Blood Coagulation

Blood Coagulation Lab Tests and health information

The blood coagulation tests measure your coagulation profile, including INR, APTT, platelets, and fibrinogen. It is a screening test for abnormal blood clotting that examines the factors most often associated with a bleeding problem. Order from Ulta Lab Tests today with confidential results available online in 24 to 48 hours.

Did you know that as many as 900,000 people suffer blood clots each year? Learn why blood coagulation tests are so important for overall health.   

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


Name Matches
PT-Screening test for deficiencies of plasma coagulation factors other than Factors VII and XIII. The test is also used to monitor patients on heparin therapy. PTT-Screening test for abnormalities of coagulation factors that are involved in the extrinsic pathway. Also used to monitor effects of Warfarin therapy and to study patients with hereditary and acquired clotting disorders.

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.


Screening test for deficiencies of plasma coagulation factors other than Factors VII and XIII. The test is also used to monitor patients on heparin therapy.

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 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.


Platelets must be present in adequate numbers and have proper function to aid in hemostasis.

Note: Before ordering this test consider The Complete Blood Count (CBC) with Differential and Platelets Blood Test (Test # 6399) which is a better value.

In Quest's internal studies of more than two thousand patient samples, no significant abnormalities were detected with manual differentials associated with test code 20253 that were not otherwise identified thru the test code 6399 CBC.

Description: A CBC or Complete Blood Count with Differential and Platelets with Smear Review 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, Smear Review Test

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

When is a Complete Blood Count with Smear Review 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. 

When a CBC  indicates the presence of aberrant or immature cells, a blood smear is typically recommended. It may also be done if a person exhibits signs and symptoms that point to a problem with blood cell production or longevity.

What does a Complete Blood Count with Smear Review 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 ofern ordered with a Complete Blood Count with Smear Review 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 with Smear Review 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 with Smear Review 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. 

What do my Smear test results mean?

Blood smear results aren't always diagnostic in and of themselves; they usually indicate the presence of an underlying illness, its severity, and the necessity for additional diagnostic testing. The results are compared to the results of the CBC and other laboratory tests, as well as the clinical signs and symptoms of the person being tested.

The appearance of red blood cells, white blood cells, and platelets, as well as any abnormalities visible on the slide, are usually described in the results of a blood smear.

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

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

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

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

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

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

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

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

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

 


Description: An antinuclear antibody screening is a blood test that is going to look for a positive or negative result. If the result comes back as positive further test will be done to look for ANA Titer and Pattern. Antinuclear antibodies are associated with Lupus.

Also Known As: ANA Test, ANA Screen IFA with Reflex to Titer and pattern IFA Test, ANA with Reflex Test, Antinuclear Antibody Screen Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

IMPORTANT Reflex Information: If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge of $13.00

When is an ANA Screen test ordered?

When someone exhibits signs and symptoms of a systemic autoimmune illness, the ANA test is requested. Symptoms of autoimmune illnesses can be vague and non-specific, and they can fluctuate over time, steadily deteriorate, or oscillate between periods of flare-ups and remissions.

What does an ANA Screen blood test check for?

Antinuclear antibodies are a type of antibody produced by the immune system when it is unable to differentiate between its own cells and foreign cells. Autoantibodies are antibodies that attack the body's own healthy cells, causing symptoms like tissue and organ inflammation, joint and muscle discomfort, and weariness. The moniker "antinuclear" comes from the fact that ANA specifically targets chemicals located in a cell's nucleus. The presence of these autoantibodies in the blood is detected by the ANA test.

The presence of ANA may be a sign of an autoimmune process, and it has been linked to a variety of autoimmune illnesses, the most common of which being systemic lupus erythematosus.

One of the most common tests used to detect an autoimmune disorder or rule out other conditions with comparable signs and symptoms is the ANA test. As a result, it's frequently followed by other autoantibody tests that can help establish a diagnosis. An ENA panel, anti-dsDNA, anti-centromere, and/or anti-histone test are examples of these.

