Test ID: APCR
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Activated Protein C Resistance
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Useful For
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Useful in the evaluation of thrombophilia .
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Method name and description
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Turbidimetric
Test is performed using Sysmex CS5100 analyzer. When activated Protein C (APC) is added to plasma and an APTT is performed, there is normally a prolongation of the clotting time as a result of factor V and factor VIII degradation. The sample is prediluted with factor V deficient plasma to overcome possible deficiency of other coagulation factors. Presence of factor V Leiden will lead to shortening of the clotting time.
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Clinical information
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Protein C is a part of the natural anticoagulant system and it is a vitamin K-dependent protein zymogen that is synthesized in the liver and circulates at a plasma concentration of approximately 5 mcg/mL. Protein C is activated to activated protein C (APC) via proteolytic cleavage by thrombin bound to thrombomodulin, an endothelial cell surface membrane protein. APC downregulates the procoagulant system by proteolytically inactivating procoagulant factors Va and VIIIa. Protein S, another vitamin K-dependent coagulation protein, catalyzes APC inactivation of factors Va and VIIIa. APC interacts with and proteolysis factors V/Va and VIII/VIIIa at specific APC binding and cleavage sites, respectively. Resistance to activated protein C (APC resistance) is a term used to describe abnormal resistance of human plasma to the anticoagulant effects of human APC. APC resistance is characterized by a reduced anticoagulant response of patient plasma after adding a standard amount of APC. This generally indicate the presence of FV Leiden which is an abnormal version of factor V that is resistant to the proteolytic action action of APC.
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Specimen type / Specimen volume / Specimen container
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Plasma Na Cit. Plasma poor platelets
Specimen Volume: 2.7ml.
Container/Tube: Light Blue top (3.2% Sodium Citrate)
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Collection instructions / Special Precautions / Timing of collection
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1- 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 |
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Relevant clinical information to be provided
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Patient/family history of thrombotic disorder.
History of chronic diseases .
Patients suspected with the FV Leiden mutation will show APC resistance by this test.
Further testing by molecular genetics will detect the mutation if present.
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Storage and transport instructions
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Specimen Rejection Criteria
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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)
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Biological reference intervals and clinical decision values
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Normalized Ratio: 0.91– 1.19 %. .
With the currently used reagent, a cut-off of 0.7 for normalized ratio has a sensitivity of 98% for FV Leiden and a specificity of 99%.
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Factors affecting test performance and result interpretation
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No interference up to:
Triglycerides 1077 mg/dL
Hemoglobin 1000 mg/dL
Bilirubin 60 mg/dL
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Turnaround time / Days and times test performed / Specimen retention time
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