0-6 years 51-215%
7-9 years 52-176%
10-11 years 60-195%
12-13 years 50-184%
14-15 years 50-203%
16-17 years 49-204%
18 years and older 51-215%

Interpretive Data

Refer to report.

No compliance statements are in use for this test.

Note

Submission of a completed Patient History Form with test order will allow for optimal panel interpretation. The Patient History Form for Prolonged Clot Reflex Panel is available on the ARUP web site or by contacting ARUP Client Services at (800) 522-2787. 

If D-Dimer is abnormal, Soluble Fibrin Monomer is added. If PT is abnormal PT, Inhibitor Screen, 1:1 Mix is added. If PTT is abnormal, Thrombin Time is added. If Thrombin Time is normal, PTT 1:1 mix is added. If Thrombin time is abnormal, Reptilase Time and PTT Heparin Neutralization is added. If PTT Heparin Neutralization is abnormal, PTT 1:1 mix is added. If PTT 1:1 mix is abnormal, Platelet Neutralization procedure is added. If dRVVT is abnormal, dRVVT 1:1 mix is added. If dRVVT 1:1 mix is abnormal, dRVVT confirmation is added. If Platelet Neutralization procedure and dRVVT confirmation are normal or if one is normal and the other not done, Hexagonal Phospholipid Neutralization is added. Depending on findings, one or more reflexive tests may be required in order to provide a clinical interpretation. Additional charges apply.

Hotline History
N/A
CPT Codes

85384, 85379, 85610, 85730, 85613; if reflexed, additional CPT codes may apply: 85670, 85635, 85730, 85525, 85732,
85597, 85613, 85598, 85611, 85366, 85210, 85220, 85230, 85240, 85335, 85250, 85260, 85270, 85280, 85246, 85245

Components
Component Test Code* Component Chart Name LOINC
0030007 Factor II, Activity (Prothrombin) 3289-6
0030028 Bethesda Quantitative, F8 3204-5
0030033 Bethesda Quantitative, F9 3185-6
0030057 D-Dimer 7799-0
0030075 Factor V, Activity 3193-0
0030079 Lupus Anticoagulant Interpretation 75882-1
0030080 Factor VII, Activity 3198-9
0030082 Hexagonal Phospholipid Neutral Reflex 33930-9
0030084 PTT-D Heparin Neutralized 52123-7
0030095 Factor VIII, Activity 3209-4
0030100 Factor IX, Activity 3187-2
0030105 Factor X, Activity 3218-5
0030110 Factor XI, Activity 3226-8
0030115 Factor XII, Activity 3232-6
0030126 Soluble Fibrin Monomer 40702-3
0030130 Fibrinogen 3255-7
0030184 Platelet Neutralization (PTT-D, Confirm) 15191-0
0030189 dRVVT Confirmation 50410-0
0030232 PTT-LA Screen (PTT-D) 34571-0
0030246 Prothrombin Time 5902-2
0030250 von Willebrand Factor, Activity (RCF) 6014-5
0030270 Thrombin Time 3243-3
0030285 von Willebrand Factor, Antigen 27816-8
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
2003265 PT, Inhibitor Screen, 1:1 Mix 33357-5
2014319 Prolonged Clot Time Reflex Panel Interp 48767-8
* 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
Prolonged Clot Time Reflex Panel