Excessive Clotting Disorders

Blood Clotting Disorder Lab Testing and health information

Blood clots can happen to anybody and are often the result of excessive blood clotting disorders. Early diagnosis is critical, and that's why blood clotting tests are so important. Learn what these conditions are and the benefits of testing for them. Find the right blood clotting tests with Ulta Lab Tests and get reliable blood work, secure testing, and quick and confidential tests results.

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


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The Antiphospholipid Antibody Panel is a comprehensive test that measures nine biomarkers associated with antiphospholipid syndrome (APS). APS is an autoimmune disorder that can lead to recurrent miscarriages, thrombosis, and pregnancy complications. The panel includes tests for beta-2-glycoprotein I antibodies, phosphatidylserine antibodies, and cardiolipin antibodies. This comprehensive testing will provide your healthcare provider with important information about your risk for APS and allow them to tailor your treatment accordingly.

This comprehensive testing will provide your healthcare provider with important information about your risk for APS and allow them to tailor your treatment accordingly. If you have been diagnosed with APS, it is important to see your healthcare provider regularly and follow their treatment recommendations. Sometimes, treatment with blood thinners or other medications may be necessary to prevent serious complications. Most people with APS can lead healthy, normal lives with proper management.

What is included in the antiphospholipid panel?

The panel includes tests for

  • Beta-2-Glycoprotein I Antibodies (IgG, IgA, IgM)
  • Phosphatidylserine Antibodies (IgG, IgA, IgM)
  • Cardiolipin Antibodies (IgA, IgG, IgM)

What is the antiphospholipid antibody panel test for?

The Antiphospholipid Antibody Panel is a comprehensive test that measures nine biomarkers associated with antiphospholipid syndrome (APS). APS is an autoimmune disorder that can lead to recurrent miscarriages, thrombosis, and pregnancy complications. The panel includes tests for beta-2-glycoprotein I antibodies, phosphatidylserine antibodies, and cardiolipin antibodies. This comprehensive testing will provide your healthcare provider with important information about your risk for APS and allow them to tailor your treatment accordingly.

What do the results of an antiphospholipid antibody panel test mean?

A positive result on any of the panel tests suggests that you have antibodies associated with APS in your blood. This does not necessarily indicate that you have APS, but it raises your chances of having the disorder. Your healthcare professional will analyze your results and, if necessary, conduct more tests.

What follow-up is necessary after an antiphospholipid antibody panel test?

If you have a positive result on any of the tests in the panel, your healthcare provider will likely order additional testing to confirm the diagnosis of APS. Once APS has been diagnosed, it is important to see your healthcare provider regularly and follow their treatment recommendations. Treatment with blood thinners or other drugs may be required in some cases to avoid serious consequences. With careful management, most persons with APS can live healthy, regular lives.

Is APS the same as lupus?

No, APS is an autoimmune condition that can cause thrombosis, repeated miscarriages, and pregnancy difficulties. Chronic inflammatory disease called lupus can harm several organs. Although they are both autoimmune illnesses, the two conditions are not the same.

Is APS an autoimmune disease?

Yes, APS is an autoimmune condition. When the body's immune system targets healthy cells and tissues, autoimmune disorders result. In APS, the immune system assaults the ubiquitous phospholipids present in all cells. This can result in repeated miscarriages, thrombosis, and problems during pregnancy.

What are the symptoms of APS?

The most common symptom of APS is recurrent miscarriages. Other symptoms may include thrombosis, pregnancy complications, and stroke. Many people with APS do not have any symptoms.

What are the causes of APS?

The exact causes of APS remain unknown. However, it is believed to be a result of both genetic and environmental influences.

What are the risks of APS?

APS can lead to recurrent miscarriages, thrombosis, and pregnancy complications. If left untreated, APS can also lead to stroke or heart attack.

How is APS diagnosed?

APS is typically diagnosed with a blood test. The Antiphospholipid Antibody Panel is a comprehensive test that measures nine different biomarkers that are associated with APS. Your healthcare practitioner will assist you in interpreting your results and, if required, order more tests.

How is APS treated?

There is no cure for APS. However, it is treatable with medicine and lifestyle modifications. Medications may include blood thinners or other medications to prevent serious complications. Lifestyle changes may include avoiding smoking, maintaining a healthy weight, and managing stress. With proper management, most people with APS can lead healthy, normal lives.

What is the prognosis for APS?

The prognosis for APS is generally good. Most people with APS can lead healthy, normal lives with proper diagnosis and treatment. However, APS can lead to serious complications if it is not properly managed. Recurrent miscarriages, thrombosis, and pregnancy complications are the most common complications associated with APS. If left untreated, APS can also lead to stroke or heart attack.

What are the three antiphospholipid antibodies?

The three antiphospholipid antibodies are beta-2-glycoprotein I, phosphatidylserine, and cardiolipin. These antibodies are associated with APS and can lead to recurrent miscarriages, thrombosis, and pregnancy complications.



Description: The CRP test is used to identify and/or monitor inflammation in patients.

Also Known As: CRP Test, Inflammation test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a C-Reactive Protein test ordered?

When a person's medical history and signs and symptoms indicate that they may have a significant bacterial infection, a CRP test may be recommended. When a newborn displays signs of infection or when a person has sepsis symptoms including fever, chills, and rapid breathing and heart rate, it may be ordered.

It's also commonly requested on a regular basis to check illnesses like rheumatoid arthritis and lupus, and it's routinely repeated to see if medication is working. This is especially effective for inflammation issues because CRP levels decrease as inflammation decreases.

What does a C-Reactive Protein blood test check for?

C-reactive protein is a protein produced by the liver and released into the bloodstream within a few hours following tissue injury, infection, or other inflammatory event. After trauma or a heart attack, with active or uncontrolled autoimmune illnesses, and with acute bacterial infections like sepsis, markedly higher levels are reported. CRP levels can rise by a thousand-fold in response to inflammatory diseases, and their elevation in the blood can occur before pain, fever, or other clinical signs. The test detects inflammation caused by acute situations or monitors disease activity in chronic diseases by measuring the level of CRP in the blood.

