Partial thromboplastin time
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| Partial thromboplastin time Classification and external resources |
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The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT or APTT) is a performance indicator measuring the efficacy of both the "intrinsic" (now referred to as the contact activation pathway) and the common (tissue factor pathway) coagulation pathways. Apart from detecting abnormalities in blood clotting, it is also used to monitor the treatment effects with heparin, a major anticoagulant.
| Reference Range |
| Around 35-55 seconds |
| Under heparin therapy according to indication: 1.5-2.5x longer |
| PTT is not prolonged under therapy with low-molecular heparins |
Differential Diagnosis
In alphabetical order: [1] [1]
Prolonged
- Clotting factor deficiency
- DIC
- Drugs
- Fibrinolytic states
- Fibrinogen deficiency
- Heparin
- Hypoalbuminemia
- Impaired fibrin polymerization
- Liver Disease
- Subcutaneous heparin injection
- Therapy with unfractionated heparin
- Thrombolytics
- Vitamin K deficiency
- Von Willenbrand's Disease
- Warfarin
Methodology
Blood is collected, by a phlebotomist, with oxalate or citrate which arrest coagulation by binding calcium. This specimen is delivered to the laboratory. In order to activate the intrinsic pathway, phospholipid, an activator (such as silica, celite, kaolin, ellagic acid), and calcium (to reverse the anticoagulant effect of the oxalate) are mixed into the plasma sample . The time is measured until a thrombus (clot) forms. This testing is performed by a medical technologist.
The test is termed "partial" due to the absence of tissue factor from the reaction mixture.
Interpretation
Values below 25 seconds or over 39 s (depending on local normal ranges) are generally abnormal. Shortening of the PTT has little clinical relevance. Prolonged aPTT may indicate:
- use of heparin (or contamination of the sample)
- antiphospholipid antibody (especially lupus anticoagulant, which paradoxically increases propensity to thrombosis)
- coagulation factor deficiency (e.g. hemophilia)
To distinguish the above causes, mixing studies are performed, in which the patient's plasma is mixed (initially at a 50:50 dilution) with normal plasma. If the abnormality does not disappear, the sample is said to contain an "inhibitor" (either heparin, antiphospholipid antibodies or coagulation factor specific inhibitors), while if it does correct a factor deficiency is more likely. Deficiencies of factors VIII, IX, XI and XII and rarely von Willebrand factor (if causing a low factor VIII level) may lead to a prolonged aPTT correcting on mixing studies.
History
The aPTT was first described in 1953.[1]
See also
- Prothrombin time (PT)
References
cs:Aktivovaný parciální tromboplastinový čas de:Partial Thromboplastin Timefr:Temps de céphaline activée it:Tempo di Tromboplastina nl:Geactiveerde partiële tromboplastinetijd
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
