Lab Guide
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Test ID: TT
Thrombin Time
Useful For

The test measures the time (in second ) taken to convert fibrinogen to fibrin. Therefore the test is useful in the diagnosis of cases of Hypofibrinogenemia /dysfibrinogenemia ; hereditary or acquired such as advanced liver disease , cancers and DIC .Thrombin test is sensitive to heparin contamination.

Method name and description

Coagulometric (Turbidimetric).
Test is performed using sysmex CS 5100 analyzer. Thrombin converts the fibrinogen in the plasma sample into fibrin, thus producing a fibrin clot. The time taken for the fibrin clot to form is measured

Reporting name

Thrombin Time

Clinical information

Hyperfibrinogenemia as a cause of prolonged thrombin clotting time. Recognized causes of a prolonged thrombin clotting time (TT) include a decreased plasma fibrinogen level, dysfibrinogenemia, paraproteinemia, heparin contamination, elevated levels of fibrin degradation products, and liver failure.

Specimen type / Specimen volume / Specimen container

Plasma Na Cit. Platelet-poor plasma.
Specimen Volume:  2.7 ml.
Container/Tube: Light-blue top (citrate).        

Collection instructions / Special Precautions / Timing of collection

Sample collected in  HMC facilities/others and transported to the lab within 1hour :
•    Collect sample into light blue-top (sodium citrate).
•    Tubes must be filled to within +/- 10% of their proper volume, to provide a 9:1 ratio of blood to citrate.
2-    Samples collected in  HMC facilities  / others  and which are   expected not to reach the lab within  1hour:

•    Centrifuge the whole blood and carefully remove the plasma by pipette not by decanting   and send the plasma  in a temperature-controlled environment (18-25ºC ) within one hour of centrifugation. 
•     If the transportation of  the plasma can’t be within a maximum of  2hour , prepare platelet-poor plasma  as follow:
A:    Re-centrifuge plasma again.
B:    Remove the top portion of plasma leaving approximately 250 mcL in the bottom to discard.
C:    The double-centrifuged plasma should be aliquoted (0.5 to 1 mL per aliquot) into labeled plastic tubes. The number of tests ordered will determine the aliquots needed.
D:    Freeze immediately at -20 ºC or below  .
E:    Specimens must arrive frozen.
3-    Sample for Platelets function studies (Platelets function assay) , Citrated whole blood should reach HMC within a maximum of 1-2 hours of collection.
4-     For heparin monitoring, follow the above mentioned steps.
5-    Consider patient HCT %. , if HCT is >55%, the volume of anticoagulant in the tube must  be adjusted by the referring  lab, as per  the below table shows the volume of citrate (µL) to be removed from common sizes of coagulation specimen tubes prior to specimen collection. After removal of the specified volume of citrate, enough blood is added to fill the tube to the ideal volume. .   

Hematocrit % Volume to be removed, µL
2.7 ml Tube 1.0 ml Tube
56 50 20
57 50 20
58 60 20
59 60 20
60 70 30
61 70 30
62 80 30
63 80 30
64 90 30
65 90 30
66 100 40
67 100 40
68 110 40
69 110 40
70 120 40
71 120 40
72 130 50
73 130 50
74 140 50
75 140 50
76 150 50
77 150 60
78 160 60
79 160 60
80 170 60
Relevant clinical information to be provided

Patient/family history of bleeding  disorder. History of anticoagulant therapy.History of chronic diseases.  

Storage and transport instructions

Ambient

Specimen Rejection Criteria

Specimens with no label or missing required identification
Broken, leaking or contaminated specimen
Clotted samples 
Under-filled or overfilled sample tubes.
Wrong sample container sample received
Improper specimen transport temperature (e.g. like specimens which are  needed to be sent on ice)
Old specimen (test-dependent) 
Grossly Hemolyzed sample (test-dependent)

Biological reference intervals and clinical decision values

For age > 18 years:  16.5  -  20.7 second.  

For age ≤18 years:  The reference range is quoted from literature. The reference range values have not been verified/established by Lab.       

Age Reference interval(sec)
0 Minutes-4 Days 19-28.3
4 Days-1 Months 18-29.2
1 Months-6 Months 16.2-24.9
6 Months-1 Years 15.4-21.1
1 Years-5 Years 15.3-19.7
5 Years-10 Years 14.5-19.9
10 Years-18 Years 15.2-24
Factors affecting test performance and result interpretation

No interference up to:

Triglycerides  203  mg/dL

Hemoglobin 200 mg/dL

Bilirubin   60 mg/dl

Turnaround time / Days and times test performed / Specimen retention time

STAT: 1hr.
Routine: 4 hrs /  Daily /  NA.