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HelpTest Code THRMB THROMBOTIC RISK PANEL
Additional Codes
| Software | Test Code |
|---|---|
| Label Text | THRMB |
| EPIC | LAB20139 |
| Label Text | CTHRMB - Chemistry Portion of Panel |
Performing Laboratory
NorDx Laboratories
Mayo Laboratories
Useful For
Diagnosing thrombotic disorders
Panel includes:
Antithrombin III Activity
Factor V Leiden Mutation
Fibrinogen
Hematocrit
Homocysteine, Total
Silica Screen
Silica Confirmation
DRVVT Screen
DRVVT Confirmation
Partial Thromboplastin Time (PTT)
Prothrombin Gene (G20210A)
INR, plasma
Thrombin Time
CTHRMB labeled specimens:
Beta-2-Glycoprotein, IgG, IgM
Cardiolipin Antibodies, IgA, IgG, IgM
Interpretation
If an abnormal lupus screen is detected the following tests will be performed at an additional cost:
DRVVT Mixing Assay
Silica Mixing Study
PTT using reagent more sensitive to factor deficiencies (Dade Actin FS)
Thrombin Time
If the thrombin time is greater than 30, a Reptilase Time will be performed.
Tests may be ordered individually.
Method Name
Chemiluminescent Microparticle Immunoassay (CMIA)
Clauss Clot-Based Assay
Enzyme Linked Immunosorbent Assay (ELISA)
Impedance
Polymerase Chain Reaction (PCR) with DNA probes
Synthetic Substrate (Chromogenics)
Reference Values
An interpretive report will be issued
Days and Times Test Performed
Monday through Friday
Varies
Report Available
14-21 Days
Specimen Type
Submit all of the following:
~ Plasma
~ Serum
~ Whole Blood
Preferred Container
Lavender Top Tube (EDTA) – Collect 3 tubes
Light Blue Top Tube (Sodium Citrate) – Collect 3 tubes. **Citrate tubes must be filled--short draws will be rejected
Serum Separator Tube (SST)- Collect 1 tube
Minimum Volume
Collecting minimum volumes can result in a need for sample recollection, and/or a delay in results. Minimum volumes are subjective and cannot account for all aspects of specimen and testing needs. Refer to the Preferred Volume section for optimal volumes for laboratory specimens.
Light Blue Top Tube (Sodium Citrate) – Collect 3 tubes.
Lavender Top Tube (EDTA) – Collect 2 tubes. Each must have at least 2.0 mL.
Serum Separator Tube (SST)- Collect 1 tube. Must have at least 4.0 mL.
Specimen Collection and Handling
BLOOD, PLASMA, AND SERUM ARE REQUIRED FOR THIS TEST:
BLOOD FOR FACTOR 5 LEIDEN and PROTHROMBIN 20210:
1. Draw blood in a lavender-top (EDTA) tube
2. Send 5.0 mL of EDTA whole blood at ambient temperature.
PLASMA FOR HOMOCYSTEINE, TOTAL:
1. Draw blood in a lavender-top (EDTA) tube from a fasting patient.
2. IMMEDIATELY spin down and IMMEDIATELY separate plasma from cells.
3. Send 1.0 mL of plasma refrigerated in a plastic screw-capped vial.
BLOOD FOR HEMATOCRIT:
1. Draw blood in a lavender-top (EDTA) tube.
2. Mix specimen well.
3. Send a minimum of 1mL EDTA whole blood refrigerated.
4. This hematocrit is a non-reportable internal test to be run at no charge. This is done to rule out abnormal results from blue-top tubes due to a high hematocrit (55%).
5. If a high hematocrit is detected, the client will be contacted to determine the need for a recollect in properly adjusted blue-top tubes. A coagulation pathologist will assess this need with the client.
PLASMA FOR ANTITHROMBIN III, FIBRINOGEN, LUPUS ANTICOAGULANT, PROTEIN C and S, REPTILASE TIME, THROMBIN TIME, INR, and PTT:
Collect specimen(s) as follows:
1. Draw blood in 3 light blue-top (3.2% sodium citrate) tube(s). Tube(s) must be full upon collection.
2. Separate plasma from cells as soon as possible within 4 hours of collection in a centrifuge at 2,500 rpm for 15 minutes or 3,000 rpm for 10 minutes.
