Bleeding and Thrombosis Better Answers from High-Quality Testing

Bleeding and Thrombosis Better answers from high-quality testing

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Bleeding and Thrombosis Test Menu

Bleeding Profiles and Quest Diagnostics offers a comprehensive menu of routine and esoteric tests for Bleeding and Screening Tests Thrombosis. We have organized our test menu by category for easy navigation. Simply click on a category to the left to view the tests available for ordering. You can also scroll down to view the von Willebrand Disease entire menu, as well as valuable tools like specimen collection instructions/video, a list of tests

Factor Assays and affected by anticoagulants, pediatric reference ranges and more. Inhibitors Our physicians and scientists provide diagnostic insights in the form of interpretive messages, Anticoagulant Therapy consultative reports, test FAQs and physician consults. We also recognize the importance of timely results and are a leader in time-to-result testing with high clinical imperatives (e.g. ADAMTS13 Activity, HIT, TTP and Platelet Heparin-dependent platelet antibody testing). Studies Our Medical Team is available to assist with any inquiries at 1.866.MY.QUEST or by contacting our Fibrinolysis and Markers Nichols Institute locations directly. of Thrombin Generation

Thrombotic Risk Markers and Profiles - Inherited Quest Diagnostics Nichols Institute: Antiphospholipid Chantilly, VA 1.800.336.3718 Antibody & Lupus Anticoagulant San Juan Capistrano, CA 1.800.642.4657

Women’s Health

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Bleeding Profiles and Screening Tests

Test Name Test Aliases Panel Components Specimen Requirements Codes Alpha-2-Antiplasmin 4953 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.6 mL minimum Fibrinogen Activity, Clauss 461 FIB, factor I 1 room-temperature, full, unopened 3.2% sodium citrate (light blue-top) tube or 0.5 mL frozen platelet-poor plasma minimum Mixing Study 8922(X) 1:1 Mixing study Always includes PT, PTT-LA and interpretation. Possible 3 mL frozen plasma (3.2% sodium citrate [light blue-top reflexes are PT 1:1 Immediate Mixing Study and/or PTT-LA tube]); 1.5 mL minimum 1:1 Immediate and Incubated Mixing Study Partial Thromboplastin Time, 763 Activated partial 1 room-temperature, full, unopened 3.2% sodium citrate Activated thromboplastin time, (light blue-top) tube or 0.5 mL frozen platelet-poor aPTT, PTT plasma minimum Prothrombin Time with INR 8847 PT, INR 1 room-temperature, full, unopened 3.2% sodium citrate (light blue-top) tube or 0.5 mL frozen platelet-poor plasma minimum Prothrombin with INR and Partial 4914 aPTT, PT, PTT 1 room-temperature, full, unopened 3.2% sodium citrate Thromboplastin Time (light blue-top) tube or 1.0 mL frozen platelet-poor plasma minimum Reptilase Clotting Time 37700 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Thrombin Clotting Time 883 TT 1 mL frozen platelet-poor plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum von Willebrand Disease

Test Name Test Aliases Panel Components Specimen Requirements Codes Factor VIII Activity, Clotting 347 FVIII activity, functional 1 mL frozen platelet-poor plasma (3.2% sodium citrate FVIII, hemophilia A test [light blue-top tube]); 0.5 mL minimum Ristocetin Cofactor 4459(X) von Willebrand factor 1 mL frozen platelet-poor plasma (3.2% sodium citrate functional assay, [light blue-top tube]); 0.5 mL minimum VWF:RCo von Willebrand Antigen, 5168 Multimer, VWF Multimer 1 mL frozen platelet-poor plasma (3.2% sodium citrate Multimeric Analysis [light blue-top tube]); 0.5 mL minimum von Willebrand 19790(X) aPTT; Factor VIII Activity, Clotting; von Willebrand Factor Four 1-mL aliquots frozen plasma (3.2% sodium citrate Comprehensive Panel1 Antigen; Ristocetin Cofactor; von Willebrand Antigen, [light blue-top tube]); four 0.75-mL aliquots, minimum Multimeric Analysis; Interpretation