The CRP test is not a diagnostic tool, although it can tell a doctor if inflammation is occurring. This information can be combined with other indicators like signs and symptoms, a physical exam, and other tests to establish whether someone has an acute inflammatory disorder or is having a flare-up of a chronic inflammatory disease. The health care provider may next do additional tests and treatment.

This CRP test should not be confused with the hs-CRP test. These are two separate CRP tests, each of which measures a different range of CRP levels in the blood for different purposes.

Lab tests often ordered with a C-Reactive Protein test:

  • Sed Rate (ESR)
  • Procalcitonin
  • ANA
  • Rheumatoid Factor
  • Complement

Conditions where a C-Reactive Protein test is recommended:

  • Arthritis
  • Autoimmune Disorders
  • Pelvic Inflammatory Disease
  • Inflammatory Bowel Disease
  • Sepsis
  • Vasculitis
  • Systemic Lupus Erythematosus
  • Meningitis and Encephalitis

Commonly Asked Questions:

How does my health care provider use a C-Reactive Protein test?

A health practitioner uses the C-reactive protein test to diagnose inflammation. CRP is an acute phase reactant, a protein produced by the liver and released into the bloodstream within a few hours following tissue injury, infection, or other inflammatory event. The CRP test is not a diagnostic test for any ailment, but it can be used in conjunction with other tests to determine whether a person has an acute or chronic inflammatory disorder.

CRP, for example, can be used to detect or track substantial inflammation in someone who is suspected of having an acute ailment like:

  • Sepsis is a dangerous bacterial infection.
  • An infection caused by a fungus
  • Inflammation of the pelvis

People with chronic inflammatory diseases can use the CRP test to detect flare-ups and/or see if their medication is working. Here are a few examples:

  • Inflammatory bowel disease
  • Arthritis, which can take many forms.
  • Autoimmune disorders, examples include lupus and vasculitis

CRP is occasionally requested in conjunction with an erythrocyte sedimentation rate, another inflammatory test. While the CRP test is not specific enough to diagnose an illness, it does serve as a broad marker for infection and inflammation, alerting doctors to the need for more testing and treatment. A variety of additional tests may be used to determine the source of inflammation, depending on the probable cause.

What do my C-Reactive Protein test results mean?

CRP levels in the blood are usually low.

CRP levels in the blood that are high or rising indicate the existence of inflammation, but they don't tell you where it is or what's causing it. A high CRP level can establish the presence of a severe bacterial infection in people who are suspected of having one. High levels of CRP in persons with chronic inflammatory disorders indicate a flare-up or that treatment isn't working.

When the CRP level rises and then falls, it indicates that the inflammation or infection is diminishing and/or responding to treatment.

Is there anything else I should know about C-Reactive Protein?

CRP levels can rise during pregnancy, as well as with the use of birth control tablets or hormone replacement therapy. Obese people have also been found to have higher CRP levels.

In the presence of inflammation, the erythrocyte sedimentation rate test will also rise; however, CRP rises first and then falls faster than the ESR.

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


Cardiolipin Antibodies (IgA, IgG, IgM)

  • Cardiolipin Antibody (IgA) 
  • Cardiolipin Antibody (IgG) 
  • Cardiolipin Antibody (IgM) 

Cardiolipin antibodies (CA) are seen in a subgroup of patients with autoimmune disorders, particularly systemic lupus erythematosus (SLE), who are at risk for vascular thrombosis, thrombocytopenia, cerebral infarct and/or recurrent spontaneous abortion. Elevations of CA associated with increased risk have also been seen in idiopathic thrombocytopenic purpura, rheumatoid and psoriatic arthritis, and primary Sjögren's syndrome.


Cardiolipin Antibodies (IgG, IgM)

  • Cardiolipin Antibody (IgG) 
  • Cardiolipin Antibody (IgM) 

Cardiolipin antibodies (CA) are seen in a subgroup of patients with autoimmune disorders, particularly systemic lupus erythematosus (SLE), who are at risk for vascular thrombosis, thrombocytopenia, cerebral infarct and/or recurrent spontaneous abortion. Elevations of CA associated with increased risk have also been seen in idiopathic thrombocytopenic purpura, rheumatoid and psoriatic arthritis, and primary Sjögren's syndrome.


Cardiolipin antibodies (CA) are seen in a subgroup of patients with autoimmune disorders, particularly Systemic Lupus Erythematosus (SLE), who are at risk for vascular thrombosis, thrombocytopenia, cerebral infarct and/or recurrent spontaneous abortion. Elevations of CA associated with increased risk have also been seen in idiopathic thrombocytopenic purpura, rheumatoid and psoriatic arthritis, and primary Sjögren's syndrome.

Cardiolipin antibodies (CA) are seen in a subgroup of patients with autoimmune disorders, particularly Systemic Lupus Erythematosus (SLE), who are at risk for vascular thrombosis, thrombocytopenia, cerebral infarct and/or recurrent spontaneous abortion. Elevations of CA associated with increased risk have also been seen in idiopathic thrombocytopenic purpura, rheumatoid and psoriatic arthritis, and primary Sjögren's syndrome.

Cardiolipin antibodies (CA) are seen in a subgroup of patients with autoimmune disorders, particularly Systemic Lupus Erythematosus (SLE), who are at risk for vascular thrombosis, thrombocytopenia, cerebral infarct and/or recurrent spontaneous abortion. Elevations of CA associated with increased risk have also been seen in idiopathic thrombocytopenic purpura, rheumatoid and psoriatic arthritis and primary Sjögren's syndrome.

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Description: A Ferritin test is a blood test that measures Ferritin levels in your blood’s serum to evaluate the level of iron stored in your body.

Also Known As: Ferritin Serum Test, Ferritin Test, Ferritin Blood Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Ferritin test ordered?

When a CBC test’s implies iron deficiency anemia due to small red blood cells or low hematocrit and hemoglobin levels, the ferritin test, and other iron tests, may be requested, even if other clinical symptoms have not yet arisen.