3. Using a plastic transfer pipette (do not use a glass pipette) decant the plasma to a screw-capped, plastic (polypropylene) vial. Glass vials will not be accepted.
4. Spin the plasma again at 2,500 rpm for 15 minutes or 3,000 rpm for 10 minutes. Note: Double spinning the specimen ensures platelet poor plasma (<10,000 uL)
5. Divide the plasma into as many 0.5-1.0 mL aliquots as possible and cap the vial(s) tightly.
6. Place tubes upright and flash freeze specimen(s) immediately at ≤ – 20° C or below.
7. Three frozen aliquots should be forwarded to Scarborough Referrals for Protein C activity and Protein S antigen.
8. Send specimen(s) FROZEN on dry ice.
NOTE: Label all specimens appropriately (serum or plasma).
SERUM FOR CARDIOLIPIN ANTIBODIES and BETA-2-GLYCOPROTEIN ANTIBODIES:
1. Draw blood in either a plain, red-top tube or a serum separator tube.
2. Spin down and send 3.0 mL of serum.
TO PROCESS:
1. Label all specimens appropriately (serum or plasma).
Thrombotic Risk Panel Test Components
Thrombotic Risk Panel Processing Checklist
Thrombotic Risk Panel Specimen Overview
Coagulation Double Spin Process
Click here to view the Procedure for Collecting a Specimen from an A-line
Specimen Stability Information
Specimen Type: Plasma
Must be spun/separated within: 4 Hours
Note: Whole blood that remains capped and unspun is stable for up to 4 hours when stored at room temperature (18 – 24°C). Frozen plasma is stable 2 weeks @ -20°C and 12 months @ -70°C. Blue top tubes for coag assays must not be refrigerated or placed on ice.
Specimen Type: Serum
Refrigerated: 48 Hours
Must be spun/separated within: 2 Hours
Specimen Type: Whole Blood
Refrigerated: 24 Hours
Add On Capable
Not Permitted
Advance Beneficiary Notice Requirements
This test, when ordered on Medicare patients, is subject to the National Coverage Determination (NCD) policies. Please verify that the diagnosis code (ICD code) you have chosen demonstrates medical necessity for the test as documented in the physician’s patient record. The CMS web site is available to assist you with this verification. A properly executed Advance Beneficiary Notice (ABN) must be submitted with the specimen if medical necessity is not demonstrated by the ICD code chosen.
CPT Code Information
|
CPT Code |
CPT Description |
CPT Disclaimer |
|---|---|---|
| 81240 | F2 (Prothrombin, Coagulation Factor Il) Gene Analysis, 20210G>A Variant | |
| 81241 | F5 (Coagulation Factor V) Gene Analysis, Leiden Variant | |
| 83090 | Homocysteine, Quantitative | |
| 84285 | Assay of Silica, Quantitative | if Indicated |
| 85300 | Clotting Inhibitors or Anticoagulants, Antithrombin III, Activity | |
| 85303 | Clotting Inhibitors or Anticoagulants, Protein C, Activity | |
| 85306 | Clotting Inhibitors or Anticoagulants, Protein S, Free | |
| 85384 | Fibrinogen, Activity | |
| 85610 | Prothrombin Time | |
| 85613 | Russell Viper Venom Time (Includes Venom); Diluted | if Indicated |
| 85670 | Thrombin Time, Plasma | |
| 85730 | Thromboplastin Time, Partial (PTT), Plasma or Whole Blood | |
| 85732 | Thromboplastin Time, Partial (PTT), Plasma Fractions, Each | |
| 86146 x2 | Beta-2-glycoprotein antibody, each | |
| 86147 x3 | Cardiolipin (Phospholipid) Antibody, Each Ig Class |
Performing Laboratory Location
NorDx Laboratories
Acceptable Alternative Container(s)
Red Top Tube (for SST only)
Rejection Information
Underfilled Citrate tubes (<90%), clotted, or grossly hemolyzed samples.
Clinical Significance
This test is will include a pathologist interpretation. The physician professional component will be billed separately by the consulting physician.