Test ID: TT
Thrombin Time (Bovine), Plasma
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
The main utility of the thrombin time test is to detect or exclude the presence of heparin or heparin-like anticoagulants (which act by enhancing antithrombin's inhibition of thrombin and other procoagulant enzymes) when used in conjunction with the reptilase time (RT) in evaluating unexplained prolonged clotting times.
Identifying the cause of a prolonged prothrombin time, activated partial thromboplastin time, or dilute Russell's viper venom time when used in conjunction with the RT and fibrinogen assay
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
Clot-Based Assay
Measures time of fibrinogen to fibrin conversion after adding bovine thrombin
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
See Coagulation Studies in Special Instructions.
Specimen Type: Platelet-poor plasma
Collection Container/Tube: Light-blue top (citrate)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Spin down, remove plasma, and spin plasma again.
2. Freeze specimen immediately at < or =-40 degrees C, if possible.
Additional Information:
1. Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.
2. Each coagulation assay requested should have its own vial.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | Mild OK; Gross reject |
| Icterus | Mild OK; Gross reject |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Plasma Na Cit | Frozen | 14 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Prolonged clotting times may be associated with a wide variety of coagulation abnormalities including:
-Deficiency or functional abnormality (congenital or acquired) of many of the coagulation proteins
-Deficiency or functional abnormality of platelets
-Specific factor inhibitors
-Acute disseminated intravascular coagulation
-Exogenous anticoagulants (eg, heparin, warfarin)
The prothrombin time and activated partial thromboplastin time are first-order tests for coagulation abnormalities and are prolonged in many disorders. A battery of coagulation tests is often required to determine the cause of prolonged clotting times.
Thrombin catalzyes the transformation of fibrinogen to fibrin (by cleaving fibrinpeptides A and B), which is followed by polymerization of fibrin to form a clot. The thrombin time (TT) test measures the time of clot formation when thrombin is added to citrated plasma. The phospholipid-dependent procoagulant enzyme cascades (intrinsic, extrinsic, and "common" pathway) are bypassed by the addition of exogenous thrombin. Therefore, the TT mainly reflects functions and interactions of solution-phase exogenous thrombin and endogenous fibrinogen.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
15-23 seconds
Interpretation Provides information to assist in interpretation of the test results
Prolongation of the thrombin time (TT) is consistent with the presence of heparin-like anticoagulants, hypofibrinogenemia, dysfibrinogenemia, fibrin degradation products, and antibody inhibitors of thrombin. An immeasurably prolonged TT is usually the result of heparin in the specimen or, rarely, the presence of thrombin antibodies or afibrinogenemia.
When the TT test is performed with diluted bovine thrombin to achieve a normal plasma clotting time of about 20 seconds, the TT is capable of detecting unfractionated heparin at a concentration of 0.05 units/mL of heparin.
Other tests useful in interpreting the significance of prolongation of the TT include: reptilase time (RT), human thrombin time, clottable fibrinogen assay, and the fibrin D-dimer assay. These tests are available as components of coagulation profile test panels. As seen in the following table, RT can help distinguish among the various causes of a prolonged TT.
| Thrombin Time | Reptilase Time |
|
|
| Prolonged | Prolonged | Hypo- or afibrinogenemia | Ascertain by determination of fibrinogen |
| Prolonged | Prolonged | Dysfibrinogenemia | Ascertain by specific assay |
| Prolonged | Normal | Heparin or inhibitor of thrombin | Differentiate by human TT and/or heparin assays |
| Prolonged | Prolonged | Fibrin(ogen) split products (FSP) | Ascertain by FSP or D-dimer assay |
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
The thrombin time test, by itself, has little diagnostic value and should be interpreted within the context of additional coagulation assays (eg, prothrombin time, activated partial thromboplastin time, and reptilase time).
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Koepke JA: Coagulation testing systems. In Practical Laboratory Hematology. New York, Churchill Livingston, 1991
2. Corriveau DM, Fritsma G: Hemostasis and Thrombosis in the Clinical Laboratory. Philadelphia, JB Lippincott Company, 1988
3. Galanakis DK: Plasma thrombin time and related tests. In Williams Hematology. 5th edition. New York, McGraw-Hill Book Company, 1995, pp L91-L93
4. Greaves M, Preston FE: Approach to the bleeding patient. In Hemostasis and Thrombosis: Basic Principles and Clinical Practice. 4th edition. Edited by RW Colman, J Hirsh, VJ Marder, et al. Philadelphia, JB Lippincott Company, 2001, pp 783-837
Method Description Describes how the test is performed and provides a method-specific reference
The thrombin time (TT) assay is performed on the Beckman Coulter ACL TOP. Patient plasma is combined with a bovine thrombin reagent containing bovine albumin, calcium chloride, and buffer immediately triggering the coagulation process in the mixture. Time to clot formation is measured optically using a wavelength of 405 nm.
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
85670
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| TT | Thrombin Time (Bovine), P | 46717-5 |
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