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Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Test Name Test Aliases Panel Components Specimen Requirements Codes von Willebrand 15540(X) aPTT; Factor VIII Activity, Clotting; von Willebrand Factor Four 1-mL aliquots frozen plasma (3.2% sodium citrate Comprehensive Panel 21 Antigen; Ristocetin Cofactor; von Willebrand Factor [light blue-top tube]); four 0.75-mL aliquots, minimum Collagen Binding Assay; von Willebrand Antigen, Multimeric Analysis von Willebrand Factor Antigen 4919 VWF Ag, VWF antigen, 1 mL frozen platelet-poor plasma (3.2% sodium citrate VWF:Ag [light blue-top tube]); 0.5 mL minimum von Willebrand Factor Collagen 10924(X) CBA, VWF:CB 1 mL frozen plasma (3.2% sodium citrate [light blue-top Binding Assay1 tube]); 0.5 mL minimum von Willebrand Screen 90271 aPTT; Factor VIII Activity, Clotting; von Willebrand Factor Three 1-mL aliquots; three 0.75-mL aliquots, minimum Antigen; Ristocetin Cofactor

Factor Assays and Inhibitors

Test Name Test Aliases Panel Components Specimen Requirements Codes Factor IX Activity and 17845(X) If FIX Activity ≤20%, then FIX Inhibitor (Bethesda Assay) Two 2-mL aliquots frozen plasma (3.2% sodium citrate Human Inhibitor performed [light blue-top tube]); two 1-mL aliquots minimum Factor IX Activity, Clotting 352 Functional FIX 1 mL frozen platelet-poor plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Factor V Activity and 17844(X) If FV Activity ≤ 20%, then FV Inhibitor (Bethesda Assay) Two 2-mL aliquots frozen plasma (3.2% sodium citrate Human Inhibitor will be performed [light blue-top tube]); two 1-mL aliquots minimum Factor VII Activity, Clotting 346(X) Functional FVII 1 mL frozen platelet-poor plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Factor VIII Activity, Chromogenic 16049 Functional FVIII 1 mL frozen plasma (3.2% sodium citrate [light blue-top (chromogenic) tube]); 0.5 mL minimum Factor VIII Activity, Clotting 347 Functional FVIII 1 mL frozen platelet-poor plasma (3.2% sodium citrate (clotting) [light blue-top tube]); 0.5 mL minimum Factor VIII Inhibitor Panel 40083 Includes FVIII Activity, Clotting and FVIII Inhibitor, EIA Three 2-mL aliquots frozen plasma (3.2% sodium citrate Screen. If EIA positive, then FVIII Human Inhibitor [light blue-top tube]); three 1-mL aliquots minimum (Nijmegen Assay) performed Factor X Activity, Chromogenic 10663(X) Functional FX 1 mL frozen plasma (3.2% sodium citrate [light blue-top (chromogenic) tube]); 0.5 mL minimum Factor X Activity, Clotting 359(X) Functional FX (clotting) 1 mL frozen platelet-poor plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Factor XI Activity and 17854(X) If FXI Activity ≤20%, then FXI Inhibitor (Bethesda Assay) Two 2-mL aliquots frozen plasma (3.2% sodium citrate Human Inhibitor performed [light blue-top tube]); two 1-mL aliquots minimum

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Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Factor Assays and Inhibitors

Test Name Test Aliases Panel Components Specimen Requirements Codes Factor XI Activity, Clotting 360 Functional FXI 1 mL frozen platelet-poor plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Factor XI Mutation Analysis 16023(X) 5 mL room-temperature whole blood (EDTA [lavender-top (Ashkenazi Jewish)2,3 tube]); 3 mL minimum Factor XII Activity, Clotting 362(X) Functional FXII 1 mL frozen platelet-poor plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Factor XIII, Functional1 14461(X) FXIII activity 1 mL frozen platelet-poor plasma (3.2% sodium citrate [light blue-top tube]); 0.3 mL minimum Factor II Activity, Clotting 331 Prothrombin; 1 mL frozen platelet-poor plasma (3.2% sodium citrate functional FII [light blue-top tube]); 0.5 mL minimum Factor V Activity, Clotting 344 Functional FV 1 mL frozen platelet-poor plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Fibrinogen Activity, Clauss 461 FIB, factor I 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Fibrinogen Antigen, 37801 FIB, factor I 1 mL frozen plasma (3.2% sodium citrate [light blue-top Nephelometry tube]); 0.5 mL minimum

