Bleeding Disorders

Bleeding Disorder Test Center and health information

Find the right blood tests for bleeding disorders with Ulta Lab Tests and order directly to get reliable, low-cost blood work and confidential testing.

Below the list of tests is a guide that explains and answers your questions on what you need to know about bleeding disorder tests, along with information on bleeding disorders, signs, symptoms, and diagnosis.


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Description: A Prothrombin Time test will measure the speed of which your blood clots. This test can be used to detect a bleeding or clotting disorder or to determine in your blood is clotting too fast or too slow.

Also Known As: Pro Time with INR Test, Prothrombin Time and International Normalized Ratio test, Prothrombin Time PT with INR Test, Prothrombin Time with INR Test, Prothrombin with INR, Protime with INR, PT Test

Collection Method: Blood draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Prothrombin Time with INR test ordered?

When a person takes the anticoagulant medicine warfarin, a PT and INR are ordered on a regular basis to confirm that the prescription is working effectively and that the PT/INR is adequately extended. A doctor will prescribe them frequently enough to ensure that the treatment is having the desired effect, namely, boosting the person's clotting time to a therapeutic level while minimizing the danger of excessive bleeding or bruising.

When a person who isn't taking anticoagulants exhibits signs or symptoms of excessive bleeding or clotting, a PT may be ordered when they are experiencing:

  • Bleeding that isn't explained or bruises that isn't easy to get rid of
  • Nosebleeds
  • Gums that are bleeding
  • A blood clot in an artery or vein
  • Disseminated intravascular coagulation
  • A persistent disorder that affects hemostasis, such as severe liver disease

PT and PTT may be prescribed prior to surgery when there is a high risk of blood loss associated with the procedure and/or when the patient has a clinical history of bleeding, such as frequent or severe nosebleeds and easy bruising, which may indicate the presence of a bleeding problem.

What does a Prothrombin Time with INR blood test check for?

The prothrombin time is a test that determines a person's capacity to make blood clots properly. The international normalized ratio, or INR, is a calculation based on the results of a PT that is used to track people who are taking the blood thinner warfarin.

After chemicals are added to a person's blood sample, a PT measures how long it takes for a clot to develop. The PT is frequently used with a partial thromboplastin time to measure the number and function of proteins known as coagulation factors, which are essential for optimal blood clot formation.

When an injury develops in the body and bleeding ensues, the clotting process known as hemostasis begins. This process is aided by a series of chemical events known as the coagulation cascade, in which coagulation or "clotting" components are activated one by one, leading to the development of a clot. In order for normal clotting to occur, each coagulation factor must be present in appropriate quantities and operate effectively. Excessive bleeding can result from too little, while excessive clotting can result from too much.

There are two "pathways" that can trigger clotting in a test tube during a laboratory test, the extrinsic and intrinsic pathways. Both of these pathways subsequently converge to finish the clotting process. The PT test assesses how well all coagulation factors in the extrinsic and common routes of the coagulation cascade cooperate. Factors I, II, V, VII, and X are included. The PTT test examines the protein factors XII, XI, IX, VIII, X, V, II, and I, as well as prekallikrein and high molecular weight kininogen, which are all part of the intrinsic and common pathways. The PT and PTT examine the overall ability to generate a clot in a fair period of time, and the test results will be delayed if any of these elements are insufficient in quantity or are not operating effectively.

The PT test is normally done in seconds and the results are compared to a normal range that represents PT levels in healthy people. Because the reagents used to conduct the PT test vary from one laboratory to the next and even within the same laboratory over time, the normal ranges will change. The Internationalized Normalized Ratio, which is computed based on the PT test result, was developed and recommended for use by a World Health Organization committee to standardize results across various laboratories in the United States and around the globe for people taking the anticoagulant warfarin.

The INR is a formula that accounts for variations in PT reagents and enables for comparison of findings from different laboratories. When a PT test is performed, most laboratories report both PT and INR readings. However, the INR should only be used by people who are taking the blood thinner warfarin.

Lab tests often ordered with a Prothrombin Time with INR test:

  • Partial Thromboplastin Time
  • Fibrinogen Activity
  • Platelet Count
  • Complete Blood Count (CBC)
  • Coagulation Factors
  • Warfarin Sensitivity testing

Conditions where a Prothrombin Time with INR test is recommended:

  • Bleeding Disorders
  • Excessive Clotting Disorders
  • Vitamin K Deficiency
  • Liver Disease
  • DIC

How does my health care provider use a Prothrombin Time with INR test?

The prothrombin time is used to diagnose the origin of unexplained bleeding or abnormal blood clots, generally in conjunction with a partial thromboplastin time. The international normalized ratio is a calculation based on the results of a PT that is used to monitor people on the blood thinner warfarin.

Coagulation factors are proteins that are involved in the body's process of forming blood clots to assist stop bleeding. When an injury occurs and bleeding begins, coagulation factors are triggered in a series of events that finally assist in the formation of a clot. In order for normal clotting to occur, each coagulation factor must be present in appropriate quantities and operate effectively. Excessive bleeding can result from too little, while excessive clotting can result from too much.

The PT and INR are used to monitor the anticoagulant warfarin's efficacy. This medication influences the coagulation cascade's function and aids in the prevention of blood clots. It is given to those who have a history of recurrent abnormal blood clotting on a long-term basis. Warfarin therapy's purpose is to strike a balance between preventing blood clots and causing excessive bleeding. This equilibrium must be carefully monitored. The INR can be used to change a person's medication dosage in order to get their PT into the ideal range for them and their condition.

What do my PT and INR test results mean?

Most laboratories report PT findings that have been corrected to the INR for persons taking warfarin. For basic "blood-thinning" needs, these persons should have an INR of 2.0 to 3.0. Some people with a high risk of blood clot require a higher INR, about 2.5 to 3.5.

The outcome of a PT test is determined by the method utilized, with results measured in seconds and compared to a normal range defined and maintained by the laboratory that administers the test. This normal range is based on the average value of healthy persons in the area, and it will differ somewhat from test to lab. Someone who isn't on warfarin would compare their PT test result to the usual range provided by the laboratory that conducted the test.

A prolonged PT indicates that the blood is taking an excessive amount of time to clot. This can be caused by liver illness, vitamin K inadequacy, or a coagulation factor shortage, among other things. The PT result is frequently combined with the PTT result to determine what condition is present.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: A PTT test is used to diagnose and monitor bleeding disorders or excessive clotting disorders. The biomarker in the test is used to measure the tsime it takes for the blood to form a clot.