There are frequently no physical symptoms in the early stages of iron insufficiency. Symptoms rarely develop before hemoglobin falls below dangerous levels. However, when the iron deficit continues, symptoms emerge, prompting a doctor to order ferritin and other iron-related testing. The following are the most prevalent symptoms of iron deficiency anemia:

  • Chronic tiredness/fatigue
  • Weakness
  • Dizziness
  • Headaches
  • Skin that is pale

Shortness of breath, ringing in the ears, sleepiness, and irritability may occur as iron levels are reduced. Chest pain, headaches, limb pains, shock, and even heart failure may occur as the anemia worsens. Learning impairments can occur in children. There are some symptoms that are specific to iron deficiency, in addition to the usual signs of anemia. Pica, a burning feeling in the tongue or a smooth tongue, ulcers at the corners of the mouth, and spoon-shaped finger- and toe-nails are only a few of the symptoms.

When iron overload is suspected, a ferritin level may be requested. Iron overload symptoms differ from person to person and tend to worsen over time. They are caused by an excess of iron in the blood and tissues. Among the signs and symptoms are:

  • Joint discomfort
  • Weakness and exhaustion
  • Loss of weight
  • Energy deficiency
  • Pain in the abdomen
  • Suffering from a lack of sexual desire
  • Hair loss on the body
  • Congestive heart failure is an example of a cardiac issue

Other iron tests including a genetic test for hereditary hemochromatosis may be conducted to confirm the existence of iron excess.

What does a Ferritin blood test check for?

Ferritin is an iron-containing protein that stores iron in cells in its most basic form. The amount of total iron stored in the body is reflected in the little amount of ferritin released into the blood. This test determines how much ferritin is present in the blood.

About 70% of the iron consumed by the body is integrated into the hemoglobin of red blood cells in healthy humans. The remaining 30% is stored primarily as ferritin or hemosiderin, which is a combination of iron, proteins, and other elements. Hemosiderin and ferritin are typically found in the liver, although they can also be found in the bone marrow, spleen, and skeletal muscles.

Iron stores are depleted and ferritin levels fall when available iron is insufficient to meet the body's needs. This can happen owing to a lack of iron, poor absorption, or an increased need for iron, such as during pregnancy or if you have a condition that causes persistent blood loss. Before any indicators of iron shortage appear, significant loss of iron reserves may occur.

When the body absorbs more iron than it needs, iron storage and ferritin levels rise. Chronic iron absorption causes a gradual buildup of iron compounds in organs, which can eventually lead to organ malfunction and failure. Even on a typical diet, this happens in hemochromatosis, a hereditary disorder in which the body absorbs too much iron.

Lab tests often ordered with a Ferritin test:

  • Complete Blood Count
  • Iron Total
  • Iron Total and Total Iron binding capacity
  • Transferrin
  • Comprehensive Metabolic Panel
  • Lipid Panel
  • Zinc Protoporphyrin

Conditions where a Ferritin test is recommended:

  • Anemia
  • Hemochromatosis
  • Lead poisoning
  • Pregnancy
  • Restless Leg Syndrome

How does my health care provider use a Ferritin test?

The ferritin test is used to determine the amount of iron a person has in their body. To determine the existence and severity of iron shortage or iron overload, the test is sometimes ordered in conjunction with an iron test and a TIBC test.

One source of iron overload can be the use of iron supplements.

What does my ferritin lab test result mean?

Ferritin levels are frequently measured alongside other iron tests.

Ferritin levels are low in iron deficient people and high in people who have hemochromatosis or have had several blood transfusions.

Ferritin is an acute phase reactant that can be elevated in persons who have inflammation, liver illness, chronic infection, autoimmune disorders, or cancer. Ferritin isn't commonly utilized to detect or monitor these problems.

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


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 PT with INR and PTT test is used to diagnose and monitor bleeding disorders or excessive clotting disorders. The biomarkers in the test are used to measure the time it takes for the blood to form a clot.

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, Activated Partial Thromboplastin Time Test, aPTT test, PTT Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Prothrombin with INR and Partial Thromboplastin Time 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 a vein or artery
  • Disseminated intravascular coagulation
  • A persistent disorder that affects hemostasis, such as severe liver disease

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 Prothrombin with INR and Partial Thromboplastin Time blood test check for?

The prothrombin time with INR and partial thromboplastin 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. The PTT evaluates the number and function of specific proteins known as coagulation factors, which are crucial in blood clot formation.

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. The normal ranges will fluctuate because the reagents used to perform the PT test differ from one laboratory to the next and even within the same laboratory over time. For people taking the anticoagulant warfarin, a World Health Organization committee developed and recommended the use of the Internationalized Normalized Ratio, which is calculated based on the PT test result, to standardize results across different laboratories in the United States and around the world.

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 with INR and Partial Thromboplastin Time test:

  • Fibrinogen Activity
  • Platelet Count
  • Complete Blood Count (CBC)
  • D-Dimer
  • Lupus Anticoagulant
  • ACT
  • Von Willebrand Factor
  • Antiphospholipid Antibodies
  • Warfarin Sensitivity Testing

Conditions where a Prothrombin with INR and Partial Thromboplastin Time test is recommended:

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

How does my health care provider use a Prothrombin with INR and Partial Thromboplastin Time 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.

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 PT with INR and PTT 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.

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: 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 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

The Protein S Functional (also known as Protein S, Activity) test assesses protein activity to determine its ability to regulate blood clotting and screen for an excessive clotting disease. 

This Protein S Functional test measures protein S activity to evaluate if they regulate blood clotting appropriately and to screen for a potential blood clotting issue.

This Protein S Functional test can be ordered to assess protein S activity to see whether blood clotting is being adequately regulated and to check for potential blood clotting disorders. Blood clot formation is controlled by the interaction of proteins S and C. Hemostasis, also referred to as bleeding, takes place when a blood vessel is damaged. In order to restrict blood loss until the blood artery has healed, platelets, which are blood cells, team up with proteins S and C (coagulation factors) to create a clot at the wound. For a stable clot to form, there must be enough platelet count, and coagulation factors and each must be in good working order. 