Anticoagulant Therapy

Test Name Test Aliases Panel Components Specimen Requirements Codes AccuType® Warfarin2,3 16160(X) VKORC1, CYP2C9 Includes variations in 2 genes (VKORC1 and CYP2C9) 5 mL room-temperature whole blood (EDTA [lavender-top tube]); 3 mL minimum Dabigatran with Reflex to 91115 Pradaxa® Reflex to Thrombin Clotting Time if dabigatran <45 ng/mL 1 mL frozen plasma (3.2% sodium citrate [light blue-top Thrombin Time tube]); 0.5 mL minimum Fondaparinux Sodium 16103 Arixtra® 1 mL frozen plasma (3.2% sodium citrate [light blue-top (Xa Inhibition) tube]); 0.5 mL minimum Heparin, Anti-Xa 30292 Anti-Xa for UFH 2 mL frozen platelet-poor plasma (3.2% sodium citrate and LMWH [light blue-top tube]); 1 mL minimum Prothrombin Time with INR 8847 PT, INR 1 room-temperature, full, unopened 3.2% sodium citrate (light blue-top) tube Rivaroxaban 90981 Xarelto® 1 mL frozen plasma (3.2% sodium citrate [light blue-top (Xa inhibition method) tube]); 0.5 mL minimum Vitamin K 36585 4 mL frozen plasma (sodium heparin [green-top tube]); 2 mL minimum

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges HIT, TTP and Platelet Studies

Test Name Test Aliases Panel Components Specimen Requirements Codes ADAMTS13 Activity with 14532 VWF protease activity ADAMTS13 activity with reflex to ADAMTS13 inhibitor when 1 mL frozen plasma (3.2% sodium citrate [light blue-top Reflex to Inhibitor1 activity is ≤30% tube]); 0.5 mL minimum Aspirin Resistance 16174 4 mL room-temperature random urine (BD C&S (11-Dehydrothromboxane B2) Vacutainer® tube); 3 mL minimum Heparin-Induced 414 HIT, HIT antibody, 1 mL frozen serum (red-top [no gel] tube); Platelet Antibody Heparin-dependent 0.5 mL minimum platelet antibody Heparin-Induced Platelet 15334(X) HIT, HIT antibody, Reflex to SRA (unfractionated heparin) when Two 1-mL aliquots frozen serum, two 0.5-mL aliquots Antibody with Reflex to SRA, heparin-dependent heparin-induced antibody weak positive or positive minimum Unfractionated Heparin platelet antibody Heparin-Induced 14874 HIT panel, Heparin- Serotonin Release Assay (SRA), Unfractionated Heparin; Two 1-mL aliquots frozen serum (red-top [no gel] tube), Thrombocytopenia Panel2 dependent platelet Heparin-Induced Platelet Antibody two 0.9-mL aliquots minimum antibody, HIT Antibody, SRA, HPA , PLA ½ Human Platelet Antigen 1 10707(X) Detects variant that may lead to neonatal alloimmune 5 mL room-temperature whole blood (EDTA [lavender-top Genotype thrombocytopenia tube]); 1 mL minimum Platelet Antibody Screen 16288 Detects Antibodies to HLA class I antigens and 3 mL frozen serum (red-top [no gel] tube); 1 mL minimum (Indirect) platelet-specific glycoproteins IIb/IIIa, Ib/IX and Ia/IIa Platelet Antibody, Direct, 5019(X) Detects platelet-associated IgG, IgA and IgM antibodies 7 mL room-temperature whole blood (EDTA [lavender-top Flow Cytometry4 tube]); 5 mL minimum Platelet Function Studies NA (Aggregation, PFA-100RTM) Not performed at Quest Diagnostics due to requirement for fresh platelets Serotonin Release Assay (SRA), 16284 HIT, Heparin-dependent 1 mL frozen serum; 0.4 mL minimum LMWH2 platelet antibody Serotonin Release Assay (SRA), 14627 HIT, Heparin-dependent 1 mL frozen serum; 0.4 mL minimum Unfractionated Heparin platelet antibody

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Fibrinolysis and Markers of Thrombin Generation