Also Known As: Activated Partial Thromboplastin Time Test, aPTT test, PTT Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is Partial Thromboplastin Time test ordered?

When a person has the following symptoms, the PTT may be ordered along with other tests, such as a PT:

  • Bleeding that isn't explained or bruises that isn't easy to get rid of
  • A blood clot in a vein or artery is a serious condition.
  • Disseminated intravascular coagulation
  • A chronic disorder that affects hemostasis, such as liver disease

A PTT can be requested in the following situations:

  • When a person develops a blood clot or a woman has repeated miscarriages, as part of a lupus anticoagulant, anticardiolipin antibodies, or antiphospholipid syndrome examination
  • When a person is on standard heparin therapy, the two are overlapped and both the PTT and PT are monitored until the person has stabilized. When a person is switched from heparin therapy to extended warfarin therapy, the two are combined and both the PTT and PT are monitored until the person has stabilized
  • Prior to surgery, if there is a high risk of blood loss and/or if the patient has a history of bleeding, such as frequent or severe nasal bleeds and easy bruising, which could suggest the presence of a bleeding problem

What does a Partial Thromboplastin Time blood test check for?

The partial thromboplastin time is a screening test that determines a person's capacity to form blood clots properly. It counts how long it takes for a clot to develop in a person's blood sample after chemicals have been administered. The PTT evaluates the number and function of specific proteins known as coagulation factors, which are crucial in blood clot formation.

When bodily tissues or blood vessel walls are harmed, bleeding ensues, and hemostasis is initiated. Platelets are little cell fragments that cling to the damage site and subsequently clump together. A process known as the coagulation cascade begins at the same time, and coagulation factors are activated. Fibrin threads develop and crosslink into a net that attaches to the damage site and stabilizes it as a result of the cascade reactions. This, combined with the platelets sticking, forms a stable blood clot that seals off injuries to blood arteries, prevents further blood loss, and allows damaged areas to heal.

For appropriate blood clot formation, each component of this hemostatic mechanism must operate effectively and be present in sufficient quantities. If one or more of these factors are deficient, or if they function improperly, a stable clot may not form, and bleeding may continue.

A PTT compares a person's sample to a normal clotting time reference period. A person's PTT is considered "prolonged" if it takes longer than usual to clot. A prolonged PTT could be caused by a disease that causes one or more coagulation factors to diminish or become dysfunctional. It's also possible that it's caused by a disorder in which the body creates antibodies that attack one or more coagulation factors, impairing their activity.

A PTT may take longer than expected if the person being tested creates an autoantibody termed an antiphospholipid antibody, which interferes with the test. Because it targets phospholipids, which are employed in the PTT, this type of antibody has an effect on the test findings. Antiphospholipid antibodies can extend the PTT test result, although they are linked to increased clotting in the body. A person who makes these antibodies may be more susceptible to blood clots. A PTT could be used to assess someone who has signs and symptoms of excessive clotting or antiphospholipid syndrome.

A PTT is frequently ordered in conjunction with a prothrombin time while investigating bleeding or clotting episodes. The results of these tests will be analyzed by a health professional in order to discover the reason of bleeding or clotting episodes.

Coagulation tests like the PT and PTT are now known to be reliant on what happens artificially in the test setting and so do not always reflect what happens in the body. They can, however, be utilized to assess certain aspects of the hemostasis system. The PTT and PT tests measure coagulation components that are part of the intrinsic, extrinsic, and common chemical reaction pathways in the cascade, respectively.

Lab tests often ordered with a Partial Thromboplastin Time test:

  • PT and INR
  • Fibrinogen
  • D-Dimer
  • Lupus Anticoagulant
  • ACT
  • Coagulation Factors
  • Platelet Count
  • Complete Blood Count (CBC)
  • Von Willebrand Factor
  • Antiphospholipid Antibodies

Conditions where a Partial Thromboplastin Time test is recommended:

  • Bleeding Disorders
  • Excessive Clotting Disorders
  • Vitamin K Deficiency
  • DIC
  • Antiphospholipid Syndrome

How does my health care provider use a Partial Thromboplastin Time test?

The PTT is mostly used to look into unexplained bleeding or clotting. It may be ordered in conjunction with a prothrombin time test to assess hemostasis, the body's process of forming blood clots to stop bleeding. Excessive bleeding or clotting issues are frequently investigated with these tests as a starting point.

Coagulation factors are proteins that have a role in hemostasis and the development of blood clots. When an injury occurs and bleeding begins, coagulation factors are triggered in a series of events that finally assist in the formation of a clot.

Prekallikrein and high molecular weight kininogen, as well as coagulation factors XII, XI, IX, VIII, X, V, II, and I, are all assessed using the PTT. The coagulation factors VII, X, V, II, and I are evaluated in a PT test. A health practitioner can determine what type of bleeding or clotting condition is present by combining the findings of the two tests. The PTT and PT aren't diagnostic, but they can help you figure out if you need more tests.

The following are some examples of PTT applications:

  • To detect coagulation factor deficit; if the PTT is extended, additional tests can be performed to ascertain whether coagulation factors are deficient or malfunctioning, or to see if the blood contains an antibody to a coagulation factor.
  • Nonspecific autoantibodies, such as lupus anticoagulant, can be detected and are linked to clotting episodes and recurrent miscarriages. As a result, PTT testing may be included in a clotting disorder panel to aid in the investigation of recurrent miscarriages or the diagnosis of antiphospholipid syndrome. The LA-sensitive PTT, a version of the PTT, could be used for this.
  • Heparin is an anticoagulant medicine that is given intravenously or by injection to prevent and treat blood clots; it is used to monitor routine heparin anticoagulant therapy. PTT is extended as a result of it. Heparin must be constantly managed when it is used for medicinal purposes. If too much is given, the patient may bleed excessively; if not enough is given, the patient may continue to clot.

The PTT and PT tests are sometimes used to screen for potential bleeding tendencies before surgical or other invasive treatments based on carefully acquired patient histories.

Other tests that may be done in conjunction with a PTT or in response to aberrant results include:

  • Platelet count — should be checked often during heparin therapy to detect any thrombocytopenia caused by the drug.
  • Thrombin time testing – used to rule out the possibility of heparin contamination.
  • Fibrinogen testing - to rule out a low level of fibrinogen as the cause of a delayed PTT.
  • A second PTT test is conducted after a first PTT is delayed by mixing the person's plasma with pooled normal plasma.  If the PTT time returns to normal, it indicates that one or more coagulation factors in the person's plasma are deficient. If the condition persists, it could be caused by the presence of an aberrant specific factor inhibitor or nonspecific lupus anticoagulant.
  • Coagulation factor tests are used to determine how active coagulation factors are. They can identify low protein levels or proteins that aren't working properly. A coagulation factor's antigen level is occasionally tested.
  • If the presence of lupus anticoagulant is suspected, a test for dilute Russell viper venom may be performed.
  • Von Willebrand factor is a test that is sometimes conducted to see if von Willebrand disease is causing a prolonged PTT.

