Test Id : ADIC

Initial testing includes prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen, D-dimer, and disseminated intravascular coagulation/intravascular coagulation and fibrinolysis (DIC/ICF) profile interpretation.

If PT is greater than 13.9 seconds, then PT mix will be performed at an additional charge.

If aPTT is 38 seconds or more, then aPTT mix and dilute Russell's viper venom time (dRVVT) will be performed at an additional charge.

If dRVVT ratio is 1.20 or more, then dRVVT mix and dRVVT confirmation will be performed at an additional charge.

If fibrinogen is less than 150 mg/dL, or clinically indicated, then PT-fibrinogen will be performed at an additional charge.

If D-dimer is greater than 500 ng/mL fibrinogen equivalent units, then soluble fibrin monomer will be performed at an additional charge.

If aPTT mix is 38 or more seconds and TT is less than 35.0 seconds (no evidence of heparin), then platelet neutralization procedure will be performed at an additional charge.

If TT is 25.0 or more seconds, then reptilase time will be performed at an additional charge.

This profile will not detect all bleeding disorders, such as von Willebrand disease. For patients with amyloidosis and bleeding symptoms, obtaining a limited bleeding diathesis profile is suggested.

Multiple coagulation profile tests are available. See Coagulation Profile Comparison for testing that is performed with each profile.

Send the 5 aliquot tubes in the same shipping container.

Specimen Type: Platelet-poor plasma

Patient Preparation: Patient should not be receiving Coumadin or heparin. If so, note on request.

Collection Container/Tube: Light-blue top (3.2% sodium citrate)

Submission Container/Tube: 5 Plastic vials

Specimen Volume: 5 mL in 5 plastic vials, each containing 1 mL

Collection Instructions:

1. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing.

2. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.

3. Aliquot plasma (1 mL per aliquot) into 5 separate plastic vials, leaving 0.25 mL in the bottom of centrifuged vial.

4. Freeze plasma immediately (no longer than 4 hours after collection) at -20 degrees C or, ideally -40 degrees C or below.

Additional Information: Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.

• Coagulation Guidelines for Specimen Handling and Processing
• Coagulation Patient Information
• Coagulation Profile Comparison

1. Coagulation Patient Information (T675)

2. If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.

See Specimen Required

Establishing laboratory evidence of disseminated intravascular coagulation

Initial testing includes prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen, D-dimer, and disseminated intravascular coagulation/intravascular coagulation and fibrinolysis (DIC/ICF) profile interpretation.

If PT is greater than 13.9 seconds, then PT mix will be performed at an additional charge.

If aPTT is 38 seconds or more, then aPTT mix and dilute Russell's viper venom time (dRVVT) will be performed at an additional charge.

If dRVVT ratio is 1.20 or more, then dRVVT mix and dRVVT confirmation will be performed at an additional charge.

If fibrinogen is less than 150 mg/dL, or clinically indicated, then PT-fibrinogen will be performed at an additional charge.

If D-dimer is greater than 500 ng/mL fibrinogen equivalent units, then soluble fibrin monomer will be performed at an additional charge.

If aPTT mix is 38 or more seconds and TT is less than 35.0 seconds (no evidence of heparin), then platelet neutralization procedure will be performed at an additional charge.

If TT is 25.0 or more seconds, then reptilase time will be performed at an additional charge.

Disseminated intravascular coagulation (DIC) and intravascular coagulation and fibrinolysis (ICF), collectively termed DIC/ICF, is a consumptive hemorrhagic and microthrombotic disorder that manifests as clinical bleeding or thrombosis. Conditions associated with DIC/ICF can include sepsis, trauma (eg, head injury, severe tissue injury), obstetric complications (eg, amniotic fluid embolism, abruptio placentae), malignancies, vascular disorders (eg, hemangiomas, aortic aneurysm), and immunologic disorders.

These disorders can cause thrombin and fibrin intravascular formation, which can result in widespread fibrin deposition contributing to thrombosis and organ failure or, conversely, can result in bleeding due to consumption of coagulation proteins and platelets. DIC/ICF is not a disease, rather it is a syndrome that is secondary to an underlying disorder.

An interpretive report is provided.

An interpretive report will be provided when testing is completed, noting presence or absence of disseminated intravascular coagulation and intravascular coagulation and fibrinolysis.