Test Name Test Aliases Panel Components Specimen Requirements Codes D-Dimer, Quantitative 8659 D-Di 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Euglobulin Clot Lysis Time 462(X) ECT 2 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 1 mL minimum Fibrin Monomer 11074 FM 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Fibrinogen Activity, Clauss 461 FIB 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Fibrinogen Antigen, Nephelometry 37801 FIB 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Fibrinogen Degradation Products 458(X) Fibrin split products 1 mL frozen plasma (3.2% sodium citrate [light blue-top (FDP), Semiquantitative tube]); 0.5 mL minimum Fibrinolysis Comprehensive Panel 90923 Alpha 2-Antiplasmin; D-Dimer, Quantitative; Euglobulin Four 1-mL aliquots frozen plasma (3.2% sodium citrate Clot Lysis Time; Fibrinogen Degradation Products, Semi- [light blue-top tube]); four 0.8-mL aliquots minimum Quantitative; Plasminogen Activator Inhibitor-1; Plasminogen Activity; Tissue Plasminogen Activator, EIA; Fibrin Monomer Plasminogen Activator Inhibitor-1 11368 5 mL room-temperature whole blood (EDTA [lavender-top (PAI-1) 4G/5G2,3 tube]); 3 mL minimum Plasminogen Activity 4458(X) PLG activity 2 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 1 mL minimum Plasminogen, Antigenic 5164(X) PLG antigen 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Prothrombin Fragment 1.2 37674(X) 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Thrombin-Antithrombin (TAT) 10162(X) 1 mL frozen plasma (3.2% sodium citrate [light blue-top Complex tube]); 0.5 mL minimum Tissue Plasminogen Activator 29816 TPA 1 mL frozen plasma (3.2% sodium citrate [light blue-top (TPA), EIA tube]); 0.3 mL minimum

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Thrombotic Risk Markers and Profiles–Inherited

Test Name Test Aliases Panel Components Specimen Requirements Codes Activated Protein C-Resistance 22 APCR, APC-R 2 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 1 mL minimum Activated Protein C Resistance 19704 APCR, APC-R If APCR <2.1 ratio, Factor V Leiden Mutation will 2 mL frozen plasma (3.2% sodium citrate [light blue-top with Reflex to Factor V be performed tube]) and 4 mL frozen whole blood (EDTA [lavender-top (Leiden) Mutation4 tube]); 1 mL plasma and 2 mL whole blood minimum Antithrombin III Activity 216 ATIII activity 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Antithrombin III Activity 7017(X) ATIII Two 1-mL aliquots frozen plasma (3.2% sodium citrate and Antigen [light blue-top tube]); two 0.5-mL aliquots minimum Antithrombin III Activity with 8267(X) ATIII If ATIII Activity decreased, ATIII Antigen will be performed 2 mL frozen plasma (3.2% sodium citrate [light blue-top Reflex to Antithrombin III Antigen tube]); 1 mL minimum Antithrombin III Antigen 5158(X) ATIII antigen 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Factor V (Leiden) 17900 FV Leiden mutation 5 mL room-temperature whole blood (EDTA [lavender-top Mutation Analysis4 tube]); 3 mL minimum Homocysteine 31789 1 mL room-temperature serum (red-top [no gel] tube); 0.5 mL minimum Lipoprotein (a) 34604 Lp(a) 1 mL room-temperature serum (red-top [no gel] tube); 0.5 mL minimum Methylenetetrahydrofolate 17911 5 mL room-temperature whole blood (EDTA [lavender-top Reductase (MTHFR), tube]); 3 mL minimum DNA Mutation Analysis4 Protein C Activity 1777 Functional PC Activity, 1 mL frozen plasma (3.2% sodium citrate [light blue-top clotting tube]); 0.5 mL minimum Protein C Activity and Antigen 8757(X) Functional PC, Two 1-mL aliquots frozen plasma (3.2% sodium citrate PC antigen [light blue-top tube]); two 0.5-mL aliquots minimum