What do my Partial Thromboplastin Time test results mean?

PTT findings are usually available in seconds. A normal clotting function is usually indicated by a PTT result that falls within a laboratory's reference interval. However, a single coagulation factor deficiency may be present in low to moderate amounts. The PTT should not be extended until the factor levels have dropped to 30% to 40% of normal. Lupus anticoagulant may also be present, but it is unlikely to affect the PTT result. A more sensitive LA-sensitive PTT or a dilute Russell viper venom time can be used to test for the lupus anticoagulant if it is suspected.

A delayed PTT indicates that clotting is taking longer than usual and could be caused by a number of factors. This frequently indicates that the body's clotting ability is being harmed by a coagulation factor deficit or a particular or nonspecific antibody. Defects in coagulation factors can be acquired or inherited.

It's possible that prolonged PTT tests are caused by:

  • Von Willebrand disease is the most prevalent inherited bleeding disorder, and it inhibits platelet function because von Willebrand factor levels are low.
  • Hemophilia A and B are two more inherited bleeding disorders that are caused by a lack of factors VIII and IX, respectively.
  • Other coagulation factors, such as factors XII and XI, are deficient.

Deficiencies in acquired factors:

  • A vitamin K insufficiency. Vitamin K is required for the production of clotting factors. Vitamin K deficiency is uncommon, but it can occur as a result of a poor diet, malabsorption issues, or the use of certain antibiotics over an extended period of time, for example.
  • Because the liver produces the majority of coagulation components, liver illness might result in extended PT and PTT. PT is more likely to be prolonged than PTT in patients with liver disease and vitamin K insufficiency.
  • A nonspecific inhibitor, such as lupus anticoagulant—the presence of these inhibitors is usually linked to abnormal clotting, but they can also lengthen the PTT. For further information, see the individual test articles.
  • Antibodies that selectively target certain coagulation factors, such as antibodies that target factor VIII, are known as specific inhibitors. They can form in people who are receiving factor replacements or they can develop spontaneously as an autoantibody in people who have a bleeding condition. Factor-specific inhibitors have the potential to induce serious bleeding.
  • Heparin is an anticoagulant that will prolong a PTT if it is present in the sample as a contaminant or as part of anticoagulation therapy. The goal PTT for anticoagulant therapy is usually 1.5 to 2.5 times longer than the pretreatment level.
  • The PTT is not used to monitor warfarin anticoagulation therapy, but it may be influenced by it. The PT is commonly used to track warfarin therapy.
  • Anticoagulation therapy with a direct thrombin inhibitor or a direct factor Xa inhibitor are examples of other anticoagulants.
  • Leukemia, severe bleeding in pregnant women prior to or after delivery, and recurrent miscarriages can all cause elevated PTT levels

The PTT results are frequently combined with the PT results to determine what ailment is present.

PTT testing may be shortened as a result of:

  • Disseminated intravascular coagulation—circulating procoagulants shorten the PTT in the early phases of DIC.
  • Extensive cancer
  • An acute-phase reaction is a disease that causes significant tissue inflammation or trauma, which causes factor VIII levels to rise. It's frequently a one-time occurrence that isn't tracked with a PTT test. The PTT will return to normal once the condition that caused the acute phase reaction is resolved.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: A CBC or Complete Blood Count with Differential and Platelets test is a blood test that measures many important features of your blood’s red and white blood cells and platelets. A Complete Blood Count can be used to evaluate your overall health and detect a wide variety of conditions such as infection, anemia, and leukemia. It also looks at other important aspects of your blood health such as hemoglobin, which carries oxygen. 

Also Known As: CBC test, Complete Blood Count Test, Total Blood Count Test, CBC with Differential and Platelets test, Hemogram test  

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

When is a Complete Blood Count test ordered?  

The complete blood count (CBC) is an extremely common test. When people go to the doctor for a standard checkup or blood work, they often get a CBC. Suppose a person is healthy and their results are within normal ranges. In that case, they may not need another CBC unless their health condition changes, or their healthcare professional believes it is necessary. 

When a person exhibits a variety of signs and symptoms that could be connected to blood cell abnormalities, a CBC may be done. A health practitioner may request a CBC to help diagnose and determine the severity of lethargy or weakness, as well as infection, inflammation, bruises, or bleeding. 

When a person is diagnosed with a disease that affects blood cells, a CBC is frequently done regularly to keep track of their progress. Similarly, if someone is being treated for a blood condition, a CBC may be performed on a regular basis to see if the treatment is working. 

Chemotherapy, for example, can influence the generation of cells in the bone marrow. Some drugs can lower WBC counts in the long run. To monitor various medication regimens, a CBC may be required on a regular basis. 

What does a Complete Blood Count test check for? 

The complete blood count (CBC) is a blood test that determines the number of cells in circulation. White blood cells (WBCs), red blood cells (RBCs), and platelets (PLTs) are three types of cells suspended in a fluid called plasma. They are largely created and matured in the bone marrow and are released into the bloodstream when needed under normal circumstances. 

A CBC is mainly performed with an automated machine that measures a variety of factors, including the number of cells present in a person's blood sample. The findings of a CBC can reveal not only the quantity of different cell types but also the physical properties of some of the cells. 

Significant differences in one or more blood cell populations may suggest the presence of one or more diseases. Other tests are frequently performed to assist in determining the reason for aberrant results. This frequently necessitates visual confirmation via a microscope examination of a blood smear. A skilled laboratory technician can assess the appearance and physical features of blood cells, such as size, shape, and color, and note any anomalies. Any extra information is taken note of and communicated to the healthcare provider. This information provides the health care provider with further information about the cause of abnormal CBC results. 

The CBC focuses on three different types of cells: 

WBCs (White Blood Cells) 

The body uses five different types of WBCs, also known as leukocytes, to keep itself healthy and battle infections and other types of harm. The five different leukocytes are eosinophiles, lymphocytes, neutrophiles, basophils, and monocytes. They are found in relatively steady numbers in the blood. Depending on what is going on in the body, these values may momentarily rise or fall. An infection, for example, can cause the body to manufacture more neutrophils in order to combat bacterial infection. The amount of eosinophils in the body may increase as a result of allergies. A viral infection may cause an increase in lymphocyte production. Abnormal (immature or mature) white cells multiply fast in certain illness situations, such as leukemia, raising the WBC count. 