No significant cautionary statements

Boender J, Kruip MJ, Leebeek FWG. A diagnostic approach to mild bleeding disorders. J Thromb Haemost.. 2016;14(8):1507-1516. doi: 10.1111/jth.13368

Prothrombin Time:

The prothrombin time (PT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is incubated and combined with a PT reagent containing recombinant human tissue factor, synthetic phospholipids, calcium chloride, polybrene, and buffer. Tissue thromboplastin (phospholipid and recombinantly-derived human tissue factor) and calcium are added to citrated plasma, bypassing the action of platelets and factors VIII, IX, XI, and XII in the intrinsic procoagulant pathway. The tissue thromboplastin-factor VII/VIIa complex activates factor X. Activated factor X (factor Xa) forms a complex with factor Va, calcium, and phospholipid to activate factor II (prothrombin) to thrombin. Thrombin then acts on fibrinogen (factor I) to form fibrin, which clots, providing the assay endpoint (the "prothrombin time").(Package insert: HemosIL RecombiPlasTin 2G. Instrumentation Laboratory Company; R4, 03/2019)

Activated Partial Thromboplastin Time:

The activated partial thromboplastin time (aPTT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is combined and incubated with an aPTT reagent containing phospholipid, a negatively charged contact factor activator, and buffer. After a specified incubation time, calcium is added to trigger the coagulation process in the mixture. Subsequently, the time to clot formation is measured optically using a wavelength of 671 nm. Mixing studies (see APMSC / Activated Partial Thromboplastin Time [APTT] Mix 1:1, Plasma) using normal pooled plasma are performed on samples with a prolonged aPTT to assist in discriminating between factor deficiency states and coagulation inhibitors, unless further testing is not indicated.(Package insert: HemosIL SynthASil. Instrumentation Laboratory Company; R11, 06/2017)

Thrombin Time:

The thrombin time (TT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is combined with a bovine thrombin reagent containing bovine albumin, calcium chloride, and buffer, immediately triggering the coagulation process in the mixture. Time to clot formation is measured optically using a wavelength of 405 nm.(Package insert: HemosIL Thrombin Time. Instrumentation Laboratory Company; R1, 12/2018)

Fibrinogen:

The Clauss fibrinogen assay is performed using the HemosIL Fibrinogen-C kit on the Instrumentation Laboratory ACL TOP. Patient plasma, containing fibrinogen, is mixed with reagent containing excess thrombin. The excess thrombin converts the fibrinogen in the patient plasma to fibrin. The amount of time it takes to form a clot is inversely proportional to the amount of fibrinogen present in the patient plasma.(Package insert: HemosIL Fibrinogen-C. Instrumentation Laboratory Company; R7, 06/2017)

D-Dimer:

D-dimer is assayed in plasma by adding polystyrene latex particles coated with monoclonal antibodies specific for D-dimer domain. The latex particles agglutinate in the presence of soluble fibrin degradation products containing the D-dimer domain. The degree of agglutination is directly proportional to the concentration of D-dimer in the sample and is determined by measuring the decrease of transmitted light caused by the aggregates (turbidimetric immunoassay).(Package insert: HemosIL D-Dimer HS 500. Instrumentation Laboratory Company; R6, 04/2018)

Monday through Friday

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• Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
• Prospective clients should contact their account representative. For assistance, contact Customer Service.

See Individual Test IDs

85610-PTSC

85730-APTSC

85670-TTSC

85379-DIMER

85384-CLFIB

85390-26-ADICI

85210-Factor II (if appropriate)

85220-Factor V (if appropriate)

85230-Factor VII (if appropriate)

85240-Coagulation factor VIII assay (if appropriate)

85250-Factor IX (if appropriate)

85260-Factor X (if appropriate)

85270-Factor XI (if appropriate)

85280-Factor XII (if appropriate)

85366-Soluble fibrin monomer (if appropriate)

85385-PT-Fibrinogen (if appropriate)

85597-Platelet neutralization for lupus inhibitor (if appropriate)

85598-Hex LA (if appropriate)

85611-PT mix 1:1 (if appropriate)

85613-DRVVT (if appropriate)

85613-DRVVT mix (if appropriate)

85613-DRVVT confirm (if appropriate)

85635-Reptilase time (if appropriate)

85732-APTT mix 1:1 (if appropriate)