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Test Name Test Aliases Panel Components Specimen Requirements Codes Protein C Activity with Reflex to 8754(X) Functional PC, If Protein C Activity is <70%, Protein C Antigen will be Two 1-mL aliquots frozen plasma (3.2% sodium citrate Protein C Antigen PC antigen performed. [light blue-top tube]); two 0.5-mL aliquots minimum Protein C and Protein S, 39457(X) PC, PS Protein C Activity, Protein S Activity 1 mL frozen plasma (3.2% sodium citrate [light blue-top Functional tube]); 1 mL minimum Protein C and S Activity with 7942 PC, PS If Protein C Activity is abnormally low, Protein C Antigen is Two 2-mL aliquots frozen plasma (3.2% sodium citrate Reflex to Protein C and/or performed. If Protein S Activity is abnormal low, Protein S [light blue-top tube]); two 1-mL aliquots minimum S Antigen Antigen is performed Protein C Antigen 4948 PC antigen 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Protein S Activity 1779 Functional PS, 1 mL frozen plasma (3.2% sodium citrate [light blue-top PS Activity, clotting tube]); 0.5 mL minimum Protein S Activity with Reflex to 8838(X) Functional PS, Two 1-mL aliquots frozen plasma (3.2% sodium citrate Protein S Antigen, Total PS antigen [light blue-top tube]); two 0.5-mL aliquots minimum Protein S Activity with Reflex to 17494(X) Functional PS, If Protein S Activity is abnormally low, Protein S Antigen 2 mL frozen plasma (3.2% sodium citrate [light blue-top Protein S Antigen, Total and Free PS antigen Total and Free will be performed at an additional charge tube]); 1 mL minimum Protein S Antigen, Free 10170 PS, FPS 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Protein S Antigen, Total 5165 PS, TPS 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Protein S Antigen, Total and Free 36457 PS, FPS, TPS 2 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); 1 mL minimum Prothrombin Factor II 20210G>A 17909 Prothrombin gene 5 mL room-temperature whole blood (EDTA [lavender-top Mutation Analysis4 mutation tube]); 3 mL minimum Thrombophilia DNA Mutation 17907 FV Leiden mutation, Factor V (Leiden) and Prothrombin 5 mL room-temperature whole blood (EDTA [lavender-top Analysis4 prothrombin gene (Factor II) Gene Analysis tube]); 3 mL minimum mutation Thrombophilia Screen II, 11327 Hypercoagulable/ Factor V (Leiden) Mutation with Reflex to HR2 Mutation Three 1-mL aliquots frozen plasma (3.2% sodium citrate Inherited4 thrombophilia Analysis; Prothrombin Gene Mutation; Antithrombin III [light blue-top tube]) and 5 mL whole blood (EDTA evaluation Activity; Protein C Activity; Protein S Antigen, Free [lavender-top tube]); three 0.5-mL aliquots plasma and 5 mL whole blood minimum

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Antiphospholipid Antibody and Lupus Anticoagulant

Test Name Test Aliases Panel Components Specimen Requirements Codes Antiphospholipid 14890(X) Beta-2-Glycoprotein I Antibodies (IgG, IgA, IgM), Phosphatidylserine 5 mL refrigerated platelet-poor plasma (3.2% sodium citrate Antibody Panel Antibodies (IgG, IgA, IgM), Cardiolipin Antibodies (IgG, IgA, IgM) [light blue-top tube]); 2.3 mL minimum Antiphospholipid 19872(X) Cardiolipin and Beta-2-Glycoprotein I Antibodies (IgG, IgA, IgM); 3 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); Syndrome Diagnostic Panel Lupus Anticoagulant Evaluation with Reflex 2 mL minimum Beta-2-Glycoprotein I 30340(X) 3 mL room-temperature plasma (3.2% sodium citrate Antibodies (IgG, IgA, IgM) [light blue-top tube]); 1.5 mL minimum Beta-2-Glycoprotein I Antibody 36552 1 mL room-temperature plasma (3.2% sodium citrate (IgA) [light blue-top tube]); 0.5 mL minimum Beta-2-Glycoprotein I Antibody 36554 1 mL room-temperature plasma (3.2% sodium citrate (IgG) [light blue-top tube]); 0.5 mL minimum Beta-2-Glycoprotein I Antibody 36553 1 mL room-temperature plasma (3.2% sodium citrate (IgM) [light blue-top tube]); 0.5 mL minimum Cardiolipin Antibodies (IgG, IgM) 36333 1 mL room-temperature plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Cardiolipin Antibody (IgA) 4661 1 mL room-temperature plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Cardiolipin Antibody (IgG) 4662 1 mL room-temperature plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum Cardiolipin Antibody (IgM) 4663 1 mL room-temperature plasma (3.2% sodium citrate [light blue-top tube]); 0.5 mL minimum DRVVT Screen with Reflex to 15780(X) 2 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); DRVVT Confirm and DRVVT 0.5 mL minimum 1:1 Mix Lupus Anticoagulant Evaluation 7079 LA PTT-LA with reflex to Hexagonal Phase Confirm and Thrombin 3 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); with Reflex Time; DRVVT Screen with reflex to DRVVT Confirm and mixing 2 mL minimum study; Interpretation Phosphatidylserine Antibodies 10062 1 mL room-temperature plasma (3.2% sodium citrate (IgG, IgA, IgM) [light blue-top tube]); 0.5 mL minimum Phosphatidylserine Antibodies 36595 1 mL room-temperature plasma (3.2% sodium citrate (IgG, IgM) [light blue-top tube]); 0.5 mL minimum Phosphatidylserine Antibody 10163(X) 1 mL room-temperature plasma (3.2% sodium citrate (IgA) [light blue-top tube]); 0.5 mL minimum Prothrombin Antibodies 11265 Factor II, FII 1 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); (IgG, IgM) 0.3 mL minimum PTT-LA with Reflex to Hexagonal 17408 1.5 mL frozen plasma (3.2% sodium citrate [light blue-top tube]); Phase Confirmation 0.5 mL minimum