RBCs (Red Blood Cells) 

The bone marrow produces red blood cells, also known as erythrocytes, which are transferred into the bloodstream after maturing. Hemoglobin, a protein that distributes oxygen throughout the body, is found in these cells. Because RBCs have a 120-day lifespan, the bone marrow must constantly manufacture new RBCs to replace those that have aged and disintegrated or have been lost due to hemorrhage. A variety of diseases, including those that cause severe bleeding, can alter the creation of new RBCs and their longevity. 

The CBC measures the number of RBCs and hemoglobin in the blood, as well as the proportion of RBCs in the blood (hematocrit), and if the RBC population appears to be normal. RBCs are generally homogeneous in size and shape, with only minor differences; however, considerable variances can arise in illnesses including vitamin B12 and folate inadequacy, iron deficiency, and a range of other ailments. Anemia occurs when the concentration of red blood cells and/or the amount of hemoglobin in the blood falls below normal, resulting in symptoms such as weariness and weakness. In a far smaller percentage of cases, there may be an excess of RBCs in the blood (erythrocytosis or polycythemia). This might obstruct the flow of blood through the tiny veins and arteries in extreme circumstances. 

Platelets 

Platelets, also known as thrombocytes, are small cell fragments that aid in the regular clotting of blood. A person with insufficient platelets is more likely to experience excessive bleeding and bruises. Excess platelets can induce excessive clotting or excessive bleeding if the platelets are not operating properly. The platelet count and size are determined by the CBC. 

Lab tests often ordered with a Complete Blood Count test: 

  • Reticulocytes
  • Iron and Total Iron Binding Capacity
  • Basic Metabolic Panel
  • Comprehensive Metabolic Panel
  • Lipid Panel
  • Vitamin B12 and Folate
  • Prothrombin with INR and Partial Thromboplastin Times
  • Sed Rate (ESR)
  • C-Reactive Protein
  • Epstein-Barr Virus
  • Von Willebrand Factor Antigen

Conditions where a Complete Blood Count test is recommended: 

  • Anemia
  • Aplastic Anemia
  • Iron Deficiency Anemia
  • Vitamin B12 and Folate Deficiency
  • Sickle Cell Anemia
  • Heart Disease
  • Thalassemia
  • Leukemia
  • Autoimmune Disorders
  • Cancer
  • Bleeding Disorders
  • Inflammation
  • Epstein-Barr Virus
  • Mononucleosis

Commonly Asked Questions: 

How does my health care provider use a Complete Blood Count test? 

The complete blood count (CBC) is a common, comprehensive screening test used to measure a person's overall health status.  

What do my Complete Blood Count results mean? 

A low Red Blood Cell Count, also known as anemia, could be due many different causes such as chronic bleeding, a bone marrow disorder, and nutritional deficiency just to name a few. A high Red Blood Cell Count, also known as polycythemia, could be due to several conditions including lung disease, dehydration, and smoking. Both Hemoglobin and Hematocrit tend to reflect Red Blood Cell Count results, so if your Red Blood Cell Count is low, your Hematocrit and Hemoglobin will likely also be low. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Differential results mean? 

A low White Blood Cell count or low WBC count, also known as leukopenia, could be due to a number of different disorders including autoimmune issues, severe infection, and lymphoma. A high White Blood Cell count, or high WBC count, also known as leukocytosis, can also be due to many different disorders including infection, leukemia, and inflammation. Abnormal levels in your White Blood Cell Count will be reflected in one or more of your different white blood cells. Knowing which white blood cell types are affected will help your healthcare provider narrow down the issue. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Platelet results mean? 

A low Platelet Count, also known as thrombocytopenia, could be due to a number of different disorders including autoimmune issues, viral infection, and leukemia. A high Platelet Count, also known as Thrombocytosis, can also be due to many different disorders including cancer, iron deficiency, and rheumatoid arthritis. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

NOTE: Only measurable biomarkers will be reported. Certain biomarkers do not appear in healthy individuals. 

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
     
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
>1000 
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
     
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Description: The D-Dimer Quantitative test is used to evaluate fibrinolytic activation and intravascular thrombosis.

Also Known As: Fragment D-Dimer Test, Fibrin Degradation Fragment Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a D-Dimer test ordered?

When a patient presents to the emergency room with signs of a dangerous disease, D-dimer testing is frequently prescribed.

When a patient exhibits signs of pulmonary embolism or deep vein thrombosis, a D-dimer test may be prescribed.

When a doctor suspects that another condition other than deep vein thrombosis or pulmonary embolism is the likely cause of symptoms, D-dimer is particularly helpful. It is a rapid, non-invasive method that can help rule out excessive or irregular coagulation. However, it should not be taken if a clinical examination indicates that there is a high likelihood of pulmonary embolism.

To help in the diagnosis of disseminated intravascular coagulation, a D-dimer test coupled with a PT, PTT, fibrinogen, and platelet count may be prescribed for someone who exhibits symptoms like bleeding gums, nausea, vomiting, intense muscle and abdominal pain, seizures, and decreased urine output. When someone is receiving therapy for DIC, D-dimer orders may also be placed periodically to help track the condition's development.

What does a D-Dimer blood test check for?

One of the protein fragments created when a blood clot dissolves in the body is called D-dimer. Normally, it goes unnoticed until the body is generating and dissolving blood clots. Its blood level may then increase as a result. D-dimer in the blood is found using this test.

The body starts a process known as hemostasis when a blood vessel or tissue is injured and starts bleeding in order to form a blood clot that will eventually stop the bleeding. A fibrin net is created by the crosslinking of fibrin threads, which are produced as a result of this process. Platelets and that net work together to contain the blood clot that is forming until the wound has healed.

The body utilizes an enzyme called plasmin to break the thrombus into small pieces so that it can be eliminated after the area has had time to heal and the clot is no longer required. Known as fibrin degradation products, the fragments of the breaking down fibrin in the clot are made up of different sized bits of crosslinked fibrin. D-dimer, one of the last byproducts of fibrin breakdown, can be detected in blood samples and quantified. When blood clots are formed and broken down significantly in the body, the level of D-dimer in the blood may increase.