Lab tests often ordered with an ANA Screen test:

  • ENA Panel
  • Sed Rate (ESR)
  • C-Reactive Protein
  • Complement
  • AMA
  • Centromere antibody
  • Histone Antibody

Conditions where an ANA Screen test is recommended:

  • Autoimmune Disorders
  • Lupus
  • Rheumatoid Arthritis
  • Sjogren Syndrome
  • Scleroderma

How does my health care provider use an ANA Screen test?

One of the most often performed tests to diagnose systemic lupus erythematosus is the antinuclear antibody test. It serves as the first step in the evaluation process for autoimmune diseases that might impact various body tissues and organs.

When a person's immune system fails to discriminate between their own cells and foreign cells, autoantibodies called ANA are created. They attack chemicals found in a cell's nucleus, causing organ and tissue damage.

ANA testing may be utilized in conjunction with or after other autoantibody tests, depending on a person's indications and symptoms and the suspected condition. Antibodies that target specific compounds within cell nuclei, such as anti-dsDNA, anti-centromere, anti-nucleolar, anti-histone, and anti-RNA antibodies, are detected by some of these tests, which are considered subsets of the general ANA test. In addition, an ENA panel can be utilized as a follow-up to an ANA.

These further tests are performed in addition to a person's clinical history to assist diagnose or rule out other autoimmune conditions such Sjögren syndrome, polymyositis, and scleroderma.

To detect ANA, various laboratories may employ different test procedures. Immunoassay and indirect fluorescent antibody are two typical approaches. The IFA is regarded as the gold standard. Some labs will test for ANA using immunoassay and then employ IFA to confirm positive or equivocal results.

An indirect fluorescent antibody is created by mixing a person's blood sample with cells attached to a slide. Autoantibodies in the blood bind to the cells and cause them to react. A fluorescent antibody reagent is used to treat the slide, which is then inspected under a microscope. The existence of fluorescence is observed, as well as the pattern of fluorescence.

Immunoassays—these procedures are frequently carried out using automated equipment, however they are less sensitive than IFA in identifying ANA.

Other laboratory tests linked to inflammation, such as the erythrocyte sedimentation rate and/or C-reactive protein, can be used to assess a person's risk of SLE or another autoimmune disease.

What do my ANA test results mean?

A positive ANA test indicates the presence of autoantibodies. This shows the presence of an autoimmune disease in someone who has signs and symptoms, but more testing is needed to make a definitive diagnosis.

Because ANA test results can be positive in persons who have no known autoimmune disease, they must be carefully assessed in conjunction with a person's indications and symptoms.

Because an ANA test can become positive before signs and symptoms of an autoimmune disease appear, determining the meaning of a positive ANA in a person who has no symptoms can take some time.

SLE is unlikely to be diagnosed with a negative ANA result. It is normally not required to repeat a negative ANA test right away; however, because autoimmune illnesses are episodic, it may be desirable to repeat the ANA test at a later date if symptoms persist.

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


Description: A B12 and Folate test measures the levels of B12 and folic acid in the blood. These results can be used to determine a B12 and/or folate deficiency and evaluate a person's nutritional status. Anemia and Neuropathy can also be evaluated using the results from this test.

Also Known As: Vitamin B12 and Folate test, Cobalamin and Folic Acid Test, Vitamin B12 and Vitamin B9 Test, Vitamin B12 Test, Vitamin B9 Test, Cobalamin Test, Folic Acid Test, Folate Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is Vitamin B12 and Folate panel test ordered?

When a complete blood count and/or blood smear, performed as part of a health checkup or anemia evaluation, reveal a low red blood cell count with the presence of big RBCs, B12 and folate levels may be ordered. A high mean corpuscular volume, in particular, implies that the RBCs are enlarged.

When a person exhibits the following signs and symptoms of a deficit, testing for B12 and folate levels may be necessary.

  • Diarrhea
  • Dizziness
  • Muscle weakness, fatigue
  • Appetite loss.
  • Skin that is pale
  • Irregular heartbeats, rapid heart rate
  • Breathing problems
  • Tongue and mouth ache
  • In the feet, hands, arms, and legs, there is tingling, numbness, and/or burning 
  • Confusion or obliviousness
  • Paranoia

When a person is at risk of deficiency, such as those with a history of malnutrition or a condition associated to malabsorption, B12 and folate testing may be ordered.

