Menorrhagia Screen without Consultation

Test Code

19649

CPT Codes
85240, 85245, 85246, 85270, 85610, 85730

Includes

Partial Thromboplastin Time, Activated
Prothrombin Time with INR
Factor XI Activity, Clotting
von Willebrand Factor Antigen
Ristocetin Cofactor
Factor VIII Activity, Clotting

Preferred Specimen

1 mL platelet-poor plasma collected in each of three separate 3.2% sodium citrate (light blue-top) tubes

Minimum Volume

0.5 mL (x3)

Instructions

Collect blood in three sodium citrate tubes (light blue-top) tubes must be filled to capacity to insure correct blood to anticoagulant ratio. Centrifuge whole blood at 1500g for 15 minutes. Avoiding the buffy coat, transfer plasma using a plastic pipette into a new plastic tube and repeat centrifugation. Aliquot plasma using a plastic pipette into 3 new plastic vials and freeze.

For preparation of platelet poor plasma and calculations for the collection of Sodium Citrate tubes from individuals with elevated Hct, refer to the Quest Diagnostics Directory of Services under Specimen Collection section, Coagulation Testing, for further information on specimen processing.

Specimens must remain frozen during storage and shipment.

All requests for coagulation assays should include a brief patient history and other pertinent clinical information.

Transport Temperature

Frozen

Specimen Stability

Room temperature: Unacceptable
Refrigerated: Unacceptable
Frozen: 14 days

Methodology
Clotting Assay • Immunoturbidimetric • Platelet Agglutination • Photo/Optical • Photometric Clot Detection

Setup Schedule

Set up and Report available: See individual tests

Reference Range

See Laboratory Report

Clinical Significance

This panel may be used to screen for bleeding disorders in patients with abnormal uterine bleeding (AUB; formerly called menorrhagia). It includes initial laboratory evaluation of the 2 most common bleeding disorders affecting women: von Willebrand disease (VWD) and coagulation factor XI deficiency [1].

AUB is classified into 9 categories based on cause per the PALM-COEIN system: polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial disorders, latrogenic, and not otherwise classified [2]. The International Federation of Gynecology and Obstetrics (FIGO) recommends using systems for nomenclature and symptoms (System 1) and for classification of potential causes of AUB in the reproductive years (System 2) to guide clinical investigation of AUB [2].

Screening for coagulopathy in patients with AUB starts with a structured history. Specific coagulopathy tests and consultation with a hematologist are appropriate in patients with a relevant history [2]. Testing for VWF antigen, ristocetin cofactor, and factor VIII activity is recommended for initial diagnosis of VWD [3]. Additional tests may be needed to determine VWD subtypes. A factor XI activity test can identify a congenital factor XI deficiency; when an inhibitor pattern is observed, this test may help identify an acquired factor XI inhibitor. Factor XI specific inhibitors may be quantitated using a Bethesda assay (test code 17854).

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

References
1. NORD. Factor XI Deficiency. Accessed April 7, 2023. https://rarediseases.org/rare-diseases/factor-xi-deficiency/
2. Munro MG, et al; FIGO Menstrual Disorders Committee. Int J Gynaecol Obstet. 2018;143(3):393-408.
3. Higgins RA, et al. Platelets and van Willebrand factor. In: Rifai R, et al, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier Inc; 2022.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.