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APTT and PT

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12 views

APTT and PT

Uploaded by

aroojfatimasajjad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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PT and

APTT
Presented Abeer
by : Khalid
APT
(activated partial thromboplastin
T
time)
APTT is a screening test used to detect and
diagnose a bleeding disorder or clotting
disorder ; and helps to evaluate your ability
to form blood clots.

BASIC CONCEPT
Hemostasis
Hemostasis refers to the body's processof
stopping bleeding, typically by forming a
.Primary platelet
.plug
Secondary platelet plug/Secondary hemostatic
plug
Coagulation
Series of complex reactions that involves
clotting factors result in the conversion of
soluble fibrinogen into insoluble strands of
fibrin, which help to stabilize the clot and stop
.
bleeding.
Intrinsic
.
Itpathway
has two pathways
Extrinsic
pathway
For APTT intrinsic and Common
coagulation pathway is involved .
When blood comes in contact with injured
endothelial cells, subendothelial exposed
collagen and activated platelets, intrinsic
pathway is activated
Objective/
Purpose
1)To determine activity of intrinsic and
common coagulation pathway.

2)Used to determine effectiveness of


heparin therapy .

3)To diagnosis bleeding disorders.

4)Before surgery to access the risk of


excessive bleeding.
Principle of
test
Kaolin (surface activator) and platelet
substitute (phospho-lipid) are incubated
with citrated plasma at 37°C for the time
specified in the test method.
Calcium chloride (CaCl2) is added and the
time taken for the mixture to clot is
measured.
Requirement
s :
1)Reagents
Kaoline/platelet substitute
mixture Calcium
chloride,0.025mol/l
2)Patient plasma
3)Control plasma
4)Centrifuge
5)Pipettes
6)Glass
tubes
7)Incubato
r
Blood
specimen:
Collect 9 ml of venous blood(well taken with
minimum of stasis) into a plastic tube
containing 1 ml of aqueous tri-sodium citrate
anticoagulant, 32 g/l (see Reagent No. 73). Mix
the blood well with the anticoagulant.
Without delay, centrifuge the blood at 1 200 g–
2 000
g for 15 minutes. This will provide platelet poor
plasma. Immediately remove the plasma into a
plastic tube (vial) and stopper. If a delay in
performing the APTT
is unavoidable, refrigerate the sample at 4–8
Procedur
1e Pipette 0.2 ml of well-mixed
kaolin/platelet substitute in a small
glass tube.

2 Add 0.1 ml of plasma, mix, and incubate


at 37°C for exactly 2 minutes (tilting the
tube at intervals).

3 Add 0.1 ml 0.025 mol/l calcium


chloride, mix and start the stop-watch.
Hold the tube in the water bath and tilt
the mixture back and forth, looking for
clot formation. When a clot forms, stop
4 Report the patient’s APTT (average of the
duplicate tests) providing the APTT of the
normal
control plasma is satisfactory.

Reference APTT
range :
Normal plasma clots in 36–50
seconds
Abnormal APTT results can indicate

1)Clotting factors deficiency (Factor XII, XI,


IX, VIII, X, V, II, and fibrinogen).
2) liver disease.
3)disseminated intravascular coagulation
(DIC).
4)the presence of inhibitors to clotting
factors.
5) Vitamin K deficiency (essential for the
synthesis of clotting factors II, VII, IX, and
X in the liver)
6) 6)VWF(Von Willebrand
Disease) 7)Hemophilia
PT (Prothrombin
Time )
It is a screening test that measures how long
it takes blood to clot, through extrinsic
coagulation pathway.

BASIC CONCEPT
When vascular or tissue injury occurs injured
tissue, endothelial cells, platelet produce
Tissue factor which when come in contact
with Factor VII ,extrinsic pathway is initiated
Objectiv
1)To determine activity of extrinsic and
ecommon coagulation pathway.
2)To diagnosis bleeding disorders.

3)Before surgery to access the risk of


excessive bleeding.

4)To monitor patients receiving


warfarin anticoagulation.

5)INR (International Normalized Ratio) is


calculated by PT result.
Principle of the
test :
Plasma or capillary blood is added to a
thromboplastin and calcium chloride reagent
at 37°C and the time taken for a clot to form is
measured. The clotting time in seconds is
converted to the International Normalized
Ratio (INR).
Blood specimen:
Use free-flowing capillary bloodor collect and
centrifuge venous blood as described
previously for the APTT test. Do not however
refrigerate the venous blood or plasma.
Requirements:
1) Reagents
Lypholized thromboplastin/calcium chloride
reagen (Also called Diagen rabbit brain
capillary reagent)
2) Patient plasma
3)Control plasma
4)Water bath at 37 C
5) Micropipette
6)Stop watch
7) Centrifuge
Procedure
1 Pipette 0.25 ml of the
thromboplastin/calcium reagent into a
small glass tube. Place in a 37 C
water bath for 1–2 minutes.
2Using a calibrated capillary or delivery
pipette, add 50 l (0.05 ml) of capillary
blood or plasma, mix, and start the stop-
watch. Hold the tube in the water bath
and tilt the mixture back and forth
looking for clot formation. When a clot
forms, stop the stop-watch and record
the time in seconds.
provided by the manufacturer. Separate
INR tables are provided for capillary
blood and plasma.
Reference PT
range :
Normal plasma samples (patients not on
anticoagulant) clot in 11–16 seconds.
Prolonged PT
1)DIC
2)Treatment with oral anticoagulants drugs
such as warfarin
3)Liver disease
4)Vitamin K deficiency
5)Rarely deficiency of factor VII, X, V, II, and
fibrinogen
INTERNATIONAL
NORMALIZED RATIO
(INR):
Pt result from different labs using different
reagents may lead to different results even
when plasma warfarin concentration is
Therefore all thromboplastin reagents are
same.
calibrated against WHO reference
preparation.

The calibration number is


called international sensitivity index(ISI).
INR= (PT patient/ geometric mean of
INR
An INR of 1 means PT is
normal.
INR greater than 1 means increased
clotting time.

INR greater than 5 means unacceptable


high risk bleeding.

An INR of 0.5 means increased chanced


of clotting.

NORMAL RANGE: 0.9-1.3


Prolonged and decreased
INR
INR increased in

1)Patients who take warfarin medication


which is blood thinning medicine
2) bleeding disorders
3)liver disease

INR decrease indicates clotting disorder


ANY
QUESTIONS ?
THANK
YOU
.....

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