Sunday, September 24, 2023

Performance of Activated Partial Thromboplastin Time (APTT) Test in Coagulation Lab

 Requirements

  • Personal protective equipment
    • Lab coat 
    • Protective Apron 
    • Lab-grade gloves 
    • Shoe covers
    • Protective face shield or protective goggles 
    • Spill kit 
  • Workstation 
    • Clean & disinfected workstation 
    • Tube discarder box 
    • Sharps discarder 
    • Calibrated Pipettes
    • Calibrated water-bath 
    • Coagulation calibrated electrical centrifuge 
    • Thermometer 
    • Optimally functioning digital stopwatch
    • Labelling marker 
    • Light source (Bright lamp)
    • PT result recording sheet 
    • Calculator 
  • Test related 
    • Multiple clean glass tubes 
    • Citrated Control Platelet Poor Plasma (C-PPP)
    • Citrated Test/Patient's Platelet Poor Plasma (T-PPP)
    • QC verified Thromboplastin Reagent 
    • QC Verified Calcium Chloride CaClReagent 

Procedure 

  • Step 1 
    • Label a clean glass test tube as CaCl2
    • Add >100 μL CaCl2 reagent in this tube
    • Place this test tube in water-bath at 37 0C for >2 mins 
  • Step 2 
    • Label 4 clean glass test tubes as following: 
      • C1 → Citrated Control PPP
      • C2 → Citrated Duplicate Control PPP
      • T1 → Citrated Test PPP
      • T2 → Citrated Duplicate Test PPP
  • Step 3 
    • Add 100 μL Citrated Platelet Poor Plasma (PPP) into C1 labelled tube 
    • Incubate C1 labelled tube in water-bath at 370C for 02 mins
  • Step 4 
    • Take out 100 μL APTT reagent (from commercial APTT reagent bottle at room temperature) and add it to C1 labelled tube (which has completed 2 mins incubation in water-bath in Step 3)
    • Incubate C1 labelled tube for 3 more minutes in water-bath at 370C
  • Step 5
    • After completion of 3 mins incubation in step 4, take out 100 μL CaCl2 reagent from CaCl2 labelled tube (which is already in water-bath from step 1) and add it to C1 labelled tube
    • Start the stopwatch 
  • Step 6
    • From 25 seconds onwards remove the C1 labelled tube from water-bath to see for clot formation at regular intervals (every 2 seconds)
    • Note the time when the clot has formed & stop the Stopwatch
  • Step 7
    • Repeat the procedure as per above steps in C2 labelled tube 
    • Take the average of the readings from C1 & C2 labelled tubes
  • Step 8
    • Now, repeat all the above mentioned steps in duplicate with Test PPP from the patient in T1 & T2 labelled tubes
    • Record the average of the readings from T1 & T2 labelled tubes

Reporting of Results 

  • Results are reported as per following two formats:
    • The mean (average) of the APTT readings run in duplicate in seconds
    • APTT ratio between Citrated Test & Control PPP
  • For APTT Value of Citrated Control PPP in Routine 
    • GMNAPTT is calculated as the mean of PT for 20 healthy individuals as under:
      • 10 samples from healthy males 
      • 10 samples from healthy females
      • No sample from those receiving any oral anticoagulant

Interpretation of Results

  • Causes of Isolated APTT prolongation with normal PT (Click For Details)
    • Factor VIII, IX, XI, XII, Prekallikrein or HMWK deficiency
    • FVIII deficiency secondary to VWD
    • Circulating anticoagulant, e.g., Lupus Anticoagulant
    • Heparin or direct acting anticoagulant
    • Mild factor II, V or X deficiency

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