Individuals being treated for malnutrition or a B12 or folate deficit may have these tests done on a frequent basis to see how effective their treatments are. This could be part of a long-term therapy plan for people who have a disease that causes chronic deficiency.

What does a Vitamin B12 and Folate panel blood test check for?

The B complex of vitamins includes vitamins including vitamin B12 and folate. They are required for the creation of normal red blood cells, tissue and cell repair, and the synthesis of DNA, the genetic material in cells. Both are nutrients that the body cannot make and must be obtained from the diet.

Vitamin B12 and folate tests diagnose vitamin deficiencies by measuring vitamin levels in the liquid section of the blood. The amount of folate in red blood cells is sometimes tested as well.

Folate is a naturally occurring form of the vitamin, whereas folic acid is a supplement that can be added to foods and beverages. Leafy green vegetables, dry beans and peas, citrus fruits, yeast, and liver all contain it. Vitamin B12, also known as cobalamin, can be found in animal-based foods such red meat, fish, poultry, milk, yogurt, and eggs. Fortified cereals, breads, and other grain products have become key sources of B12 and folate in recent years.

A lack of B12 or folate can cause macrocytic anemia, a condition in which red blood cells are bigger than normal. Megaloblastic anemia is a kind of macrocytic anemia marked by the generation of fewer but larger RBCs known as macrocytes, as well as cellular abnormalities in the bone marrow. Reduced white blood cell and platelet counts are two more test results linked to megaloblastic anemia.

B12 is also necessary for nerve function, and a lack of it can induce neuropathy, which causes tingling and numbness in the hands and feet of those who are affected.

Folate is required for cell division, which occurs in the developing fetus. In a growing fetus, a lack of folate during early pregnancy can raise the chance of neural tube abnormalities such spina bifida.

B12 and folate deficiency is most commonly caused by not getting enough of the vitamins through diet or supplements, poor absorption, or increased requirement, as observed during pregnancy:

  • Dietary deficiencies are uncommon in the United States since many meals and beverages are fortified with vitamins that the body stores. Adults normally have many years' worth of vitamin B12 and around three months' worth of folate stored in their liver. Dietary deficiencies normally do not manifest symptoms until the body's vitamin supplies have been exhausted. Vegans and their breast-fed infants can suffer from B12 deficiency.
  • Inadequate absorption—the absorption of vitamin B12 is a multi-step process. B12 is normally released from food by stomach acid and then bound to intrinsic factor, a protein produced by parietal cells in the stomach, in the small intestine. After being absorbed by the small intestine and bound by carrier proteins, the B12-IF complex reaches the blood. B12 absorption is hampered if any of these processes are disrupted by a disease or condition.
  • Increased demand—this can occur as a result of a range of diseases and disorders. When a woman is pregnant or nursing, in early childhood, with malignancies, or with chronic hemolytic anemias, there is an increased demand for folate.

Lab tests often ordered with a Vitamin B12 and Folate panel test:

  • Complete Blood Count
  • Methylmalonic Acid
  • Homocysteine
  • Vitamin B1
  • Vitamin B3
  • Vitamin B5
  • Vitamin B6
  • Vitamin B7
  • Intrinsic Factor Antibody
  • Parietal Cell Antibody
  • Reticulocyte Count

Conditions where a Vitamin B12 and Folate panel test is recommended:

  • Neural Tube Defects
  • Vitamin B12 and Folate Deficiencies
  • Anemia
  • Alcoholism
  • Malnutrition
  • Celiac Disease
  • Malabsorption
  • Neuropathy
  • Inflammatory Bowel Disease

How does my health care provider use a Vitamin B12 and Folate panel test?

Separate tests for vitamin B12 and folate are frequently used in conjunction to detect deficiencies and to aid in the diagnosis of anemias such as pernicious anemia, an inflammatory condition that inhibits B12 absorption.