The D-dimer test's strength is that it can be utilized in a hospital emergency room setting to assess the likelihood of a clot's existence for a person who is at low or moderate risk for blood clotting and/or thrombotic embolism. If the D-dimer test is negative, a thrombus is extremely unlikely to be present. A positive D-dimer test, however, cannot indicate the presence or absence of a clot. It suggests that additional testing is necessary.

Unwanted blood clot formation is related to a number of variables and diseases. Deep vein thrombosis, which causes clots to form in the body's deep veins, most usually in the legs, is one of the most frequent. These clots have the potential to become very large and obstruct blood flow to the legs, resulting in swelling, discomfort, and tissue damage. It is possible for a fragment of the clot to separate and spread to different bodily regions. This "embolus" may become lodged in the lungs and result in pulmonary embolism. Up to 300,000 deaths in the U.S. are attributed to pulmonary embolisms brought on by DVT each year.

Clots can develop in different places, though they most frequently do so in the veins of the legs. Any of these places may benefit from D-dimer measurements to aid in the discovery of clots. For instance, myocardial infarction is brought on by clots in the coronary arteries. When the heart is pounding irregularly or when the valves are damaged, clots are more likely to form on the lining of the heart or its valves. Additionally, clots can develop in big arteries due to atherosclerosis-related constriction and damage. Such clot fragments may break off and create an embolus, which stops an artery in another organ, such the kidneys or the brain.

In addition to other tests, D-dimer measurements may be requested to assist in the diagnosis of disseminated intravascular coagulation. DIC is a condition when the body's clotting factors are activated and subsequently depleted. This causes multiple small blood clots to form while also making the victim susceptible to heavy bleeding. It is a challenging, occasionally fatal illness that can develop following a number of medical procedures, infections, toxic snake bites, liver diseases, and postpartum conditions. While the underlying ailment gets better, measures are taken to support the affected person. In DIC, the D-dimer level is frequently very high.

Lab tests often ordered with a D-Dimer test:

  • PT and INR
  • PTT
  • Fibrinogen Activity
  • Platelet Count
  • Complete Blood Count (CBC)

Conditions where a D-Dimer test is recommended:

  • Excessive Clotting
  • Disseminated Intravascular Coagulation
  • Pulmonary Embolism
  • Deep Vein Thrombosis

How does my health care provider use a D-Dimer test?

D-dimer tests are used to assist in excluding the possibility of an unexpected blood clot.

This test can assist establish whether more testing is required to evaluate diseases and conditions that lead to hypercoagulability, or a propensity to clot unnecessarily.

A D-dimer level can be used to monitor DIC therapy effectiveness and aid in the diagnosis of disseminated intravascular coagulation.

What do my D-Dimer test results mean?

The likelihood that a person examined does not have an acute ailment or disease that causes aberrant clot formation and breakdown increases if the D-dimer result is normal or negative. The majority of medical professionals concur that a negative D-dimer test is most reliable and helpful when it is performed on individuals who are thought to have a low to moderate risk of thrombosis. The test is employed to assist in excluding coagulation as the root of the symptoms.

A high level of fibrin breakdown products may be present if the D-dimer test is positive. It does not specify the location or origin, but rather suggests that there may be major blood clot development and disintegration in the body. For instance, it might be caused by disseminated intravascular coagulation or venous thromboembolism. In DIC, the D-dimer level is frequently very high.

However, because a number of different causes might result in a raised level, an elevated D-dimer does not always mean that a clot is present. Elevated amounts may be present in diseases or conditions where fibrin is not regularly eliminated, such as liver illness, or diseases or conditions where fibrin is not normally cleared, such as recent surgery, trauma, infection, heart attack, and several malignancies. D-dimer is therefore rarely used to exclude VTE in hospitalized patients.

During pregnancy, fibrin is also produced and degraded, which could cause a rise in D-dimer levels. The D-dimer test, combined with a PT, PTT, fibrinogen, and platelet count, may be utilized, however, to help detect DIC in a woman who is pregnant or who is soon after giving birth. Her D-dimer level will be exceedingly high if the woman has DIC.

D-dimer is advised as an additional test. The D-dimer test should only be performed to rule out deep vein thrombosis and not to confirm a diagnosis because it is a sensitive test but has low specificity. When the clinical likelihood of pulmonary embolism is high, it shouldn't be utilized to treat the condition. Follow-up and additional testing may be necessary for both elevated and normal D-dimer levels. Further investigation using diagnostic imaging is necessary for patients with positive D-dimer tests and those who have a moderate to high risk for DVT.

When used to track the effectiveness of DIC treatment, decreasing levels signify success while rising levels could mean treatment failure.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: A Fibrinogen Activity Clauss test is a blood test that measures the amount of active Fibrinogen in your blood to evaluate your blood’s ability to form clots.

Also Known As: Fibrinogen Activity Test, Factor 1 Assay Test, Cardiac Fibrinogen Test, Fibrinogen Test, Clotting factors Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Fibrinogen test ordered?

A fibrinogen activity test may be ordered by a doctor if someone:

  • Has any unexplained or prolonged bleeding
  • Has thrombosis
  • Has a PT and PTT test result that is abnormal
  • Has DIC or abnormal fibrinolysis symptoms or is being treated for it.
  • Has or may have inherited coagulation factor deficiency or dysfunction
  • Has a bleeding issue, and their health care provider wishes to assess and monitor their clotting capacity

When someone obtains a low result on a fibrinogen activity test, a fibrinogen antigen test may be used to establish whether the low result is due to insufficient or malfunctioning fibrinogen.

Coronary heart disease, myocardial infarction, and peripheral artery disease have all been linked to high fibrinogen levels. When a health practitioner wants to assess an individual's risk of developing cardiovascular disease, fibrinogen activity testing may be used in conjunction with other tests.

What does a Fibrinogen blood test measure?

Fibrinogen is a protein that is a coagulation factor in the production of blood clots. A fibrinogen activity test determines how well fibrinogen aids in the formation of a blood clot, whereas a fibrinogen antigen test determines the amount of fibrinogen in the blood.

Fibrinogen is produced in the liver, and is then delivered into the bloodstream along with many other coagulation factor proteins. Hemostasis stops bleeding at the site of injury when a blood vessel or body tissue is damaged. Platelets, small cell fragments, stick to and cluster at the site, triggering a coagulation cascade in which clotting components are activated one by one.

As the cascade develops, soluble fibrinogen turns into insoluble fibrin strands. At the wound site, a fibrin net is created by the crosslinking of these threads and stabilizes it. Together with the platelets, the fibrin net adheres to the area of injury and creates a solid blood clot. This barrier prevents more blood loss and is present while the injured area recovers.