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Women’s Health

Test Name Test Aliases Panel Components Specimen Requirements Codes Menorrhagia Screen 19649(X) aPTT; PT with INR; Factor XI Activity; von Willebrand Three 1-mL aliquots frozen plasma (3.2% sodium citrate without Consultation Factor Antigen; Ristocetin Cofactor Activity; [light blue-top tube]); two 1-mL aliquots minimum Factor VIII Activity von Willebrand 19790(X) aPTT; Factor VIII Activity, Clotting; von Willebrand Factor Four 1-mL aliquots frozen plasma (3.2% sodium citrate Comprehensive Panel Antigen; Ristocetin Cofactor; von Willebrand Antigen, [light blue-top tube]); four 0.75-mL aliquots minimum Multimeric Analysis; Interpretation von Willebrand 15540(X) aPTT; Factor VIII Activity, Clotting; von Willebrand Four 1-mL aliquots frozen plasma (3.2% sodium citrate Comprehensive Panel 21 Factor Antigen; Ristocetin Cofactor; von Willebrand [light blue-top tube]); four 0.75-mL aliquots minimum Factor Collagen Binding Assay; von Willebrand Antigen, Multimeric Analysis von Willebrand Screen 90271 aPTT; Factor VIII Activity, Clotting; von Willebrand Factor Three 2-mL aliquots frozen plasma (3.2% sodium citrate Antigen; Ristocetin Cofactor [light blue-top tube])

1 This test was performed using a kit that has not been cleared or approved by the FDA. The analytical performance characteristics of this test have been determined by Quest Diagnostics. This test should not be used for diagnosis without confirmation by other medically established means. 2 This test was developed and its performance characteristics have been determined by Quest Diagnostics. Performance characteristics refer to the analytical performance of the test. 3 This test is performed pursuant to a license agreement with Orchid Biosciences Inc. 4 This test was developed and its performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the FDA. The FDA has determined that such clearance or approval is not necessary. Performance characteristics refer to the analytical performance of the test. Reflex tests are performed at an additional charge and are associated with an additional CPT code. Multiple test codes may be used for a test. Please refer to your local business unit or the online Directory of Services (QuestDiagnostics.com/TestCenter).

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Tests Affected by Anticoagulants It’s important to note that certain anticoagulant drugs can interfere with clot-based assays, as shown in the table below.