B12 and folate are two vitamins that the body cannot generate and must be obtained from the diet. They're needed for red blood cell creation, tissue and cell repair, and DNA synthesis, which is the genetic material in cells. B12 is required for normal nerve function.

B12 and folate tests can also be used to assess someone who is experiencing mental or behavioral changes, especially in the elderly. A B12 test can be ordered with or without folate, as well as with other screening laboratory tests like a complete blood count, comprehensive metabolic panel, antinuclear antibody, C-reactive protein, and rheumatoid factor, to help determine why a person is exhibiting signs and symptoms of a nerve disorder.

B12 and folate tests can also be performed in conjunction with a variety of other tests to assess a person's overall health and nutritional status if they have signs and symptoms of substantial malnutrition or dietary malabsorption. People with alcoholism, liver disease, stomach cancer, or malabsorption diseases including celiac disease, inflammatory bowel disease, or cystic fibrosis may fall into this category.

Testing may be performed to assess the success of treatment in patients with known B12 and folate deficits. This is especially true for people who cannot absorb B12 and/or folate effectively and must be treated for the rest of their lives.

Folate levels in the blood's liquid part might fluctuate depending on a person's recent diet. Because red blood cells contain 95 percent of circulating folate, a test to evaluate folate levels inside RBCs could be employed instead of or in addition to the serum test. Some doctors believe that the RBC folate test is a better predictor of long-term folate status and is more clinically useful than serum folate, however there is no consensus on this.

Homocysteine and methylmalonic acid are two more laboratory tests that can be used to detect B12 and folate deficits. In B12 deficiency, both homocysteine and MMA are high, whereas in folate deficit, only homocysteine, not MMA, is elevated. This distinction is critical because treating anemia with folate treats the anemia but not the brain damage, which may be irreparable.

What do my Vitamin B12 and Folate test results mean?

Normal B12 and folate levels may indicate that a person does not suffer from a deficiency and that the signs and symptoms are caused by something else. Normal levels, on the other hand, may indicate that a person's stored B12 and/or folate has not yet been depleted.

A health practitioner may request a methylmalonic acid test as an early sign of B12 insufficiency if a B12 level is normal but a deficiency is still suspected.

A low B12 and/or folate level in a person with signs and symptoms implies a deficiency, although it does not always indicate the severity of the anemia or related neuropathy. Additional tests are frequently performed to determine the source of the deficit. Low B12 or folate levels can be caused by a variety of factors, including:

Dietary folate or B12 deficiency is uncommon in the United States. It can be evident in people who are malnourished in general and vegans who do not eat any animal products. Folate deficiency has become extremely rare since the development of fortified cereals, breads, and other grain products.

Both B12 and folate deficits can be caused by diseases that prevent them from being absorbed in the small intestine. These may include the following:

  • Pernicious anemia.
  • Celiac disease
  • Crohn's disease and ulcerative colitis
  • Bacterial overgrowth or the presence of parasites in the intestines, such as tapeworms
  • Long-term usage of antacids or H2 proton pump inhibitors reduces stomach acid production.
  • Absorption can be considerably reduced by surgery that removes part of the stomach or the intestines, such as gastric bypass.
  • Insufficiency of the pancreas
  • Chronic alcoholism or heavy drinking
  • Some treatments, such as omeprazole, metformin, methotrexate, and/or anti-seizure medications like phenytoin.
  • Increased requirement for healthy fetal development, all pregnant women require an increased amount of folate and are advised to consume 400 micrograms of folic acid every day. People who have cancer that has spread or who have chronic hemolytic anemia require more folate.
  • Smoking

If a person is taking supplements to treat a B12 or folate deficiency, normal or higher findings indicate that the treatment is working.

High amounts of B12 are uncommon, and they aren't routinely evaluated clinically. If a person has a condition such chronic myeloproliferative neoplasm, diabetes, heart failure, obesity, AIDS, or severe liver disease, their vitamin B12 level may be elevated. High B12 levels can also be caused by using estrogens, vitamin C, or vitamin A.