There must be enough typically functioning platelets and coagulation factors for a stable clot to form. It can cause bleeding episodes and/or the creation of an inappropriate blood clot if there are defective factors or platelets, or if there are too few or too many of them. Hemostasis can be assessed using a variety of laboratory techniques, including fibrinogen assays.

Coagulation tests are now known to be based on what happens artificially in the test setting and so do not always reflect what happens in the body. The tests can, however, be used to assess individual components of the hemostasis system. The fibrinogen activity test measures the amount of soluble fibrinogen that is transformed into fibrin threads during the hemostatic process. The fibrinogen test bypasses the rest of the coagulation factors and concentrates on the function of fibrinogen after adding thrombin to the test sample.

A fibrinogen activity test determines how long it takes for a fibrin clot to form after a standard dose of thrombin is added to plasma. This test assesses the function of fibrinogen, specifically its capacity to convert into fibrin. The amount of active fibrinogen present directly correlates with the time it takes for a clot to develop. Prolonged clot formation periods can be caused by low levels of normal fibrinogen or by fibrinogen that is dysfunctional.

Acute phase reactants are a group of blood components that include fibrinogen. When conditions cause acute tissue inflammation or injury, blood levels of fibrinogen and other acute phase reactants rise dramatically. These acute phase reactants, including fibrinogen, can be tested to see how much inflammation is present in the body.

Lab tests often ordered with a Fibrinogen test:

  • PT and INR
  • PTT
  • D-Dimer
  • Coagulation Factors
  • Thrombin Time
  • Hs-CRP
  • Complete Blood Count CBC

Conditions where a Fibrinogen test is recommended:

  • Excessive Clotting Disorders
  • Bleeding Disorders
  • Liver Disease
  • Cardiovascular Disease
  • DIC

Commonly Asked Questions:

How does my health care provider use a Fibrinogen test?

This test is designed to assess fibrinogen, a protein that is required for the production of blood clots. When an injury happens and bleeding occurs, the body goes through a sequence of actions to build a blood clot. One of the final phases is converting soluble fibrinogen into insoluble fibrin threads that crosslink to form a net that stabilizes and binds to the injured site until it heals.

A fibrinogen activity test assesses fibrinogen's function and capacity to convert to fibrin. It's utilized to:

  • It's utilized to:
  • As follow-up testing to an abnormal bleeding disorder test result and/or an episode of prolonged or inexplicable bleeding
  • To help detect disseminated intravascular coagulation or aberrant fibrinolysis, testing such as Prothrombin, Partial Thromboplastin Times, Platelet Count, and D-dimer are often ordered.
  • Occasionally, to aid in the monitoring of the progress of a progressive disease over time, or, in rare cases, to aid in the monitoring of the treatment of an acquired ailment.

Other cardiac risk markers, such as C-reactive protein, are sometimes used to assist in evaluating a person's overall risk of developing cardiovascular disease. However, because there are no direct treatments for increased levels, this application of the test has not achieved general adoption. Many health professionals, on the other hand, believe that measuring fibrinogen activity provides them with extra information that may drive them to be more aggressive in addressing those risk factors that they can control.

What do my fibrinogen activity test results mean?

The concentration of protein in the blood is reported as the result of a fibrinogen test. 

The presence of normal fibrinogen activity usually indicates that the blood clotting ability is normal.

Reduced or malfunctioning fibrinogen may be the cause of significantly reduced fibrinogen activity. Reduced fibrinogen activity and antigen levels can make it more difficult for the body to produce a stable blood clot.

Reduced production owing to a hereditary illness such as afibrinogenemia or hypofibrinogenemia, or a condition such as malnutrition or liver disease, can cause chronically low levels.

Acutely low levels are frequently associated with fibrinogen consumption, such as in disseminated intravascular coagulation and irregular fibrinolysis, which happens when the body is overly active in removing blood clots. Reduced fibrinogen levels can also occur as a result of quick, large-volume blood transfusions or in malnourished patients.

A ratio of the antigen test and the activity test is sometimes used by a doctor. This is to differentiate dysfibrinogenemia from hypofibrinogenemia.

Fibrinogen is an acute phase reactant, which means that it can rapidly rise in amounts in any situation that causes inflammation or tissue injury. Elevated fibrinogen concentrations aren't specific, which means they don't inform the doctor what's causing the problem or where it's happening. These increases in fibrinogen are usually just transitory, returning to normal after the underlying problem is treated. Elevated levels can be seen in the following ways:

  • Infections that are severe
  • Cancer
  • Myocardial infarction, coronary artery disease
  • Stroke
  • Inflammatory conditions
  • Trauma
  • Smoking a cigarette
  • Pregnancy
  • Peripheral artery disease, a condition that affects the arteries
  • When fibrinogen levels are high, a person's risk of cardiovascular disease and producing a blood clot is raised

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


von Willebrand Disease is the most common hereditary bleeding disorder. von Willebrand Factor is necessary for platelet adhesion to injured endothelium. Ristocetin cofactor is useful in assessing binding of von Willebrand Factor to platelet factor GP1b. When combined with other tests, results are useful in categorizing the type of von Willebrand Disease.

von Willebrand Disease is the most common hereditary bleeding disorder; it may also be acquired. von Willebrand Factor is necessary for platelet adhesion to injured endothelium. von Willebrand Factor Antigen is useful in assessing the quantity of von Willebrand Factor. When combined with other tests, results are useful in categorizing the type of von Willebrand Disease.

von Willebrand Disease is the most common hereditary bleeding disorder; it may also be acquired. von Willebrand Factor is necessary for platelet adhesion to injured endothelium. von Willebrand Factor Antigen, Multimeric Analysis is useful when type 2 disease is suspected and to further categorize disease.

Von Willebrand disease is a bleeding disorder that slows the blood clotting process, causing prolonged bleeding after an injury. People with this condition often experience easy bruising, long-lasting nosebleeds, and excessive bleeding or oozing following an injury, surgery, or dental work. Von Willebrand disease is estimated to affect 1 in 100 to 10,000 individuals. Because people with mild signs and symptoms may not come to medical attention, it is thought that this condition is underdiagnosed. Most researchers agree that von Willebrand disease is the most common genetic bleeding disorder.