A deficiency or malfunction of these proteins may result in excessive blood clotting or a condition known as deep vein thrombosis (DVT). Deep vein thrombosis may begin in the arms or legs and move to the lungs, causing a potentially fatal pulmonary embolism (PE). 

An underlying health problem such as: 

  • Pregnancy 
  • Hepatic disease 
  • Renal disease 
  • Virulent diseases (HIV/AIDS). 
  • Cancer 
  • Use of Warfarin (Coumadin®) 
  • In certain cases, it may be a genetic disorder. 

Protein S exists in two states, free and bound, but only the free form binds to protein C. Consequently, protein S deficits can be classified into three groups: 

  • Deficiency owing to insufficient quantity 
  • Deficiency owing to improper function 
  • Deficiency due to lower quantities of free protein S, but normal levels of total protein S 

Individuals who have suffered excessive blood clots in unexpected areas or blood clots for unexplained reasons should consider ordering this test. This test can also assist in determining if the lower protein S activity is the result of a deficiency or a rare malfunction.

What does elevated Protein S activity indicate? 
In most cases, elevated Protein S levels are clinically insignificant and not connected with medical issues. Activity and concentrations of protein C and Protein S antigens indicate normal clotting control. A low level of Protein S activity might result in abnormal or excessive blood coagulation. 

What causes low Protein S activity?
Acquired Protein S deficiency is caused by a condition such as liver illness, nephrotic syndrome, some infections, oral contraceptives, vitamin K deficiency, surgery, or chemotherapy. 

What is the severity of Protein S deficiency? 
Individuals with modest Protein S deficiency are susceptible to developing deep vein thrombosis (DVT) in the deep veins of the arms or legs. A pulmonary embolism, a potentially fatal blood clot, can result from a DVT that enters the bloodstream and lodges in the lungs (PE) 

What is the functional test for protein S? 
Protein S aids in blood coagulation regulation. A deficiency of this Protein or an issue with its function may lead to the formation of blood clots in veins. This test is also used to screen the relatives of individuals with known Protein S deficiency. This test is sometimes used to determine the cause of repeated miscarriages. 

What should your levels of Protein S be? 
Typically, these percentage values should range between 60 and 150. There may be minor variations between testing centers. Low amounts of protein S may raise the risk of blood clots, although high levels do normally not cause for worry. 

Can a lack of Protein S induce a stroke? 
In young populations, Protein S deficiency is an uncommon cause of recurrent ischemic stroke. 

How can Protein S insufficiency be treated? 
If you have Protein S deficiency but have never had a blood clot, you will likely not need therapy unless certain conditions apply. Heparin, warfarin, rivaroxaban, apixaban, and dabigatran are anticoagulants that are commonly prescribed. 

How does a protein deficiency manifest itself? 
Protein insufficiency manifests as fatigue, weakness, hair loss, brittle nails, and dry skin. Protein deficit is particularly prevalent among vegans, vegetarians, individuals over the age of 70, and those with digestive disorders such as celiac disease and Crohn's disease. 

Aspirin and protein S deficiency: can it help? 
Many specialists recommend that women with Protein S deficiency, a history of fetal death, and severe or recurrent eclampsia get prophylactic-dose low molecular weight heparin (LMWH) medication during pregnancy, with the LMWH prophylaxis continuing for 6 weeks postpartum.


Aids in diagnosis of decreased activity of Protein C characterized by recurrent venous thrombosis. Acquired deficiencies associated with Protein C include: oral anticoagulant therapy, liver disease, vitamin K deficiency, malignancy, consumptive DIC, surgery, trauma, antibodies to Protein C and hepatic immaturity of the newborn.

Comprehensive test assesses the total level of protein and its functional activity in determining Protein C deficiency, which is strongly prothrombotic, and may require long-term anticoagulation therapy. In the presence of low Protein C Activity, Protein C Antigen helps to confirm and to classify Protein C Deficiency as Type I or Type II. Protein C is a highly thrombophilic protein.

In the presence of low Protein C Activity, Protein C Antigen is useful in classifying the deficiency as Type I or II.

Aids in diagnosis of congenital deficiencies characterized by recurrent venous thrombosis. Acquired deficiencies associated with Protein C include: oral anticoagulant therapy, liver disease, vitamin K deficiency, malignancy, consumptive DIC, surgery, trauma, antibodies to Protein C and hepatic immaturity of the newborn.

Factor V (Leiden) Mutation is a point mutation that causes resistance of Factor V protein degradation by activated protein C (APC). This mutation is associated with increased risk of venous thrombosis.

Preferred test in patients with Lupus anticoagulant, on heparin or direct thrombin inhibitors, or on Factor VIII concentrates.

This test is useful to evaluate a prolonged aPTT. The most common form of hemophilia is caused by a deficiency of Factor VIII. Hemophilia A is an X-linked disorder affecting between 1 in 5000 to 10000 males.

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.


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Description: Homocysteine is an amino acid that is present in every cell. There is a small amount present as it is an amino acid that changes quickly into other needed products in the body.

Also Known As: Homocysteine Cardiac Risk Test, Homocysteine Blood Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Fasting for at least 8 hours is preferred

When is a Homocysteine test ordered?

When a doctor feels a person may be deficient in vitamin B12 or folate, he or she may request this test. At first, the signs and symptoms are vague and ambiguous. People who have an early deficit may be diagnosed before they show any visible symptoms. Other persons who are impacted may experience a range of moderate to severe symptoms, including:

  • Diarrhea
  • Dizziness
  • Weakness and exhaustion
  • Appetite loss
  • Paleness
  • Heart rate that is quite fast
  • Breathing problems
  • Tongue and mouth ache
  • In the feet, hands, arms, and legs, there is tingling, numbness, and/or burning

Depending on an individual's age and other risk factors, homocysteine may be requested as part of determining a person's risk of developing cardiovascular disease. It may also be ordered after a heart attack or stroke to aid in treatment planning.

When newborn screening identifies an increased level of methionine or if an infant or kid shows signs and symptoms of homocystinuria, this test may be ordered. Babies with this illness will appear normal at birth, but if left untreated, they will develop symptoms such as a displaced lens in the eye, a long slender build, long thin fingers, and skeletal abnormalities within a few years.

