LUPUS ANTICOAGULANT REFLEXIVE PANEL

Test Code

LUPS1

CPT Codes
85610; 85730; 85520; 85670, if reflexed 85384; If results for all 4 tests above are normal, then: 85613 (up to x3); 85730 (up to x3)

Includes

Panel components: PT, PTT, Thrombin Time, Anti-Xa, Fibrinogen (if indicated), dRVVT and Silica Clotting Time Screen (SCT), dRVVT and SCT confirmation (if indicated), dRVVT and SCT mixing studies (if indicated) and Pathologist interpretation.

Preferred Specimen

2 Blue tubes (Sodium Citrate)

Minimum Volume

1 mL

Other Acceptable Specimens

None

Instructions

Tube MUST be full for proper whole blood to anticoagulant ratio. Invert tube "end-to-end" to prevent clotting. Centrifuge to obtain platelet-poor plasma. See Additional Information below for obtaining a platelet-poor sample.

Transport Container

Stanfard transfer tube

Transport Temperature

Frozen

Specimen Stability

Frozen at -20°C or lower up to 14 days

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

The following conditions will be rejected:

Refrigerated plasma samples that are >4 hours from collection
Clotted samples
Grossly hemolyzed samples

Methodology
Clot Detection

Setup Schedule

M, W, F only

Report Available

Within 24 hours of day tested at the performing laboratory.

Reference Range

Component	Reference Range
PT	10.1 - 13.1 sec
PTT	25.0 - 36.0 sec
Thrombin Time	10.3 - 16.6 sec
Anti-Xa	Not Present
Fibrinogen (if indicated)	163 - 463 mg/dL
dRVVT Screen Ratio	<1.20
Silica Clotting Time Screen Ratio (SCT)	<1.22
dRVVT Confirmation Total Ratio (if indicated)	<1.20
Silica Clotting Time Confirmation (SCT) Total Ratio (if indicated)	<1.22
dRVVT Screen Mixing Study Ratio (if indicated)	<1.20
Silica Clotting Time Confirmation (SCT) Screen Mixing Study Ratio (if indicated)	<1.22

Clinical Significance

Use for unexplained prolonged PTT or for patients with a significant probability of having antiphospholipid syndrome (APS).

Performed By
Alverno Laboratories

Performing Laboratory
Alverno Central Lab
NHMC (Hematology, IL Coag)

Additional Information
Obtaining A Platelet-Poor Specimen

Last Updated: June 9, 2023

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.