The Collagen Binding Assay (vWF:CBA) is a test procedure that quantifies the binding of vWF to collagen. Collagen binding of vWF is associated with the functionally more important HMW forms of vWF. Therefore, vWF:CBA may correlate more closely with vWF function and bleeding problems than vWF antigen assay (vWF: Ag) which measures total vWF multimers. When used in conjunction with the vWF: Ag assay, vWF:CBA can be used to differentiate between vWD type 1 and type 2 (A and B subtypes) by calculating a ratio of the two assay results (ratio = vWF:CBA/vWFAg).

The factor X assay is a blood test to measure the activity of factor X. This is one of the proteins in the body that helps the blood clot.


Description: Fecal Globulin by immunochemistry is a test that measures the amount of blood present in fecal samples. The results from the fecal globulin test can be used to detect a lower gastrointestinal disorder. It is recommended to be a part of the routine physical examination.

Also Known As: Fecal Immunochemical Test, Fecal Occult Blood Test, Stool Occult Blood Test, FIT, FOBT

Collection Method: Fecal specimen collected from toilet water and brushed onto InSure® FOBT test card

Specimen Type: Fecal Specimen

Test Preparation: No preparation required

When is a Fecal Globin test ordered?

When a person chooses fecal occult blood testing as a method of colon cancer screening, the American Cancer Society and other major healthcare organizations recommend yearly testing. The American Cancer Society and others recommend that colon cancer screening begin around age 50 for the general population, but it may begin earlier if a person has a family history of colon cancer.

An FOBT may be ordered by a doctor if a patient has unexplained anemia that could be caused by gastrointestinal bleeding.

What does a Fecal Globin test check for?

The majority of colon cancer cases begin with the formation of benign intestinal polyps. Benign polyps are quite common in adults over 50, and while the majority do not cause health problems, some can turn malignant and spread to other parts of the body. These finger-like growths protrude into the rectum or the intestinal cavity. They can be delicate and bleed on occasion, as when food debris rubs against them.

The blood expelled is normally not visible in the stool, but a fecal occult blood test or a fecal immunochemical test can detect it. The FOBT and FIT are effective colorectal cancer screening techniques because this small amount of blood may be the earliest and sometimes only evidence of early colon cancer. A guaiac-based test, an over-the-counter flushable reagent pad, and an immunochemical technique are all options for testing.

It is advised that at least three stool samples be taken on different days be tested. According to the American Cancer Society, a single test performed during a digital rectal exam at a doctor's office is not recommended since it may not be sensitive enough to detect cancer. Because collecting feces on three different days increases the chances of identifying cancer, the home FOBT or FIT is advised. Additionally, those who choose this type of colon cancer screening should be screened every year.

Lab tests often ordered with a Fecal Globin test:

  • Complete Blood Count (CBC)
  • Calprotectin

Conditions where a Fecal Globin test is recommended:

  • Colon Cancer

How does my health care provider use a Fecal Globin test?

The fecal occult blood test, also known as the fecal immunochemical test, is primarily used to screen for early colon cancer. The majority of colon cancer cases begin with the formation of benign intestinal polyps. People over the age of 50 are more likely to develop benign polyps. The majority are non-cancerous, however some can develop malignant.

Blood in the stool could be the only sign of early cancer, so if caught early, therapy can begin right away, increasing the chances of a cure.

What do my Fecal Occult Blood test results mean?

Normally, the fecal occult blood test is negative.

A positive test result for the guaiac-based FOBT shows that abnormal bleeding is occurring anywhere in the digestive tract. Ulcers, diverticulosis, polyps, inflammatory bowel disease, hemorrhoids, blood eaten owing to bleeding gums or nosebleeds, or benign or malignant tumors could all cause blood loss.

A positive result for the fecal immunochemical test shows abnormal bleeding in the lower digestive tract. Other sources of blood, such as those found in the diet, do not generate a positive result since this test only identifies human hemoglobin. Furthermore, hemoglobin from upper digestive tract hemorrhage is broken down before reaching the lower digestive tract and is undetectable by the FIT. As a result, the FIT is a more precise test than the gFOBT.

Follow-up testing is required after a positive result from either the guaiac-based FOBT or the immunochemical FIT. Direct imaging of the colon and rectum is generally used.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


The fecal occult blood test is an immunochromatographic fecal occult blood test that qualitatively detects human hemoglobin from blood in fecal samples. This is a useful screening aid for detecting primarily lower gastrointestinal (G.I.) disorders that may be related to iron deficiency anemia, diverticulitis, ulcerative colitis, polyps, adenomas, colorectal cancers or other G.I. lesions that can bleed. It is recommended for use by health professionals as part of routine physical examinations and in screening for colorectal cancer or other sources of lower G.I. bleeding.

Plasminogen Activator Inhibitor-1 (PAI-1) 


Von Willebrand disease is a bleeding disorder that slows the blood clotting process, causing prolonged bleeding after an injury. People with this condition often experience easy bruising, long-lasting nosebleeds, and excessive bleeding or oozing following an injury, surgery, or dental work. Von Willebrand disease is estimated to affect 1 in 100 to 10,000 individuals. Because people with mild signs and symptoms may not come to medical attention, it is thought that this condition is underdiagnosed. Most researchers agree that von Willebrand disease is the most common genetic bleeding disorder.


If you didn’t already know, bleeding disorders are classified as someone having the tendency to bruise easily or even bleed excessively for a long period of time. However, these usually come from genetics and can be inherited. These disorders can also be caused by various factors that come about during the lifetime of a person.  

From a general point of view, blood stays inside the blood vessels within the circulatory system. In the case of sustaining an injury to the blood vessels, bleeding begins. The human body relies on the complex clotting process of hemostasis to stop blood loss. In the primary stage of hemostasis, all injured blood vessels constrict to reduce the flow of blood.  

When blood flow is restricted, fragments of cells within the blood known as platelets stick to the injured part. They try to clump together with others as they release a series of chemical compounds. When the compounds are released, they aggregate the other platelets present, and together they form a very loose plug of the platelet.  

Platelets are responsible for supporting the coagulation of the cascade. This is simply a series of steps that require the activation of proteins. These proteins are referred to as the clotting factor or the coagulation factor.  

As this secondary process takes place, fibrin strands form and weave through any loose platelet that is found on the plug. After weaving, they compress to form a stable clot. The newly formed barrier then remains securely on the area until it is healed.  

The process of hemostasis is quite dynamic, and as soon as the clot is formed, several factors come into effect to reduce the speed of the process. After some time, the clot is then dissolved via fibrinolysis. This allows the clot to be removed after healing takes place. When persons are healthy, this balance exists to prevent excess bleeding and clots are successfully removed after healing.  