What does a Homocysteine blood test check for?

Homocysteine is an amino acid that is found in trace amounts in all of the body's cells. The body generally converts homocysteine to other compounds fast. Because vitamins B6, B12, and folate are required for homocysteine metabolism, elevated levels of the amino acid could indicate a vitamin deficit. The level of homocysteine in the blood is determined by this test.

Increased homocysteine levels have also been linked to an increased risk of coronary heart disease, stroke, peripheral vascular disease, and artery hardening. Homocysteine has been linked to cardiovascular disease risk through a variety of processes, including damage to blood vessel walls and support for the production of abnormal blood clots, but no direct linkages have been established. Several studies have also found no benefit or reduction in CVD risk with folic acid and B vitamin supplementation. The American Heart Association does not believe it to be a significant risk factor for heart disease at this time.

Homocysteine levels in the blood can also be dramatically increased by a rare genetic disorder known as homocystinuria. In homocystinuria, one of multiple genes is mutated, resulting in a defective enzyme that prevents the normal breakdown of methionine, the precursor of homocysteine. Methionine is one of the eleven necessary amino acids that the body cannot make and must therefore be obtained from food.

Homocysteine and methionine build up in the body without the necessary enzyme to break them down. Babies born with this condition appear normal at birth, but develop symptoms such as a long slender build, a dislocated lens in the eye, long thin fingers, osteoporosis, skeletal abnormalities, and a significantly increased risk of thromboembolism and atherosclerosis, which can lead to premature CVD within a few years.

In addition to intellectual disability, mental illness, a little low IQ, behavioral issues, and seizures, artery blockages can induce intellectual disability, mental illness, and seizures. Some of them can be avoided if homocystinuria is diagnosed early, which is why all states screen neonates for the disease.

Lab tests often ordered with a Homocysteine test:

  • Vitamin B12
  • Folate
  • MTHFR Mutation
  • Intrinsic Factor Antibody

Conditions where a Homocysteine test is recommended:

  • Vitamin B12 and Folate Deficiency
  • Heart Attack
  • Heart Disease
  • Stroke

How does my health care provider use a Homocysteine test?

The homocysteine test can be used in a variety of ways, including:

A homocysteine test may be ordered by a doctor to see if a person is deficient in vitamin B12 or folate. Before B12 and folate tests are abnormal, the homocysteine level may be raised. Homocysteine testing may be recommended by some health professionals in malnourished people, the elderly, who absorb less vitamin B12 from their diet, and people who have poor nutrition, such as drug or alcohol addicts.

For those at high risk of a stroke or heart attack, homocysteine testing may be requested as part of a health screening. It could be beneficial for someone who has a family history of coronary artery disease but no other recognized risk factors like smoking, high blood pressure, or obesity. However, because the specific role of homocysteine in the course of cardiovascular disease is unknown, the screening test's efficacy continues to be questioned.

If a health professional believes that an infant or kid has homocystinuria, tests for both urine and blood homocysteine can be utilized to assist diagnose the genetic condition. As part of their newborn screening in the United States, all babies are regularly tested for excess methionine, a symptom of homocystinuria. If a baby's test results are positive, urine and blood homocysteine tests are frequently used to confirm the results.

What do my homocysteine test results mean?

Homocysteine levels may be high in cases of suspected malnutrition, vitamin B12, or folate insufficiency. If a person does not consume enough B vitamins and/or folate through diet or supplements, the body may be unable to convert homocysteine into forms that the body can use. The level of homocysteine in the blood may rise in this scenario.

According to studies conducted in the mid- to late-1990s, those with high homocysteine levels have a substantially higher risk of heart attack or stroke than those with normal levels. The study of the relationship between excessive homocysteine levels and heart disease is still ongoing. However, considering that multiple trials studying folic acid and B vitamin supplementation have found no benefit or reduction in CVD risk, the use of homocysteine levels for risk assessment of cardiovascular disease, peripheral vascular disease, and stroke is now questionable.

A 2012 research study using various datasets, including 50,000 persons with coronary heart disease, called into question the possibility of a cause-and-effect relationship between homocysteine levels and heart disease. Although the American Heart Association recognizes a link between homocysteine levels and heart attack/stroke survival rates, it does not consider high homocysteine to be a major CVD risk factor.

While the AHA does not advocate for widespread use of folic acid and B vitamins to reduce the risk of heart attack and stroke, it does advocate for a balanced, nutritious diet and advises doctors to consider total risk factors as well as nutrition when treating cardiovascular disease.

Significantly elevated homocysteine concentrations in the urine and blood indicate that an infant is likely to have homocystinuria and need additional testing to confirm the reason of the increase.

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


Lupus anticoagulants (LA) are members of a family of antibodies with phospholipid specificity. LA may be defined as an immunoglobulin, IgG or IgM or a mixture of both, that interferes with one or more of the in vitro phospholipid (PL) dependent tests of coagulation. These antibodies are not associated with a hemorrhagic diathesis, but rather have been linked to thrombotic events. In addition to thrombosis other clinical complications have been associated with the presence of LA. These include strokes, nonbacterial thrombotic endocarditis, livedo reticularis and a variety of obstetrical complications such as intrauterine fetal death, recurrent spontaneous abortion, fetal growth retardation, early onset preeclampsia and chorea gravidarum.

Description: The MTHFR gene is responsible for making Methylenetetrahydrofolate reductase, which is an enzyme that plays an important role in processing amino acids. This test will be used to determine if there is a DNA gene mutation with the MTHFR gene.

Also Known As: MTHFR Factor Test, MTHFR Mutation Test, MTHFR Gene Mutation Test, Methylenetetrahydrofolate Reductase Gene Test, MTHFR Disease Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Methylenetetrahydrofolate Reductase DNA Mutation Analysis test ordered?

When a person has excessive homocysteine levels, the MTHFR mutation test may be conducted, especially if the person has a personal or family history of early cardiovascular disease or thrombosis. When a close family has MTHFR gene mutations, it may be ordered, but it isn't always effective if that family member has normal homocysteine levels, and some labs and organizations advise against using it for thrombophilia screening.