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


Includes

Hepatitis A Antibody, Total; Hepatitis B Surface Antibody, Qualitative; Hepatitis B Surface Antigen with Reflex Confirmation; Hepatitis B Core Antibody, Total; Hepatitis C Antibody with Reflex to HCV, RNA, Quantitative, Real-Time PCR

Hepatitis B Surface Antigen with Reflex Confirmation: Positive samples will be confirmed based on the manufacturer's FDA approved recommendations at an additional charge (CPT code(s): 87341).


If Hepatitis C Antibody is reactive, Hepatitis C Viral RNA, Quantitative, Real-Time PCR will be performed at an additional charge (CPT code(s): 87522).


Most Popular
Vitamin K is a required co-factor for the synthesis of factors 2, 7, 9, and 10 and proteins C and S. Deficiencies of vitamin K lead to bleeding. Coumadin® (warfarin) acts as an anticoagulant because it is a vitamin K antagonist

C4B is a complement binding protein that specifically binds 50% circulating protein S, a vitamin K dependent cofactor of protein C activation. Since C4B may be elevated in certain disease states, this may affect the available "free protein S" to engage in anticoagulant activity.

Most Popular
Serum calcium is involved in the regulation of neuromuscular and enzyme activity, bone metabolism and blood coagulation. Calcium blood levels are controlled by a complex interaction of parathyroid hormone, vitamin D, calcitonin and adrenal cortical steroids. Calcium measurements are useful in the diagnosis of parathyroid disease, some bone disorders and chronic renal disease. A low level of calcium may result in tetany.

Screening test to aid in diagnosis of disseminated intravascular coagulation (DIC) and acute occlusive vascular disease.

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.

False elevations of potassium may be due to hemolysis or rupture of platelets during coagulation process. The use of plasma potassium levels should be limited to those patients with spuriously elevated or depressed potassium levels due to blood samples left at room temperature, in patients with chronic lymphocytic leukemia with very high WBC counts (false decline), and those with thrombocytosis (increased platelets) with counts in excess of one million (false elevation).

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.

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.



In the United States, 100,000 people die due to blood clots annually. In addition to that, 900,000 people end up dealing with venous thromboembolism every year. These numbers are so high because these blood clots are not caught in time to get taken care of before it becomes a serious problem.

Continue reading to learn more about clotting disorders and blood coagulation tests. 

What Are Clotting Disorders?

The body has a natural blood clotting process known as hemostasis. The body forces the injured blood vessel to constrict, and then platelets are sent to the injury site. They attach to the wound, and coagulation occurs. 

In clotting disorders, excessive clotting takes place. This is also known as a hypercoagulable state. This allows large blood clots to form where they shouldn't: in the bloodstream. These blood clots make their way to the legs (venous thromboembolism), the lungs (pulmonary embolism), and even the arteries of the heart (arterial thrombosis), and they block off blood vessels.

Clotting Disorders Causes

In some cases, it is acquired via underlying health conditions. These conditions might include:

  • Prolonged immobilization or bed rest
  • Autoimmune disorders (like Lupus)
  • Cancer or malignant tumor growth
  • Catheter use
  • Pregnancy or childbirth
  • Medical drug use (Hormone Replacement Therapy, oral contraceptives, or Heparin)
  • Cholesterol or calcium buildup in the bloodstream
  • Blood vessel inflammation
  • Heart failure
  • Obesity

It can also be an inherited health condition through genetic mutations, such as:

  • Factor V Leiden mutation
  • Prothrombin 20210 mutation
  • MTHFR mutation

It can be an inherited health condition due to:

  • Antithrombin
  • Protein C and S
  • Elevated Factor VII levels

Catching these blood clots early makes all of the difference between life or death in these patients. Knowing the signs can help in diagnosing these blood clots in time to seek treatment. 

Signs and Symptoms of Clotting Disorders

The different signs and symptoms of blood clotting disorders depend on the location of the blood clot. If the clot is in the leg, the symptoms include:

  • Leg pain or tenderness
  • Edema or swelling
  • Discoloration in the leg

If the clot is in the lung, the symptoms might include:

  • Sudden shortness of breath
  • Chest pain
  • Coughing up blood
  • Irregular heartbeat 
  • Fainting or lightheadedness
  • Anxiety

In other areas of the body, blood clot symptoms may mimic a heart attack or a stroke. If you find that you have any of these symptoms, you should speak with your doctor as soon as possible. 