For these processes to take place, the elements needed for primary and secondary hemostasis must be there. However, they must also be activated at the right moment and be working properly to ensure that the clotting process takes place effectively. In the case of insufficient coagulation factors or platelets, stable clots will not form. This results in excessive bleeding.  

Bleeding disorders come about when there is a problem with the clotting process. If someone is suffering from a deficiency or components are not working properly or they are missing, disorders develop. Additionally, some disorders involve the blood vessel structure as well as the ability to produce healthy platelets.  

Bleeding disorders are rarely inherited and are known to be caused by dysfunctions of some type or a deficiency in the clotting element. If the disorder was acquired and there’s a high possibility that no genetic components existed. This means that it came about due to another factor.  

Signs and Symptoms 

Bleeding disorders have been known to result in some symptoms and signs. However, they are all dependent on the causes, and different combinations can exist. This leaves many symptoms and signs that all have a different degree of severity.  

For some, bleeding can begin early on during childhood. These episodes are sometimes mild or severe. In some instances, persons require surgery to deal with prolonged bleeding. Bleeding problems can also cause trauma and dental procedures. If they begin early on, there a chance that it was inherited.  

Some signs and symptoms may include: 

  • Bleeding gums 
  • Nosebleeds that occur frequently 
  • Easy or unexplained bruising 
  • Excessive bleeding from dental procedures or small cuts  
  • Muscle, joint pain or swelling after injuries and accidents that were minor 
  • Women who experience heavy, longer menstrual periods 
  • Purplish small spots or large lesions on the skin indicate bleeding under the skin 
  • Red spots that look like rash on the skin 
  • Bleeding in the eyes with loos of vision 
  • Chronic anemia 
  • Arthritic-type symptoms that come from bleeding into the joints 
  • Bleeding in the digestive tract that causes blood in the stool 

Tests 

If a doctor is suspicious of the symptoms and signs experienced by a patient, they can order several laboratory tests. To properly investigate the disorder, several steps must be followed. The following tests can be ordered if need be: 

In the case where PTT or PT or both result in the need for further testing, additional tests are performed to determine the problems associated with the coagulation factors. They also determine if there are specific inhibitors that could also be causing the problem. It should be noted that not all tests listed below are needed for persons suffering from bleeding disorders.  

Tests for Bleeding Disorders 

The following tests are some of the most common tests that are ordered by healthcare practitioners to further evaluate bleeding disorders: 

  • Blood Smear – Blood smears involve the microscopic examination of a blood sample. It goes on to further estimate and even evaluate the size and appearance of the platelets. This test is usually required if someone experiences bleeding without a cause or if they have an abnormal platelet count. However, abnormal platelets tend to point toward platelet disorders.  
  • Complete Blood Count (CBC) – Blood cells are categorized and counted. These include the white blood cells (WBCs), red blood cells (RBCs) and platelets. This test is carried out to perform routine screening or general tests. These usually detect underlying anemia and other abnormalities. Decreased platelet counts are also identified with the CBC and can signal a platelet disorder just like anemia can suggest excessive bleeding.  
  • Coagulation Factors, Activity – The activity or function of coagulation factors are measured with this test. However, this test is only needed when the PTT or PT results were not normal. A decreased activity level usually indicates a deficiency or a specific factor inhibitor.  
  • Coagulation Factors, Antigen – The coagulation factor antigen test is used to measure the number of factors present. This test is done when a specific factor is low. Lower levels usually indicate a factor deficiency that was caused by an increase or a decrease of a factor.  
  • D-dimer – The types of degradation cross-linked fibrin products are measured with this test. Hence, blood clot formation is evaluated during the bleeding and clotting phases. When elevated, it means that clotting occurred recently. This can occur because of disseminated intravascular coagulation (DIC) or blood clots (thrombosis).  
  • Factor Inhibitors – These detect the antibodies that are directed at coagulation factors. If the coagulation factor test was out of the normal range, this test is requested. If for some reason, it is present, some factors are specific and indicate deficiencies.  
  • Fibrinogen (activity) – This gives a better indication of the activity as well as the ability of the clotting indicator. Hence, clots and bleeding are evaluated. These elevate when someone sustains an infection or is suffering from inflammation.  

The previously mentioned tests are carried out because of the following: 

  • PTT – Factors I (fibrinogen), II (prothrombin), V, VIII, IX, X, XI, XII, prekallikrein (PK) and high weight kininogen (HMWK) are evaluated on a general screen. During this analysis, bleeding is investigated. If prolonged PTT is suggested, then further tests can indicate nonspecific inhibitors such as the anticoagulant of lupus, a coagulation factor deficiency, or even a specific inhibitor like the antibody factor VIII.  
  • Aggregation studies or Platelet Function Tests – Studies the ability of the platelets to clump or adhere to a damaged spot. Further evaluation of bleeding is done if normal levels occur. In the case of abnormal values, the presence of von Willebrand disease could be present.  
  • PT – The factors I (fibrinogen), II, V, VII, and X are examined on the general screen. If prolonged, further testing can result in dysfunction, coagulation deficiency, or a specific factor deficiency.  
  • Ristocetin Cofactor – Measures the von Willebrand factors (VWF) function or activity. Bleeding episodes are evaluated with this test, and when decreased, the VWF factor less active. Hence, platelets don’t adhere to an injury site.  
  • Thrombin Time (TT) – The TT test detects the time required for thrombin to activate fibrinogen to form the fibrin strands. Bleeding episodes are also evaluated, and if PTT is prolonged, the sample could have been contaminated by heparin. When elevated, heparin is suspected as the contaminant. Additionally, elevation also indicates the degradation of fibrin products, abnormal levels of fibrin, or even abnormally low levels.  
  • The von Willebrand Factor Antigen – Successfully measures the activity of VWF. If low, bleeding episodes are then evaluated. Low levels usually indicate conditions that were derived from acquired platelet conditions. There is also a risk of bleeding.  
  • Thromboelastography (TEG) – TEG evaluates the clotting abilities. Platelet functions, clot breakdown, and coagulation factors are also assessed. Prolonged bleeding or excessive bleeding after major surgery is also assessed with the TEG test. Results that are not in the normal range express a qualitative or quantitative platelet defect, or fibrinolytic and coagulation factors. These results are useful in determining the treatment and management of blood transfusion.  

Along with those mentioned, metabolic panels can also be ordered. These perform a thorough assessment of the kidney and liver functions. In the case of kidney or liver failure or both, patients have a higher risk of experiencing increased bleeding.