PROTHROMBIN

TIME
ACTIVITY 9

J.L.B. NARVASA, RMT, MBA

  The prothrombin time (PT) or “protime” is one of the most
frequently
performed coagulation test.

 It evaluates the function of the extrinsic and common

pathways of hemostasis.

INTRODUCTION  It is especially effective in monitoring oral anticoagulant

therapy.
 Prothrombin (factor II) is produced in the liver and is vitamin K

dependent.

 A deficiency of vitamin K causes reduced amount of prothrombin

and
can result in bleeding.

 Developed by Dr. A.J. Quick who named it “prothrombin time”.

  Prothrombin time may be reported in three
ways:
- In seconds
- NV: 11.0 – 15.0 seconds (can vary by
laboratory)

- Prothrombin time ratio (PT

INTRODUCTION ratio)
- Patient’s PT/ PT normal control

- International Normalized Ratio (INR)

- Used to minimize differences in PT results between laboratories

- INR = (Patient’s PT/ Control PT)isi

*International Sensitivity Index (ISI): a value that relates the sensitivity

of
the reagent against the standard thromboplastin reagent.
  Blood must be drawn with minimal trauma to the vein and
surrounding
tissue to prevent the release of tissue thromboplastin into the
sample.
 Transfer into 3.8% sodium citrate tube

Centrifuge the specimen at 1,500rpm for 15

MANUAL minutes.
 Incubate the PT reagent at 37C for at least 10
minutes.
 Pipet 25uL of sample into a test cuvette. Incubate at 37C
METHO
for 1-2 minutes.
D
 Add 50uL of PT liquid reagent and simultaneously start
test.

Record the clotting time in seconds.

  Turn on instrument.

 Label desired number of sample cups and place in heat block.

 Pipet 0.2mL of PT reagent (thromboplastin- CaCl2) into cups.

 Pipet sufficient patient plasma and control (0.4-0.5mL) into separate

cups.
 Incubate for prescribed amount of
AUTOMATE time.
 Place one sample cup with measured PT reagent into the center of the
D fibrometer.
 Draw 0.1 mL of patient plasma
METHOD
 Expel plasma into center cup containing 0.2mL PT reagent. The timer will
start automatically.

 Wait for the timer to stop. Signaling the formation of a clot.

 Record the time in seconds.

 Turn off the instrument.

 • Reporting the patient and control specimens in
seconds
• Percentage of of
• % Activity patient activity
Patient: Control(% activity) calculated
time
Reporting as: (seconds) Patient’s time x10
of Results • INR calculated as:
(seconds) 0
in • INR = Patient’s time (seconds) IS
I

Laboratory Mean PT of the normal

range
  For Percent
Activity
 Patient’s Time : 12.0
seconds
 Control Time : 12. 3
seconds

Sample  12.3 / 12.0 x 100 = 102. 5 %

 For INR:
Computatio  Patient’s time : 12.0 seconds
 Mean PT of normal range: 12.4
ns seconds
 ISI 12.0
of reagent:
1.21 1.21

12.4
=
0.96
Sample
result for PT
and APTT
 Common causes of prolonged Prothrombin
time:
 Administration of oral anticoagulant
drugs

Liver disease (obstructive jaundice)

INTERPRETATION  Vitamin K
deficiency
 Disseminated Intravascular Coagulation
(DIC)

Deficiency or defect of factors II, V, VII, or X

THANKYO
U!