What does a Methylenetetrahydrofolate Reductase DNA Mutation Analysis blood test check for?

The DNA code for the MTHFR enzyme is found in the methylenetetrahydrofolate reductase gene. Two of the most common mutations are detected by this test.

Homocystinuria, anencephaly, spina bifida, and other significant genetic illnesses can result from mutations or polymorphisms in the MTHFR gene. The MTHFR enzyme is required for the conversion of one type of B vitamin, folate, into another. It's also involved in the conversion of homocysteine to methionine, a crucial component of many proteins.

Homocysteine levels over normal indicate that the body is not digesting it adequately. A homocystinuria-causing mutation in the MTHFR gene could be one explanation. While there are at least seven different MTHFR mutations seen in persons with homocystinuria, only two DNA sequence variants known as single nucleotide polymorphisms are analyzed. Individuals can inherit one or both of the MTHFR variations, which are C677T and A1298C. These SNPs cause DNA changes that are linked to elevated homocysteine levels in the blood, which may raise the risk of early cardiovascular disease, abnormal blood clot formation, and stroke.

About 5-14 percent of the population in the United States is homozygous for C677T, which means they have two copies of the gene. The frequency varies with ethnicity, with individuals of Mediterranean descent having the highest frequency and those of African ancestry having the lowest.

The C677T variation causes the MTHFR enzyme to be less active and has a lower ability to handle folate and homocysteine. Reduced MTHFR enzyme activity slows down the homocysteine-to-methionine conversion process and can lead to a buildup of homocysteine in the blood when a person has two copies of the MTHFR C677T gene mutation or one copy of MTHFR C677T and one copy of A1298C.

The increase in homocysteine is usually mild to moderate, but the level of MTHFR enzyme activity varies from person to person. Even if a person has two copies of the MTHFR gene, proper folate consumption can "balance out" the effect of the MTHFR mutation, preventing elevated homocysteine levels.

According to some research, excessive levels of homocysteine in the blood may increase the risk of CVD by weakening blood vessel walls and encouraging plaque development and abnormal blood clotting. However, no direct link has been discovered between homocysteine levels and cardiovascular disease or thrombotic risk. See the Homocysteine article for further information.

Lab tests often ordered with a Methylenetetrahydrofolate Reductase DNA Mutation Analysis test:

  • Homocysteine
  • Vitamin B12
  • Folate
  • Lipoprotein Fractionation Ion Mobility
  • Apolipoprotein Evaluation
  • Lipid Panel
  • Factor V Leiden Mutation

Conditions where a Methylenetetrahydrofolate Reductase DNA Mutation Analysis test is recommended:

  • Heart disease
  • Cardiovascular Disease
  • Excessive Clotting Disorders
  • Stroke
  • Neural Tube Defects

How does my health care provider use a Methylenetetrahydrofolate Reductase DNA Mutation Analysis test?

The methylenetetrahydrofolate reductase mutation test is used to discover two mutations in the MTHFR gene that are linked to high homocysteine levels in the blood. It is not a common request.

If a person has a personal or family history of early cardiovascular disease or improper blood clots, this test may be done as a follow-up to a high homocysteine test. It may also be ordered in conjunction with other cardiac risk tests. However, its value in measuring CVD risk has yet to be proven, and some expert guidelines advise against using it for thrombosis screening.

If a person has a close family with known MTHFR genetic mutations, it may be ordered, especially if that person also has high homocysteine levels. The MTHFR C677T and A1298C gene variants are the most common and often tested. If someone in their family has a different mutation, that mutation should be checked.

An MTHFR test may be ordered in conjunction with other hereditary clotting risk tests, such as Factor V Leiden or prothrombin 20210 mutation tests, to assess a person's overall risk of developing dangerous blood clots.

Although the MTHFR mutation test can help establish the reason of high homocysteine levels, the utility of monitoring homocysteine levels is unclear. While some research suggests that high homocysteine levels increase the risk of cardiovascular disease and/or thrombosis, no direct correlation has been demonstrated. The American Heart Association does not suggest routine homocysteine testing as a cardiac risk measure. The American College of Medical Genetics and the College of American Pathologists both advise against testing for the C677T variation, citing its limited value in individuals with blood clots. Furthermore, the use of homocysteine levels to determine the risk of CVD, peripheral vascular disease, and stroke is controversial at this time, as multiple studies have found no benefit or reduction in risk in persons who took folic acid and vitamin B supplements to lower their homocysteine levels.

What do my MTHFR test results mean?

The results are usually reported as negative or positive, with the positive results naming the mutation. Frequently, the results are accompanied by an interpretation.

Only a small fraction of cases of high homocysteine are caused by genetic factors. MTHFR mutations C677T and A1298C are among the most frequent.

If a person has two copies of MTHFR C677T, or one copy of C677T and one copy of A1298C, it's likely that these hereditary mutations are causing or contributing to increased homocysteine levels.

Increased homocysteine levels are not usually linked to two copies of A1298C.

If the MTHFR mutation test results are negative, the C677T and A1298C mutations were not found, and the elevated homocysteine level is most likely attributable to something else. Other, more uncommon MTHFR genetic variants will be missed by standard testing.

MTHFR mutations, as well as other clotting risk factors like Factor V Leiden or PT 20210 mutations, may increase the risk of thrombosis.

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



At least 100,000 people in the United States die from blood clots yearly, and medical treatments for them exceed $10 billion every year. 

Blood clots can happen to anybody and are often the result of excessive blood clotting disorders. Early diagnosis is critical, and that's why blood clotting tests are so important.

Millions of people struggle with blood clotting disorders, and the best thing you can do is take action. Keep reading this guide to learn everything you need to know about blood clotting disorders and blood clotting tests.

What Are Excessive Blood Clotting Disorders

Often, we don't think about the process that happens when we wound or cut ourselves. The human body is an amazing machine, and it forms blood clots to stop the bleeding. Once the bleeding stops, the body should naturally break down and remove the clots.

