Test ID: APSM
Alpha-2 Plasmin Inhibitor, 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
Diagnosing congenital alpha-2 plasmin inhibitor deficiencies (rare)
Providing a more complete assessment of disseminated intravascular coagulation, intravascular coagulation and fibrinolysis, or hyperfibrinolysis (primary fibrinolysis), when measured in conjunction with fibrinogen, fibrin D-dimer, fibrin degradation products, soluble fibrin monomer complex, and plasminogen
Evaluating liver disease
Evaluating the effects of fibrinolytic or antifibrinolytic therapy
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
Hydrolysis of Synthetic Chromogenic Substrate, Colorimetric End point
Includes measurement of the function of antiplasmin, mostly alpha-2-antiplasmin, with slight interference
from alpha-2-macroglobulin.
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
Alpha-2 Proteinase Inhibitor
Antiplasmin - Off hours order 399
Antiplasmin, Functional, Plasma
Functional Antiplasmin
Plasmin Inhibitor
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 | 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
Alpha-2 plasmin inhibitor (antiplasmin) is synthesized in the liver with a biological half-life of approximately 3 days. It inactivates plasmin, the primary fibrinolytic enzyme responsible for remodeling the fibrin thrombus, and binds fibrin, together with factor XIIIa, making the clot more difficult to lyse. Absence of alpha-2 plasmin inhibitor results in uncontrolled plasmin-mediated breakdown of the fibrin clot and is associated with increased risk of bleeding.
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.
Adults: 80-140%
Normal, full-term newborn infants may have borderline low or mildly decreased levels (> or =50%) which reach adult levels within 5 to 7 days postnatal.*
Healthy, premature infants (30-36 weeks gestation) may have mildly decreased levels which reach adult levels in < or =90 days postnatal.*
*See Pediatric Hemostasis References in Coagulation Studies in Special Instructions.
Interpretation Provides information to assist in interpretation of the test results
Patients with congenital homozygous deficiency (with levels of <10%) are clinically affected (bleeding). Heterozygotes having levels of 30% to 60% of mean normal activity are usually asymptomatic.
Lower than normal levels may be suggestive of consumption due to activation of plasminogen and its inhibition by alpha-2 plasmin inhibitor.
The clinical significance of high levels of alpha-2 plasmin inhibitor is unknown.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Alpha-2 plasmin inhibitor results are potentially affected by:
-Heparin, unfractionated or low-molecular-weight >4 U/mL
-Alpha-2-macroglobulin >7 mg/mL; potentially leading to a falsely-increased result
-Hemoglobin >200 mg/dL
-Bilirubin >20 mg/dL
-Triglycerides >1,000 mg/dL
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Lijnen HR, Collen D: Congenital and acquired deficiencies of components of the fibrinolytic system and their relation to bleeding or thrombosis. Blood Coagul Fibrinolysis 1989;3:67-77
2. Francis RB Jr: Clinical disorders of fibrinolysis: A critical review. Blut 1989;59:1-14
3. Aoki N: Hemostasis associated with abnormalities of fibrinolysis. Blood Rev 1989;3:11-17
Method Description Describes how the test is performed and provides a method-specific reference
This assay is performed using the HemosIL Plasmin Inhibitor Kit on the Beckman Coulter ACL TOP. Patient plasma, containing alpha-2 plasmin inhibitor, is mixed with reagent containing excess plasmin. Plasmin activity in the reagent is rapidly inhibited by alpha-2 plasmin inhibitor. Residual plasmin activity is then measured using an amidolytic activity assay, in which residual plasmin lyses a synthetic chromogenic substrate and subsequently releases paranitroanline (detected at 405 nm) to a level that is inversely proportional to the amount of alpha-2 plasmin inhibitor in the sample.(Teger-Nilsson AC, Friberger P, Gyzander E: Determination of a new rapid plasmin inhibitor in human blood by means of a plasmin specific tripeptide substrate. Scand J Clin Lab Invest 1977;37:403-409)
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; Varies
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.
85410
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 |
|---|---|---|
| APSM | Alpha-2 Plasmin Inhibitor, P | 27810-1 |
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