Hypercoagulable States Workup

Clinic A/P, adults, Clinic A/P, Peds, HEMATOLOGY-ONCOLOGY, Hospital A/P, Adults, Hospital A/P, Peds

***Proteins C, S and ATIII levels are affected by acute thrombosis and anticoagulation. Therefore, it’s best to check levels at least two weeks after completing the anticoagulation course.

Hereditary Factors Hypercoagulable State Initial Workup Test Confirmation / Comments
Factor V Leiden  Activated Protein C Resistance Assay Factor V Leiden SNP analysis (also called Factor 5 Leiden mutation studies)
Prothrombin gene G20210A mutation  Prothrombin gene mutation (Factor II DNA Analysis)  No confirmation needed. This is a PCR test.
Protein C deficiency  Protein C functional assay (Protein C activity)  Protein C antigenic assay
Protein S deficiency  Protein S functional assay (Protein S activity)  Protein S antigenic assay
Antithrombin III deficiency  Antithrombin III (ATIII) functional assay (Antithrombin III Activity)  ATPIII antigenic assay
Hyperhomocysteinemia  Homocysteine total level  MTHFR SNP analysis
Elevated Factor VIII activity  Factor VIII levels (Factor 8 Activity)
Dysfibrinogenemia  Fibrinogen
Acquired Factors that are tested
 Antiphospholipid Syndrome PT / APTT
Hexagonal phase Phospholipid Neutralization		 Lupus anticoagulant testing: DRVVT, PNP, and incubated APTT mixing study.
 Anticardiolipin antibody assay (IgG, IgM, IgA)  B2GP1 antibody assay

SNP = Single nucleotide polymorphism. MTHFR = Methylenetetrahydrofolate reductase. DRVVT= dilute Russell Viper Venom Test. PNP = platelet neutralization procedure;

Include these (need to check):
Antithrombin III Antigenic
Protein C antigenic
Protein S antigen studies (Protein S antigenic free and total)

The Hypercoagulable States’ initial orders in our EHR

Acquired factors

  • Major surgery / trauma
  • Immobilization (e.g. hip/knee replacement, prolonged cast, stroke, bedridden because of illness)
  • Solid or hematologic malignancies
  • Pregnancy
  • Oral contraceptives
  • Estrogen replacement
  • Antiphospholipid antibody syndrome
  • Heparin-induced thrombocytopenia (HIT)
  • Paroxysmal nocturnal hemoglobinuria (PNH)–especially when the patient has a mesenteric thrombus.
  •  Obesity
  • Nephrotic syndrome
  • Smoking

NB: Protein C, S, ATIII deficiency, Hyperhomocysteinemia, elevated factor VIII activity, and Dysfibrinogenemia can be hereditary or acquired.

 

What is the anticardiolipin test?

“A cardiolipin antibodies test looks for a certain kind of antibody in your blood. The antibodies are IgG (immunoglobulin G), IgA (immunoglobulin A), and IgM (immunoglobulin M). They are antibodies that form in response to cardiolipins. Cardiolipin is a phospholipid, or a kind of fat in the blood. The levels of these antibodies are often high in people with abnormal blood clotting, autoimmune diseases like lupus, or repeated miscarriages.” The university of Rochester.

 

Reference

Blood Res. 2014 Jun; 49(2): 85–94. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090343/

https://www.machaondiagnostics.com/panel/hypercoagulability-panel/ Last Accessed 11/11/2017

https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=cardiolipin_antibody

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