Test Name Test Warfarin Heparin (UFH or LMWH)1 Thrombin Inhibitors1 Factor Xa Inhibitors1 Codes (i.e. Dabigatran, (i.e. Rivaroxaban, Argatroban) Apixaban, Endoxaban) aPTT 763 Prolonged Prolonged Prolonged Prolonged PT/INR 8847 Prolonged Little to no effect2 Normal to prolonged Prolonged Fibrinogen Activity (Clauss Method) 461 No effect No effect (LMWH) to No effect or falsely low No effect falsely low (UFH) Thrombin Clotting Time 883 No effect Prolonged Prolonged No effect aPTT-based factor assays 347, 352, FIX: Physiologic decrease No effect to inhibitor No effect to inhibitor No effect to inhibitor (FVIII Activity, FIX Activity, Factor XI Activity, 360, 362 pattern pattern pattern Factor XII Activity) FVIII/XI/XII: No effect PT-based factor assays2 331, 344, FII/VII/X: Physiologic decrease No effect2 No effect to inhibitor No effect to inhibitor (FII Activity, FV Activity, Factor VII Activity, Factor X Activity) 346, 359 pattern or falsely low pattern Factor V: No effect Antithrombin Activity (Thrombin-Based Method) 216 No effect No effect to decrease3 May falsely increase No effect Antithrombin Antigen 5158 No effect No effect to decrease3 No effect No effect Protein C Antigen 4948 No effect to physiologic decrease No effect No effect No effect Protein C Activity 1777 Physiologic decrease UFH: No effect May falsely increase May falsely increase (Clot-Based Method) LMWH: may falsely increase at higher levels Protein S Antigen, Free 10170 Physiologic decrease No effect No effect No effect Protein S Antigen, Total 5165 No effect to physiologic decrease No effect No effect No effect Protein S Activity 1779 Physiologic decrease May falsely increase at May falsely increase May falsely increase (Clot-Based Method) values ~>1.0 IU/mL Activated Protein C Resistance 22 No effect No effect Unable to obtain assay No effect (FV-dependent Prothrombin Venom-Based Method) endpoint1 Lupus Anticoagulant, (LA); (PTT-LA with reflex to 7079 Screening tests may be prolonged Possible to misclassify Possible to misclassify Possible to misclassify Hexagonal Phase Confirm & reflex to Thrombin Time; but confirmatory tests include as LA positive (panel as LA positive (panel may as LA positive DRVVT Screen with reflex to DRVVT Confirm and DRVVT mixing studies which correct for may include Thrombin include Thrombin Time, 1:1 Mixing Study) warfarin-induced factor deficiencies Time, which will detect which will detect thrombin UFH/LMWH) inhibitors) Antiphospholipid Antibody Panel 14890 No effect No effect No effect No effect

1. Therapeutic levels. Potential interference dependent on drug concentration. 2. Reagent contains a heparin neutralizer. 3. UFH may decrease levels physiologically but no assay interference.

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Commonly Misordered Tests Knowing when to order the correct test or differentiating between two tests with similar names can be difficult. We realize the importance of ordering the correct test the first time and have identified several tests as being “Commonly Misordered.” The list below provides a summary of those tests and includes the test name, test code and appropriate use for each test. If you would like to see a full description for any test, please go to QuestDiagnostics.com/TestCenter.

Commonly Misordered Tests Test Codes Appropriate Use for Test Code Specified Factor II 331 Factor II: bleeding risk 17909 Factor II Prothrombin 20210G>A Mutation Analysis: thrombotic risk Factor V 344 Factor V Activity: bleeding risk 17900 Factor V Leiden Mutation: thrombotic risk Factor VIII 347 Factor VIII: bleeding/thrombotic risk 16049 Factor VIII Chromogenic: bleeding/thrombotic risk in patients with lupus anticoagulant or other inhibitors 40083 Factor VIII Inhibitor Panel 14461 Factor XIII: bleeding risk - common clerical error Factor X 359 Factor X Activity: bleeding risk 10663 Factor X Chromogenic: warfarin monitoring for patients with lupus anticoagulant 30292 Anti Xa: monitoring heparin or LMWH Anti Xa (Xa Inhibition) 16103 Fondaparinux (Arixtra) 90981 Rivaroxaban 30292 Heparin (UFH or LMWH) Ristocetin 4459 Ristocetin Cofactor Activity Test not offered Ristocetin-induced platelet aggregation: not offered due to 4-hr specimen stability Serotonin 14627 Serotonin Release Assay: HIT/HITT 818 Serotonin: neuroendocrine hormone PF4 (anti PF4) 414 Anti-PF4: heparin-induced platelet antibody Test send out PF4: platelet factor 4

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Specimen Collection Instructions For multiple tube collection, Preparing Platelet-Poor Plasma for Coagulation Testing follow the order below for blood drawing:

Collection Cap Color 1 2 3 Tube

Draw First Blood Cultures

Fill Vacutainer to the Immediately after collection, mix specimen Centrifuge at 1500 x g for 15 minutes. minimum required fill line. by gentle inversion four times. Note: The Citrate Tube specimen must be placed in the freezer within 60 minutes of inversion.

