partial thromboplastin time

File:Blue Top.JPG

Activated partial thromboplastin time (APTT) is typically analyzed by a medical technologist or laboratory technician, either manually or using an automated instrument at 37°C, which approximates normal human body temperature. Prothrombin time utilizes complete thromboplastin, a combination of tissue factor and phospholipids. In contrast, APTT employs partial thromboplastin, containing only phospholipids and no tissue factor—hence the term "partial thromboplastin time." An activator is used in the APTT test to initiate the intrinsic pathway of blood coagulation. Common activators include kaolin, silica, celite, and ellagic acid.{{Cite journal |last=Bates |first=Shannon M. |last2=Weitz |first2=Jeffrey I. |date=2005-07-26 |title=Coagulation Assays |url=https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.104.478222 |journal=Circulation |language=en |volume=112 |issue=4 |doi=10.1161/CIRCULATIONAHA.104.478222 |issn=0009-7322}}

• Blood is drawn into a test tube containing oxalate or citrate, molecules which act as an anticoagulant by binding the calcium in a sample. The blood is mixed, then centrifuged to separate blood cells from plasma (as partial thromboplastin time is most commonly measured using blood plasma).
• A sample of the plasma is extracted from the test tube and placed into a measuring test tube.
• Next, an excess of calcium (in a phospholipid suspension) is mixed into the plasma sample (to reverse the anticoagulant effect of the citrate enabling the blood to clot again).
• Finally, in order to activate the intrinsic pathway of coagulation, an activator is added, and the time the sample takes to clot is measured optically. Some laboratories use a mechanical measurement, which eliminates interferences from lipemic and icteric samples.

The typical reference range is between 25 seconds and 33 s (depending on laboratory). Longer times of up to 50 s do apply to infants. Shortening of the PTT is considered to have little clinical relevance, but some research indicates that it might increase risk of thromboembolism.{{cite journal|last=Korte|first=Wolfgang|author2=Clarke, Susan |author3=Lefkowitz, Jerry B. |title=Short activated partial thromboplastin times are related to increased thrombin generation and an increased risk for thromboembolism|journal=American Journal of Clinical Pathology|date=January 2000|volume=113|issue=1|pages=123–7|pmid=10631865|doi=10.1309/G98J-ANA9-RMNC-XLYU|s2cid=37642249 }} Normal PTT requires the presence of the following coagulation factors: I, II, V, VIII, IX, X, XI and XII. Notably, deficiencies in factors VII or XIII will not be detected with the PTT test.{{cn|date=November 2021}}

Prolonged aPTT may indicate:{{cite web |last1=Hammami |first1=Muhammad |title=MD |url=https://emedicine.medscape.com/article/2085837-overview?form=fpf#a2 |website=Medscape |publisher=WebMD LLC |access-date=25 July 2024}}

• Use of heparin or warfarin (or contamination of the sample)
• Vitamin K deficiency
• Antiphospholipid antibody (especially lupus anticoagulant, which paradoxically increases propensity to thrombosis)
• Coagulation factor deficiency (e.g., haemophilia, cirrhosis, von Willebrand disease)
• Coagulation factor consumption (e.g., sepsis, disseminated intravascular coagulation)
• Presence of antibodies against coagulation factors (factor inhibitors)
• Von Willebrand disease

To distinguish the above causes, mixing tests 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 disappear 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.{{cn|date=February 2025}}

The aPTT is usually normal in pregnancy but tends to slightly decrease in late pregnancy.{{cite journal | vauthors = Hellgren M | title = Hemostasis during normal pregnancy and puerperium | journal = Semin Thromb Hemost | volume = 29 | issue = 2 | pages = 125–30 | date = April 2003 | pmid = 12709915 | doi = 10.1055/s-2003-38897 | s2cid = 22082884 | url = }}

{{See also|Activated protein C resistance test}}

The aPTT-based activated protein C (APC) resistance test is used in the diagnosis of APC resistance (APCR).{{cite journal | vauthors = Amiral J, Vissac AM, Seghatchian J | title = Laboratory assessment of Activated Protein C Resistance/Factor V-Leiden and performance characteristics of a new quantitative assay | journal = Transfus Apher Sci | volume = 56 | issue = 6 | pages = 906–913 | date = December 2017 | pmid = 29162399 | doi = 10.1016/j.transci.2017.11.021 | url = }} It involves a modified aPTT test performed in the presence and absence of APC.{{cite journal | vauthors = Morimont L, Haguet H, Dogné JM, Gaspard U, Douxfils J | title = Combined Oral Contraceptives and Venous Thromboembolism: Review and Perspective to Mitigate the Risk | journal = Front Endocrinol (Lausanne) | volume = 12 | issue = | pages = 769187 | date = 2021 | pmid = 34956081 | pmc = 8697849 | doi = 10.3389/fendo.2021.769187 | url = | doi-access = free }} The ratio of these aPTT values is calculated and is called the APC sensitivity ratio (APCsr) or simply APC ratio (APCr). This ratio is inversely related to the degree of APC resistance.{{cite journal | vauthors = Clark P | title = Changes of hemostasis variables during pregnancy | journal = Semin Vasc Med | volume = 3 | issue = 1 | pages = 13–24 | date = February 2003 | pmid = 15199489 | doi = 10.1055/s-2003-38329 | s2cid = 36952311 | url = }} The aPTT-based APC resistance test was developed in 1993.

The partial thromboplastin time was first described in 1953 by researchers at the University of North Carolina at Chapel Hill.{{cite journal |vauthors=Langdell RD, Wagner RH, Brinkhous KM |year=1953 |title=Effect of antihemophilic factor on one-stage clotting tests; a presumptive test for hemophilia and a simple one-stage antihemophilic factor assay procedure |journal=J. Lab. Clin. Med. |volume=41 |issue=4 |pages=637–47 |pmid=13045017}} The initial exogenous phospholipid used in PTT testing was Cephalin.{{Cite journal |last=Tripodi |first=A. |last2=Mannucci |first2=P.M. |date=April 2006 |title=Activated partial thromboplastin time (APTT). New indications for an old test? |url=https://linkinghub.elsevier.com/retrieve/pii/S1538783622131120 |journal=Journal of Thrombosis and Haemostasis |language=en |volume=4 |issue=4 |pages=750–751 |doi=10.1111/j.1538-7836.2006.01857.x|doi-access=free }}

• Thromboplastin

{{Reflist}}

{{Myeloid blood tests}}{{DEFAULTSORT:Activated Partial thromboplastin time}}

Category:Blood tests

Category:Medical signs

Category:Hematology