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Coagulation Consult: Anti Phospholipid Antibody

Path Consult: Coagulation, Coagulation Consultation for Pathology, Anti-Phospholipid Antibodies, Coagulation Consult: Anti Phospholipid Antibody

Test Codes

Antrim #26508, EPIC: LAB5170, CGAPA

Department

Coagulation

Instructions

• The Anti-Phospholipid Antibodies Panel includes a basic number of tests, however tests may be added or excluded at the pathologist’s discretion based on prior or concurrent laboratory results. The basic panel includes:
  • Activated Partial Thromboplastin Time (aPTT)
  • Antiphospholipid Antibody Panel
  • DRVVT
  • Hexagonal Phase Phospholipid
  • Protime (PT)
• It is expected that these panels will expedite work-up for complex coagulopathies or thrombotic risk factors. In addition, the pathologist will be able to order multiple tests on a single specimen, limiting the amount of blood to be drawn from the patient.

Specimen Collection Criteria

Collect: Five Light Blue-top 3.2% Sodium Citrate tubes and one Gold-top SST tube.

• SODIUM CITRATE TUBES MUST BE FULL.
• A copy of the requisition must be sent with the specimen.

Physician Office/Draw Specimen Preparation

For optimal results, maintain whole blood sodium citrate specimens at room temperature (20-26°C or 68-78.8°F) prior to transport. Transport whole blood to the Laboratory within 4 hours of collection. If transport within 4 hours is not possible, the following procedure must be followed for accurate results:

1. Centrifuge the capped tube at 1500 x g for 15 minutes.
2. Transfer plasma with a plastic pipette into a plastic polypropylene centrifuge tube, cap and centrifuge an additional 15 minutes at 1500 x g to obtain platelet poor plasma (PPP) which has a platelet count less than 10 bil/L. Plasma with a platelet count of less than 10 bil/L is critical for accurate results.
3. Immediately remove only the top two-thirds of the PPP and transfer it into five screw cap, 5 ml, 75 x 13 mm, round base, polypropylene tubes.
4. Freeze (-20°C/-4°F or below) the PPP specimens immediately.

5. Transport frozen on DRY ICE. Specimen must remain frozen during transport.

Let SST specimen clot 30-60 minutes then immediately centrifuge to separate serum from cells. Refrigerate (2-8°C or 36-46°F) the centrifuged collection tube or maintain at room temperature (20-26°C or 68-78.8°F). (Minimum Serum: 0.5 mL)

Preparation for Courier Transport

Transport: Whole blood at room temperature (20-25°C or 68-77°F), or plasma obtained through the process listed above, frozen (-20°C/-4°F or below), and centrifuged Gold-top tube at room temperature (20-26°C or 68-78.8°F).

Rejection Criteria

• Glass tubes and 3.8% Sodium Citrate tubes.
• Inappropriate specimen volume.
• Specimens that are clotted or grossly hemolyzed.
• SST specimens that are heat-inactivated, hemolyzed, or grossly lipemic.
• Thawed or partially thawed specimens.

In-Lab Processing

Whole blood sodium citrate specimens must be processed as follows upon receipt in the Laboratory:

1. Centrifuge the capped tube at 1500 x g for 15 minutes.
2. Transfer plasma with a plastic pipette into a plastic polypropylene centrifuge tube, cap and centrifuge an additional 15 minutes at 1500 x g to obtain platelet poor plasma (PPP) which has a platelet count less than 10 bil/L. Plasma with a platelet count of less than 10 bil/L is critical for accurate results.
3. Immediately remove only the top two-thirds of the PPP and transfer it into five plastic tube.

4. Test or freeze specimen according to lab protocol.

Let SST specimen clot 30-60 minutes then immediately centrifuge to separate serum from cells. Room temperature is acceptable for a maximum of twelve hours. (Minimum Serum: 0.5 mL)

Storage

Specimen Stability for Testing:

Whole Blood (Sodium Citrate)
Room Temperature (20-26°C or 68-78.8°F): 4 hours
Refrigerated (2-8°C or 36-46°F): Unacceptable
Frozen (-20°C/-4°F or below): Unacceptable

Platelet Poor Plasma (PPP)
Room Temperature (20-26°C or 68-78.8°F): Unacceptable
Refrigerated (2-8°C or 36-46°F): Unacceptable
Frozen (-20°C/-4°F or below): 30 days

Centrifuged SST Tubes and Microtainers^® with Separator Gels
Room Temperature (20-26°C or 68-78.8°F): 12 hours
Refrigerated (2-8°C or 36-46°F): 7 days
Frozen (-20°C/-4°F or below): Unacceptable

Serum Specimens (Pour-Overs)
Room Temperature (20-26°C or 68-78.8°F): 12 hours
Refrigerated (2-8°C or 36-46°F): 14 days
Frozen (-20°C/-4°F or below): 3 months

Specimen Storage in Department Prior to Disposal:

Refrigerated (2-8°C or 36-46°F): 7 days

Laboratory

Royal Oak Coagulation Laboratory
Troy Hematology/Coagulation Laboratory

Performed

Minimum once per week.
Results available in 3-5 days. Interpretation available within 5-7 business days. 

Reference Range

See individual tests listed for the appropriate reference ranges.

Activated Partial Thromboplastin Time (aPTT), Antiphospholipid Antibody Panel, DRVVT, Hexagonal Phase Phospholipid, Protime (PT).

Interpretation

An interpretative report will be included with each testing panel.

Clinical Utility

This panel should facilitate investigation of anti-phospholipid antibodies associated with anti-phosphoplipid syndrome (APA). Antibodies involved with APA include anticardiolipin, beta-2 glycoprotein I and lupus anticoagulant. As with most complex laboratory testing, correlation with the clinical findings is necessary.

CPT Codes

85390 (additional codes depending on tests chosen by pathologist).

Contacts

Last Updated

3/29/2023