Test ID: PSGN
Plasminogen Activity, 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
Evaluating patients with incident or recurrent thromboembolic events
Evaluating individuals with a family history of thrombophilia (venous or arterial)
Evaluating patients with ligneous conjunctivitis (strong association with homozygous plasminogen deficiency)
Evaluating fibrinolysis, in combination with other components of the fibrinolytic system (fibrinogen, tPa-inhibitor, and d-dimers)
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
Amidolysis of Chromoginic Substrate
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.
3. Coagulation testing is highly complex, often requiring the performance of multiple assays and correlation with clinical information. For that reason, we suggest ordering THRMP/83093 Thrombophilia Profile.
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 | NA |
| 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
During the formation of a hemostatic (fibrin) plug, biochemical mechanisms are initiated to limit the extent of the hemostatic process at the site of injury and maintain vascular patency. This process of fibrinolysis is defined as the plasmin-mediated degradation of fibrin. Plasmin limits the extent of the hemostatic process at the site of vessel injury.
Plasmin is generated from its precursor, plasminogen, by plasminogen activators (ie, tissue plasminogen-activator [tPa], urokinase-type plasminogen activator [uPa]). Plasminogen is a single-chain glycoprotein that is synthesized in the liver and has a biologic half-life of approximately 2 days.(1) Deficiency of plasminogen may be inherited or acquired. Persons with congenital plasminogen deficiency may have an increased risk for thrombosis. Homozygous deficiency has been associated with thromboembolic disease and ligneous conjunctivitis. The risk of thrombosis for heterozygous plasminogen deficiency is uncertain. This risk likely is compounded when combined with other inherited or acquired thrombophilias. Congenital deficiency of plasminogen is autosomally transmitted and rare, both in the general population and thrombosis patients, with a prevalence of approximately 0.4% and 1% to 3%, respectively.(2)
Based on the results of functional and immunologic (antigenic) assays, 2 types of plasminogen deficiency have been identified:
-Quantitative deficiency (type I)-defined by a corresponding decrease in both plasminogen activity and antigen level
-Functional deficiency (type II)-caused by a normally synthesized but dysfunctional plasminogen
This plasminogen activity assay will identify both types of deficiency.
Acquired causes of plasminogen deficiency include consumption such as with thrombolytic therapy (urokinase, tPa) or disseminated intravascular coagulation and fibrinolysis (DIC/ICF), or decreased synthesis (liver disease).(1)
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.
75-140%
Interpretation Provides information to assist in interpretation of the test results
Plasminogen activity <75% may represent a congenital deficiency state, if acquired deficiency can be excluded.
Hereditary abnormalities of plasminogen (deficiency or dysfunction) are very uncommon.
Acquired causes of plasminogen deficiency are much more common and may be the result of consumption due to thrombolytic therapy or intravascular coagulation and fibrinolysis or decreased synthesis (ie, liver disease).
Plasminogen levels are low at birth (approximately 50% of adult normal level) and reach adult levels at 6 months of age.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Proper preparation of the blood (plasma) specimen is extremely important to help insure accuracy of results and interpretation.
Plasminogen results are potentially affected by:
-Elevated levels of fibrinogen
-Heparin (unfractionated or low-molecular-weight) >4 U/mL
-Fibrin degradation products (FDP) >30 mg/dL
-Hemoglobin >200 mg/dL
-Bilirubin >20 mg/dL
-Triglycerides >1,000 mg/dL
Although this test can be performed in the absence of other coagulation tests and clinical information, it is most helpful when performed in conjunction with a consultative coagulation test panel with interpretive reporting. When the assay is performed to evaluate for thrombophilia, appropriate testing for other more common thrombophilic states should be performed, if not already done. THRMP/83093 Thrombophilia Profile includes the appropriate panel of assays for an evaluation of an acquired or familial thrombophilia.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Bachman F: Plasminogen-plasmin enzyme system. In Homeostasis and Thrombosis. Edited by RW Coman, J Hirsh, VJ Marder, et al. Lippencott, 2001, pp 275-320
2. Demarmels BF, Sulzer I, Stucki B, et al: Is plasminogen deficiency a thrombotic risk factor? Thromb Haemost 1998;80:167-170
3. Andrews M: The hemostatic system in the infant. In Hematology of Infancy and Childhood. Vol 1. 4th edition. Edited by DG Nathan, FA Oski. WB Saunders Company, 1993, pp 115-153
Method Description Describes how the test is performed and provides a method-specific reference
This assay is performed using the HemosIL Plasminogen Kit on the Beckman Coulter ACL TOP. The method is an automated chromogenic assay in which an excess of streptokinase (SK) in the presence of fibrinogen is added to sample plasma containing plasminogen. A plasminogen-streptokinase complex is formed. The complex catalyzes the splitting of p-nitroaniline (pNA) from the substrate S-2403 pyroGlu-Phe-Lys-pNAHCl. Under these conditions the enzymatic activity of the complex is not inhibited by plasma inhibitors. The rate at which the pNA is released is measured kinetically at 405 nm and is directly proportional to the plasminogen level in the test specimen. The concentration of plasminogen is calculated from a standard curve prepared from reference plasma dilutions.(Friberger P, Knos M: Plasminogen determination in human plasma. In Chromogenic Peptide Substrates: Chemistry and Clinical Usage. Edited by Edinburgh. Churchill Livingstone, 1979, pp 128-140)
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.
85420
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 |
|---|---|---|
| PSGN | Plasminogen Activity, P | 28660-9 |
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