4 5 6 or Serum Tube

Plasma Plasma Buffy coat Buffy coat Cell layer Heparin Tube Cell layer

Remove plasma without disturbing Cap and centrifuge plasma at Use a plastic pipette to transfer plasma to the buffy coat or cell layer at 1500 x g for 15 minutes. a plastic tube without disturbing the buffy the bottom of the tube. coat or cell layer. EDTA Tube

7 8 9 Draw Fluoride Last (Glucose) Tube

Watch our brief step-by-step video on proper technique for Transfer plasma to plastic storage Label tubes with patient FREEZE specimens. specimen collection. tubes. Ideally PPP platelet count information and specimen Do not use a self-defrosting freezer. should not exceed 10,000/ul. type (i.e. citrate plasma).

Bleeding and Tests Affected Commonly Specimen Collection Pediatric Contact Us Thrombosis Test Menu by Anticoagulants Misordered Tests Instructions Reference Ranges Pediatric Reference Ranges

Age 1 to 5 yr 6 to 10 yr 11 to 16 yr Adult Coagulation Tests Mean (boundary) Mean (boundary) Mean (boundary) Mean (boundary)

PT (s) 11 (10.6-11.4) 11.1 (10.1-12.1) 11.2 (10.2- 12.0) 12 (11.0-14.0) INR 1.0 (0.96-1.04) 1.01 (0.91-1.11) 1.02 (0.93-1.10) 1.10 (1.0-1.3) aPTT (s) 30 (24-36) 31 (26-36) 32 (26-37) 33 (27-40) Fibrinogen (g/L) 2.76 (1.70-4.05) 2.79 (1.57-4.0) 3.0 (1.54-4.48) 2.78 (1.56-4.0) II (U/mL)** 0.94 (0.71-1.16)* 0.88 (0.67-1.07)* 0.83 (0.61-1.04)* 1.08 (0.70-1.46) V (U/mL)** 1.03 (0.79-1.27) 0.90 (0.63-1.16)* 0.77 (0.55-0.99)* 1.06 (0.62-1.50) VII (U/mL)** 0.82 (0.55-1.16)* 0.85 (0.52-1.20)* 0.83 (0.58-1.15)* 1.05 (0.67-1.43) VIII (U/mL)** 0.90 (0.59-1.42) 0.95 (0.58-1.32) 0.92 (0.53-1.31) 0.99 (0.50-1.49) VWF (U/mL) 0.82 (0.60-1.20) 0.95 (0.44-1.44) 1.00 (0.46-1.53) 0.92 (0.50-1.58) IX (U/mL)** 0.73 (0.47-1.04)* 0.75 (0.63-00.89)* 0.82 (0.59-1.22)* 1.09 (0.55-1.63) X (U/mL)** 0.88 (0.58-1.16)* 0.75 (0.55-1.01)* 0.79 (0.50-0.97)* 1.06 (0.70-1.52) XI (U/mL)** 0.97 (0.56-1.50) 0.86 (0.52-1.20) 0.74 (0.50-0.97)* 0.97 (0.67-1.27)

XII (U/mL)** 0.93 (0.64-1.29) 0.92 (0.60-1.40) 0.81 (0.34-1.37)* 1.08 (0.52-1.64)

*Values that are significantly different from adults’. **One U/mL is approximately equal to 100% Activity or % Normal. Pediatric and adult reference ranges published by Andrew et al.1 Refer to QuestDiagnostics.com/TestCenter for test-specific ranges.

Reference: 1. Andrew M, Vegh P, Johnston M, et al. Maturation of the hemostatic system during childhood. Blood. 1992;80:1998-2005. Reprinted with permission from the American Society of Hematology.

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