Partial thromboplastin time
||This article may be too technical for most readers to understand. (July 2014)|
|Partial thromboplastin time|
Common notation of coagulation times in medical records
The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT or APTT) is a medical test that characterizes blood coagulation. Apart from detecting abnormalities in blood clotting, it is also used to monitor the treatment effects with heparin, a major anticoagulant. PTT is a performance indicator of the efficacy of both the "intrinsic" (now referred to as the contact activation pathway) and the common coagulation pathways. It is used in conjunction with the prothrombin time (PT) which measures the extrinsic pathway. Kaolin cephalin clotting time (KccT) is a historic name for the activated partial thromboplastin time.
Prothrombin time is typically analyzed by a medical technologist or a laboratory technician on an automated instrument at 37 °C (as a nominal approximation of normal human body temperature). The test is termed "partial" due to the absence of tissue factor from the reaction mixture.
- 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 oxalate enabling the blood to clot again).
- Finally, in order to activate the intrinsic pathway of coagulation, an activator (such as silica, celite, kaolin, ellagic acid) 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 30 seconds and 50 s (depending on laboratory). Shortening of the PTT is considered to have little clinical relevance, but some research indicates that it might increase risk of thromboembolism. Normal PTT times require the presence of the following coagulation factors: I, II, V, VIII, IX, X, XI, & XII. Notably, deficiencies in factors VII or XIII will not be detected with the PTT test. Prolonged APTT may indicate:
- use of heparin (or contamination of the sample)
- antiphospholipid antibody (especially lupus anticoagulant, which paradoxically increases propensity to thrombosis)
- coagulation factor deficiency (e.g. hemophilia)
- Sepsis - coagulation factor consumption
- Presence of antibodies against coagulation factors (factor inhibitors)
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 occur 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.
|Condition||Prothrombin time||Partial thromboplastin time||Bleeding time||Platelet count|
|Vitamin K deficiency or warfarin||Prolonged||Normal or mildly prolonged||Unaffected||Unaffected|
|Disseminated intravascular coagulation||Prolonged||Prolonged||Prolonged||Decreased|
|Von Willebrand disease||Unaffected||Prolonged or unaffected||Prolonged||Unaffected|
|Liver failure, early||Prolonged||Unaffected||Unaffected||Unaffected|
|Liver failure, end-stage||Prolonged||Prolonged||Prolonged||Decreased|
|Factor V deficiency||Prolonged||Prolonged||Unaffected||Unaffected|
|Factor X deficiency as seen in amyloid purpura||Prolonged||Prolonged||Unaffected||Unaffected|
|Bernard-Soulier syndrome||Unaffected||Unaffected||Prolonged||Decreased or unaffected|
|Factor XII deficiency||Unaffected||Prolonged||Unaffected||Unaffected|
- "MedlinePlus Medical Encyclopedia: Partial thromboplastin time (PTT)". Retrieved 2009-01-01.
- "KCCT - General Practice Notebook". GP Notebook. Oxbridge Solutions Ltd. Retrieved 2010-06-08.
- Korte, Wolfgang; Clarke, Susan; Lefkowitz, Jerry B. (January 2000). "Short activated partial thromboplastin times are related to increased thrombin generation and an increased risk for thromboembolism". American journal of clinical pathology 113 (1): 123–7. doi:10.1309/G98J-ANA9-RMNC-XLYU. PMID 10631865.
- Langdell RD, Wagner RH, Brinkhous KM (1953). "Effect of antihemophilic factor on one-stage clotting tests; a presumptive test for hemophilia and a simple one-stage antihemophilic factor assy procedure". J. Lab. Clin. Med. 41 (4): 637–47. PMID 13045017.