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THRMB
THROMBOTIC RISK PANEL

Test Code THRMB 
Test THROMBOTIC RISK PANEL 
Description Useful for the diagnosis of thrombotic disorders.

Antithrombin III Activity
Beta-2-Glycoprotein, IgG, IgM
Cardiolipin Antibodies, IgA, IgG, IgM
Factor V Leiden Mutation
Fibrinogen
Homocysteine, Total
Silica Screen
Silica Confirmation
DRVVT Screen
Partial Thromboplastin Time (PTT)
Protein C Activity
Protein S Activity
PTDNA
INR
Thrombin Time

If an abnormal lupus screen is detected the following tests will be performed at an additional cost:
DRVVT Confirmation Assay
DRVVT Mixing Assay
Silica Mixing Study
PTT using reagent more sensitive to factor deficiencies (Dade Actin FS)
Thrombin Time

If the thrombin time is greater than 30, a Reptilase Time will be performed.

NOTE: Tests may be ordered individually.

NOTE: This test, when ordered on Medicare patients, is subject to the National Coverage Determination (NCD) policies "Partial Thromboplastin Time (PTT)" and "Prothrombin Time (PT)". Please verify that the diagnosis code (ICD-9) you have chosen demonstrates medical necessity for the test as documented in the physician's patient record. The CMS web site or the NorDx Limited Coverage Documentation Guide are available to assist you with this verification. A properly executed Advance Beneficiary Notice (ABN) must be submitted with the specimen if medical necessity is not demonstrated by the ICD-9 code chosen. 

Specimen

BLOOD, PLASMA, AND SERUM ARE REQUIRED FOR THIS TEST.
THROMBOTIC RISK PROFILE pamphlet
PROCESSING CHECKLIST
THROM Test Component List
COAGULATION DOUBLE SPIN PROCESS


1. BLOOD FOR FACTOR 5 LEIDEN and PROTHROMBIN 20210:
Draw blood in a lavender-top (EDTA) tube. (HEMOLYZED SPECIMEN IS NOT ACCEPTABLE.) Send 5.0 mL of EDTA whole blood at ambient temperature.

2. PLASMA FOR HOMOCYSTEINE, TOTAL:
Draw blood in a lavender-top (EDTA) tube from a fasting patient. IMMEDIATELY spin down and IMMEDIATELY separate plasma from cells. Send 1.0 mL (minimum volume: 0.5 mL) of plasma refrigerated in a plastic screw-capped vial.

3. BLOOD FOR HEMATOCRIT:
Draw blood in a lavender-top (EDTA) tube. Mix well. Send a minimum of 1mL EDTA whole blood refrigerated. (Clotted or grossly hemolyzed specimens are not acceptable). This hematocrit is a non-reportable internal test to be run at no charge. It is to be tested to rule out abnormal results from blue-top tubes due to a high hematocrit (55%).

4. PLASMA FOR ANTITHROMBIN III, FIBRINOGEN, LUPUS ANTICOAGULANT, PROTEIN C and S, REPTILASE TIME, THROMBIN TIME, INR, and PTT:
Collect specimen as follows:
a. Draw blood in 3 light blue-top (3.2% sodium citrate) tubes.
Separate plasma from cells within 4 hours of collection in a
centrifuge at 2,500 rpm for 15 minutes or 3,000 rpm for 10
minutes.
b. Using a plastic transfer pipette (do not use a glass pipette)
decant the plasma to a screw-capped, plastic (polypropylene)
vial. (Glass vials will not be accepted.)
c. Obtain a platelet count on the platelet-poor plasma. If the
platelet count is > 10,000, respin the specimen and repeat steps 2
and 3 until the platelet count is < 10,000.
d. Divide the specimen into as many 0.5 - 1.0 mL aliquots as
possible and cap the vial(s) tightly.
e. Freeze specimen(s) immediately at <= -40° C.
f. Send specimen(s) FROZEN on dry ice.

5. SERUM FOR CARDIOLIPIN ANTIBODIES and BETA-2-GLYCOPROTEIN ANTIBODIES:
Draw blood in either a plain, red-top tube or an SSTŪ tube. (HEMOLYZED SPECIMEN IS NOT ACCEPTABLE.) Spin down and send 3.0 mL of serum.

NOTE:
1. Label all specimens appropriately (serum or plasma).
2. SPECIMENS FROM LIGHT BLUE-TOP TUBES WILL BE REJECTED IF UNDERFILLED (<90%), CLOTTED, OR GROSSLY HEMOLYZED.
3. If a high hematocrit is detected, the client will be contacted to determine the need for a recollect in properly adjusted blue-top tubes. A coagulation pathologist will assess this need with the client.
4. Follow "Special Procedure for Drawing Specimen from an A-Line". 

Reference Values An interpretive report will be issued. 
Analytic Time 14 - 21 Days 
Day(s) Test Set Up Varies 
CPT Code(s) 81240  PTDNA
81241  FVDNA
83090  Homocysteine
84285  Silica Screen
84285  Silica Mix Study, if indicated
84285-90  Silica Confirmation
85300  Antithrombin III activity
85303  Protein C activity
85306  Protein S activity
85384  Fibrinogen
85610  PT
85613  DRVVT Confirmation
85613  DRVVT Mix Study, if indicated
85613  DRVVT Screen
85635  Reptilase Time, if indicated
85670  Thrombin time
85730  PTT with sensitive reagent, (Dade Actin FS),if indicated
85730  PTT
85732  PTT mixing studies, if indicated
86146 x 2  Beta-2-glycoprotein antibody, each
86147 x 3  Cardiolipin antibodies, each

Special Instructions