But when you have excessive blood clotting disorders, this process is interrupted. This excessive blood clotting can be very dangerous, causing clots to form and travel to major arteries and organs. When your blood clots too much, it's referred to as a hypercoagulable state. 

Hypercoagulable states can be severe, especially when they aren't immediately identified and treated. If you're in a hypercoagulable state, you're at an increased risk of forming clots in your major arteries and blood vessels called an embolus or thrombus.

Blood clots in the veins (venous system) travel through the bloodstream and cause deep vein thrombosis in the leg, arm, liver, lungs, or intestines. 

Risk factors for Excessive Blood Clotting Disorders

Certain risk factors can lead to excessive blood clotting. Genetic risk factors include having family members with blood clots or if you have a history of unexplained miscarriages or blood clots before the age of 40.

Acquired risk factors include dehydration, smoking, overweight or obesity, pregnancy, and birth control pills or hormone replacement therapy.

Causes of Excessive Blood Clotting Disorders

What causes excessive clotting disorders and hypercoagulable states? Usually, hypercoagulable states are either genetic or an acquired condition that results from trauma, surgery, or certain medical conditions. 

Genetic or inherited hypercoagulable conditions include:

  • Factor V Leiden, which is the most common
  • Being deficient in natural clotting proteins like antithrombin and protein C
  • Prothrombin gene mutation
  • High levels of homocysteine
  • Elevated levels of factor VIII, factor IX, and  factor XI

You can also have a hypercoagulable state if you have abnormalities in your fibrinolytic system. Your fibrinolytic system functions by removing and breaking down clots after the initial injury heals. If this system doesn't function properly, then problems start to occur. Acquired conditions that cause hypercoagulable states include:

  • Cancers, especially leukemia
  • Certain medications used to treat cancer
  • Recent surgery or trauma
  • Hormone replacement therapy
  • Obesity
  • Pregnancy
  • Recent airplane travel
  • Heart failure or a heart attack
  • Stroke
  • Prolonged bed rest
  • Liver disease
  • Vitamin K deficiency

The liver plays a huge role in the clotting process, and acute or chronic liver disease as clotting factor VIII is usually increased.

Symptoms of Excessive Blood Clotting Disorders

Symptoms of excessive blood clotting disorders depend on the type you have and what the causes are from. But typical symptoms commonly include:

  • Bleeding
  • Bruising easily
  • Leg pain, swelling, and tenderness if clots present
  • Shortness of breath
  • Chest pain
  • Feeling lightheaded and faint
  • Anxiety
  • Coughing up blood

If you have a blood clotting disorder from liver disease, you'll experience symptoms like jaundice, abdominal pain, swelling, feeling unwell, and nausea.

Diagnosis of Excessive Blood Clotting Disorders

Your doctor will first take your personal and family medical history if it's suspected you have a clotting disorder. Your doctor will ask you if you have a family history of abnormal blood clotting or a history of blood clots before the age of 50.

After discussing signs and symptoms, your doctor will likely send you laboratory testing to further evaluate your blood for potential clotting problems. 

Common lab tests include a PT-INR, aPTT, fibrinogen level, and a complete blood count. Genetic tests such as factor V Leiden will be done if you have a strong family history of blood clotting disorders.

Lab Tests for Excessive Blood Clotting Disorders

Clotting disorder lab tests are key to confirming a diagnosis. Depending on your symptoms and medical history, there are different blood tests for blood clotting disorders and blood coagulation.

First, a prothrombin time (PT) with INR is one of the first coagulation blood tests to check. The PT with INR screens for any abnormalities in your coagulation factors. This test is also used to study people with both hereditary and genetic disorders.

The partial thromboplastin time (aPTT) tests for deficiencies in coagulation factors except for factors VII and XIII.

Fibrinogen Activity Clauss test measures your level of fibrinogen. Fibrinogen is necessary to form blood clots, and deficiencies in this can lead to severe bleeding disorders.

The D-Dimer quantitative is useful for measuring the activation of the fibrinolytic system and is useful in detecting blood clots in the venous system.

factor V (Leiden) mutation analysis test checks for mutations of the factor V protein that leads to blood clotting disorders and deep venous thrombosis.

complete blood count (CBC) measures your platelets and blood components and can detect problems with your platelet levels.

Other blood tests for clotting disorders include:

FAQS About Excessive Blood Clotting Disorders

Are you wondering what deep vein thrombosis (DVT) is? A DVT is a blood clot that forms in your leg veins, usually in the calf.

What is a pulmonary embolism (PE)? A PE is caused by a blood clot that originates in your leg or groin, breaks free, and travels to the lungs' arteries.

Do men or women have more of a risk of developing blood clots? The risk between men and women is just about equal.

What can you do during travel to prevent blood clots? Be sure to stop every hour or so and stand up and stretch. Even if you're traveling in an airplane, flex your toes and move your feet and ankles regularly to keep the blood flowing.

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What is Deep Vein Thrombosis (DVT)? It happens when a blood clot forms in a vein. DVTs mostly occur in a deep vein in the thigh or calf. Additionally, they can occur in deep veins in other parts of the body like arms, abdomen, or pelvis. These clots slow or block blood from returning to the lungs and heart by restricting the flow of blood.  

Clots occur easily in some people than others. Excessive blood clotting disorders can lead to the occurrence of DVTs. Pre-existing conditions, lifestyle choices, or medications increase the risk of blood clots. It is rare to have a predisposition because of inherited genes.  

Deep Vein Thrombosis keeps growing if left untreated. If DVT continues to grow, it obstructs the vein and cause pain, discoloration, swelling, inflammation, and may lead to permanent damage.  An increased risk for another DVT and long-term complications, known as postthrombotic syndrome (PTS), can occur after treatment. After a DVT, PTS can lead to chronic symptoms, such as long-term swelling, aching, pain, tiredness, heaviness, darkened skin, cramping, non-specific discomfort, or bluish tinge in the affected areas like arm or leg.  

However, the clot in its original location is not the greatest danger with DVT. The greatest danger is the risk of thromboembolism, which happens when a blood vessel is obstructed in a different part of the body. Pulmonary embolism (PE) occurs when part of a blood clot blocks blood flow to the lungs by breaking off and traveling to the lungs. PE is a medical emergency because it threatens life.  