There are certain tests that you can do to check for clotting disorders, so it's a good idea to be proactive if you notice you may have any of the risk factors associated with blood clotting disorders or you have any of the symptoms. 

Clotting Disorder FAQs

Should those with clotting disorders see a specialist? Your primary care physician can care for clotting disorders. However, when you have an active blood clot, you should make sure to see your hematologist to get it taken care of. 

If you are diagnosed with a clotting disorder, should your family members also get tested? Some of these conditions can be genetic. It is always a good idea for your family members to be tested for this disorder.

Who can have a blood clotting disorder? Men and women alike can have a clotting disorder. People of any age can develop a clotting disorder. They are more commonly diagnosed, however, among older teens and adults as they go through the normal changes in their blood.

Why Order Blood Coagulation Tests?

Blood coagulation tests are essential in finding possible blood clots throughout your body as a result of a clotting disorder. The tests that check for blood clotting include:

  • Prothrombin Time (PT)
  • Activated Partial Thromboplastin Time (aPTT)

The Prothrombin Time (PT) test monitors how fast the blood clots. The Activated Partial Thromboplastin Time (aPTT) test monitors how long it takes for the blood to clot.

At Ulta Lab Tests, we also offer a:

  • Complete Blood Count test
  • Fibrinogen level test

The Complete Blood Count test will look for signs of anemia or a low platelet count, which can cause abnormal blood clotting. The Fibrinogen test monitors your fibrinogen level (a protein found in the liver). It looks for abnormalities that point to excessive bleeding problems. 

A phlebotomist performs these tests: they are not at-home test kits! We offer these tests at affordable pricing, and you don't need a referral or insurance to get this testing done. These tests also come with a 100% satisfaction guarantee. 

Tests Needed to Confirm Low Platelet Counts

A low platelet count can be diagnosed, evaluated, and monitored through various blood tests. None of these tests can identify the cause of the low platelet count, but they can be used to identify the right treatment. These include the following:

  • Complete Blood Count – It is used to check the current platelet count and to identify if the bleeding has caused anemia (low hemoglobin levels).
  • Platelet Count – Checks the number of platelets in the blood, and it is part of the CBC test.
  • Blood Smear – It is done using a microscope to check the blood cells, including platelets.
  • Prothrombin Time and Partial Thromboplastin Time – It is used to check the clotting factors for proper clotting.
  • Basic Metabolic Panel or Comprehensive Metabolic Panel – Checks the overall health of your kidneys, liver, and other organs in your body.
  • Bone Marrow Aspiration and Biopsy – Checks cell production in the bone marrow if you have a low platelet count.
  • Heparin-induced Thrombocytopenia – Checks the antibodies against heparin and diagnoses thrombocytopenia. You can get this test if you have undergone or are currently undergoing heparin therapy.
  • Antiphospholipid Antibodies – Used to diagnose an existing autoimmune disease such as antiphospholipid syndrome as the cause of the low platelet count or its association with your platelets.
  • Antinuclear Antibody (ANA) – Used to diagnose an underlying autoimmune disease such as Lupus and its association or cause of low platelets.
  • Vitamin B12 And Folate – Any deficiencies in these vitamins cause a low platelet count, anemia, and a low white blood cell count (known as leukopenia).
  • Hepatitis B, C, and HIV – These are viral infections often associated with low platelets. If you have a low platelet count and test positive for these infections, they are the cause of the low platelet count.

Get Started Today!

If you are showing signs of a blood clot, it's important to talk to a health professional immediately. If you are worried that you might have a blood clotting disorder, blood clotting tests are available for purchase through our website. Once you have the results, you can go over them with your doctor and go from there.

Order your blood coagulation tests today, and you will get your results in 24 to 48 hours. A secure and confidential online server then sends results.