Fibrinolysis Comprehensive Panel

Test Code

90923

CPT Codes
85360, 85362 (x2), 85379, 85410, 85415 (x2), 85420

Includes

Alpha-2-Antiplasmin
D-Dimer, Quantitative
Euglobulin Clot Lysis Time
Fibrinogen Degradation Products (FDP)
Plasminogen Activator Inhibitor (PAI-1) Ag
Plasminogen Activity
Tissue Plasminogen Activator (TPA), EIA
Fibrin Monomer

Preferred Specimen

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

Patient Preparation
Morning fasting is required. Since lipemia may interfere with clotting endpoint detection, a two-hour fast is recommended.

Minimum Volume

0.8 mL (x5)

Instructions

Please submit a separate, frozen vial for each special coagulation assay ordered. Draw blood in a light blue-top tube containing 3.2% sodium citrate, mix gently by inverting 3-4 times. Centrifuge 15 minutes at 1500 g within one hour of collection. Using a plastic pipette, remove plasma, taking care to avoid the WBC/platelet buffy layer and place into a plastic vial. Centrifuge a second time and transfer platelet-poor plasma into a new plastic vial(s). Freeze immediately and transport on dry ice.
To avoid release of plasminogen activator, do not massage vein vigorously, pump fist excessively or leave tourniquet in place for a prolonged period. Centrifuge within 30 minutes after collection to get platelet-poor plasma and freeze on dry ice. Prohibit exercise prior to drawing sample.

Transport Temperature

Frozen

Specimen Stability

Room temperature: Unacceptable
Refrigerated: Unacceptable
Frozen: 14 days

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

Gross hemolysis • Grossly lipemic • Grossly icteric

Methodology
Chromogenic Assay • Clot Dissolution • Hemagglutination (HA) • Immunoassay (IA) • Latex Agglutination (LA)

FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Setup Schedule

Set up and Report available: See individual assays

Reference Range

See Laboratory Report

Clinical Significance

An increase in PAI-1 antigen is associated with an increased risk for post-operative venous thrombosis, myocardial infarction, and (probably) stroke. A severe deficiency of alpha-2 antiplasmin or PAI-1 antigen has been associated with bleeding. A shortened euglobulin lysis time correlates with a severe deficiency of alpha-2 antiplasmin or PAI-1 antigen. Elevations in fibrin monomer, fibrinogen degradation products, and D-dimer usually indicate vascular thrombosis (mainly venous) but are also associated with malignancy and infection. Conversely, a normal D-dimer and/or negative fibrin monomer suggests the absence of deep venous thrombosis and pulmonary emboli. Marked reduction in plasminogen has been associated with a prothrombotic state, and an elevated TPA level is a risk marker of coronary artery disease.

Performing Laboratory
Quest Diagnostics Nichols Inst San Juan Capistrano
33608 Ortega Highway
San Juan Capistrano, CA 92690-6130

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.