Both PE and Deep Vein Thrombosis do not form in arteries, but they form in the body’s veins. So, they are grouped into venous thromboembolism (VTE). According to the Centers for Disease Control and Prevention (CDC), VTE affects around 900,00 people in the United States. Also, VTE kills 60,000 to 100,000 of the people affected, but most people die from PE. The first symptom of around 25% of people with PE is sudden death.  

DVT causes long term complications in around 30-50% of those with DVT. DVT and/or PE will occur within ten years in about 30% of people.  

Risk Factors 

Some conditions and factors increase the risk of DVT. For people with one or more conditions or factors, this increases their risk. And the resulting risk is cumulative. For instance, having an inherited risk increases the risk if the person uses oral contraceptives or smokes.  

You are not born with the most common risk factors. You acquire them later in life. Making changes can help lower the risk of blood clots in some of these factors.  

Here are some of the acquired risk factors:

  • Age – as you get older, the risk of clots increases.  
  • Chronic conditions like lung disease, kidney diseases such as nephrotic syndrome, heart disease such as congestive heart failure, and recent or recurrent cancer.  
  • Placing catheter in a central vein – a tube, which is placed into the main vein of the body, is used to administer fluids and medications. It is usually used when DVTs occur in the upper body.  
  • Hormone estrogen increasing – Hormone estrogen increases during pregnancy and after three months of delivery, and it increases from medications such as hormone replacement therapy or estrogen-based birth control. 
  • Your history of DVT – Having a blood clot increases the risk of having another one.  
  • Immobility – sitting or staying in bed for a long period slows blood flow. Why? The calf muscles do not help in blood circulation because they do not contract. Venous stasis, which is also known as “coach-class syndrome,” happens when something slows blood flow for several hours. This usually happens when someone is put on prolonged bed rest or during a long plane ride.  
  • Surgery – orthopedic surgeries like knee or hip surgeries and surgery that involves the pelvis or abdomen may lead to an activation of tissue factors. Activation of tissue factors increases the risk of immobility during surgery and the risk of clotting.  
  • Staying in hospital – 50% of blood clots happen after surgery or after a hospital stay and when the person is staying in the hospital.  
  • Antiphospholipid syndrome (APS) – this is an excessive clotting disorder 
  • Inflammatory bowel disease 
  • Injury to the vein – blood clots are formed by an injury to the walls of veins. Muscle injuries, fractures, or other trauma can cause injury to the vein.  
  • Smoking  
  • Obesity 
  • It is rare for inherited genetic variations to increase the risk of inappropriate clotting. The following are the common inherited risk factors. 
  • Deficiency in protein S, protein C, or antithrombin  
  • Factor II mutation – prothrombin 20210 mutation 
  • Activated protein C resistance – Factor V Leiden mutation  

Signs and Symptoms  

More than half of people with DVT do not have noticeable signs and symptoms. Although some of these people have a few noticeable signs and symptoms, however, symptoms can develop suddenly or gradually if you do not have them.

Here are the signs and symptoms:

  • You will see swelling due to the buildup of fluid in the affected leg. 
  • You will feel pain or tenderness in the affected leg. If clots develop rapidly, it can cause more pain.  
  • You will see redness or warmth of the skin in the leg.  
  • The clot may break and travel to the lungs, causing a pulmonary embolism (PE). The signs and symptoms of pulmonary embolism can develop quickly. The following are the signs and symptoms of PE.  
  • Your chest pains worsen when you take a deep breath or cough  
  • You cough up blood  
  • You have difficulty breathing  
  • You experience fast or irregular heartbeat  
  • You may faint or have very low blood pressure  

Laboratory Tests 

Evaluation is done to estimate the probability of the person having DVT before doing a test. When doing an evaluation, there are so many factors, such as signs and symptoms and the person’s medical history, that are taken into consideration.  

Once the valuation is complete, a D-dimer test is first done if the person’s pre-test probability is low to medium. If the result of the D-dimer test is negative, it rules out a DVT. A DVT or any other conditioner causes a positive result. For diagnosis, this requires one or more imaging tests. 

D-dimer test is not done if the person’s pre-test probability is high for a DVT. In this case, one or more imaging tests are done.  

These are the steps from the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), and the American Society of Hematology (ASH).  

An initial evaluation can be done with some general laboratory tests. Here are some of the general laboratory tests that can be done with an initial evaluation.  

Complete blood count – the test is for evaluating blood components like cell fragments and platelets that help in blood clotting   

partial thromboplastin time (PTT) and prothrombin time (PT) – these tests are for evaluating the amount and function of the blood clotting factors.  

A person diagnosed with a DVT and does not have classic risk factors, or a person is under 50 years and has DVT, or the person in an unusual location needs more tests. Additional tests are used for determining the underlying cause. Also, these additional tests are for determining the risk of having recurrent DVTs.  

There following are the tests that are done when a person is being treated for a DVT:

Antiphospholipid antibodies like lupus anticoagulant – for diagnosing antiphospholipid syndrome (APS) 

Prothrombin 20210 mutation (factor II) and factor V Leiden – for detecting inherited risk factors. It is done if the person has a recurrent blood clot. It is not done during the first DVT.  

Treatment for a DVT and the existing blood clots can affect some tests. So, the only way to do these tests is by treating and resolving the clot. Therefore, healthcare practitioners determine the cause of a person’s DVT by ordering the following test several weeks or months later. The tests are used for detecting deficiency in blood clotting factors.  

Antithrombin  

Protein S and protein C  

Here are the tests for monitoring treatment:

PT/INR – the test is for monitoring warfarin therapy  

PTT – the test is monitoring standard heparin therapy  

Heparin anti-Xa – the test is for monitoring both standard low molecular weight heparin (LMHW) therapy and heparin therapy   

Warfarin sensitivity testing – the test is done when warfarin therapy is prescribed, and the test is for determining sensitivity and resistance to warfarin. And it helps healthcare practitioners in selecting appropriate doses.