The Partial Thromboplastin Time with Kaolin: A Simple Screening Test for First Stage Plasma Clotting Factor Deficiencies

Proctor, Robert R.; Rapaport, Samuel I.

doi:10.1093/ajcp/36.3.212

Cited by 952 publications

(255 citation statements)

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Section: Hematologic and Coagulation Studiesmentioning

confidence: 99%

“…The following tests were done in fresh plasma: euglobulin lysis time 19 ; thrombin time with 5 U per milliliter of thrombin 20 ; prothrombin time with activated rabbit brain thromboplastin; and partial thromboplastin time. 21 Fibrinogen, 22 prothrombin (Factor II), 23 accelerator globulin (Factor V), 24 anti-hemophilic globulin (Factor VIII) 25 and plasma thromboplastin component (Factor IX) 26 were assayed in frozen plasma after storage at −80°C .For the estimation of fibrin split products (FSP) 2-ml samples of blood were collected in glass tubes containing 20 U of kallikrein trypsin inhibitor (Trasylol Because the rejection of a kidney by a presensitized canine recipient can be ameliorated with a prior graft from the same donor, 7 it was planned to transplant temporarily a kidney and if necessary a spleen or liver before the definitive renal homograft was placed. Consequently, the donor left kidney, which had a small polar infarct, was removed first and revascularized in the usual way in the recipient right extraperitoneal space.…”

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confidence: 99%

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Clotting Changes, Including Disseminated Intravascular Coagulation, during Rapid Renal-Homograft Rejection

Starzl¹,

Boehmig²,

Amemiya³

et al. 1970

N Engl J Med

115

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One of two patients in whom early homograft rejection developed after renal transplantation had many antidonor antibodies before operation. By the measurement of gradients across intracorporeal and extracorporeal homografts in this patient, the new kidneys were shown to sequester host immunoglobulins, platelets, white cells and clotting factors. Moreover, the renal venous blood then contained fibrinolytic activity. This presensitized recipient, as well as a second patient who did not have detectable preformed humoral antibodies, gave evidence from clinical observation and from the various clotting tests of disseminated intravascular coagulation with fibrinolysis and a severe bleeding, diathesis. Immunofluorescent and histologic studies revealed a laying down of fibrin in the homograft vessels that continued in some cases to cortical necrosis of the transplanted kidneys or, alternatively, receded at the time fibrinolysis occurred. The variety of rejection seen in these patients has been characterized as an immunologically induced coagulopathy.When a kidney homograft is revasculurized in a recipient who is presensitized to donor antigens there is a substantial risk of either accelerated or hyperacute rejection of the transplant. [1][2][3][4][5] The mechanism of the immediate destruction has been disputed. Two years ago in this journal, a clinical report from our institutions 5 suggested that an instantaneous antigen-antibody reaction or other mechanisms could precipitate a coagulopathy like that of the Shwartzman reaction and that the consequent fibrin thrombi could occlude the renal micro-vasculature and be responsible for cortical necrosis. The principal evidence in support of this contention was from special histologic examinations. Unfortunately, clotting assays were not obtained in these patients.A subsequent publication by Colman and Merrill and their associates confirmed that there were massive fibrin deposits in two human kidneys that had been hyperacutely rejected by apparently presensitized recipients. 6 However, no systemic clotting changes could be detected in either of their patients, nor was there an arteriovenous gradient of any of the measured coagulation factors across the kidney in the most completely studied of these cases. Because of the negative findings, there was no satisfactory explanation even for the local in intravascular coagulation that the authors postulated and no evidence whatever that there had been a systemic clotting disorder at any time. In contrast, studies from our laboratories have shown that noteworthy alterations in local or systemic coagulation regularly occur in presensitized dogs after the transplantation of the kidney, liver or spleen. 7 The same thing has been seen in two recently treated patients whose renal homografts failed promptly. In both these human recipients, studies obtained revealed consumption of clotting factors either within the kidney or systemically, as well as fibrinolysis and a bleeding diathesis. MethodsThe technics of renal transplantation a...

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Section: Hematologic and Coagulation Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

Clotting Changes, Including Disseminated Intravascular Coagulation, during Rapid Renal-Homograft Rejection

Starzl¹,

Boehmig²,

Amemiya³

et al. 1970

N Engl J Med

115

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“…The PTT was essentially a modification of the re-calcification time by removing platelets from plasma and by adding negatively charged phospholipids to speed up coagulation. In 1961 Proctor and Rapaport [4] improved the design of the PTT by adding particulate substances (kaolin) in order to activate massively the contact factors (this is where the APTT name comes from) of the coagulation cascade and to shorten the coagulation time. Like the PT, the APTT also underwent many changes over years, mainly entailing the standardization of phospholipids and activators to make it more suitable for investigating patients with hemophilia and allied disorders, to monitor UFH and to screen for LACs.…”

Section: Introductionmentioning

confidence: 99%

How to report results of prothrombin and activated partial thromboplastin times

Tripodi

Lippi

Plebani

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Prothrombin time (PT) and activated partial thromboplastin time (APTT) are the most widely used tests to investigate coagulation abnormalities. Varied result reporting have been introduced over the years for the two tests, thus making their interpretation rather confusing in different clinical settings. PT results have been reported as clotting time, percentage activity, PT-ratio (patient-tonormal clotting time) and as international normalized ratio (INR). The INR scale has been devised to harmonize results stemming from different thromboplastins from patients on treatment with vitamin K antagonists. Therefore, there are some theoretical and evidence-based considerations that make the INR formally invalid when the test is used to analyze patients in other clinical settings. Unfortunately, this limitation has been frequently overlooked, and the INR has been (and is currently) used as a universal system of results harmonization. The APTT has been historically reported as clotting time or as ratio (patient-to-normal clotting time). In this opinion paper we review the current state-of-the-art for result reporting and attempt to give practical guidance on how PT and APTT should be reported in different clinical conditions for which the tests are requested.

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“…The interesting story about the test and the people behind it was described in a recommended historical sketch by White to commemorate the 50th anniversary in 2003 [17]. Proctor and Rapaport [18] reported an important refinement in 1961 that led to the APTT test. Their modification involved the addition of kaolin to the partial thromboplastin reagent, which replaced the test tube glass surface as activator.…”

Section: Abstract: Pre-analytical Variables Aptt Coagulation Analysesmentioning

confidence: 99%

Considerations in the laboratory assessment of haemostasis

2010

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Summary. This review outlines a number of key issues when performing laboratory testing of homeostasis. The effect pre-analytical variables have on the reliability and consistency of screening tests is often forgotten due to a lack of understanding and awareness. This can be improved through educating healthcare professionals who are involved in taking blood for assessment. Recent advances in coagulation testing have not enabled laboratories to replace the Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) screening tests with more advanced assays and they continue to play an important role with the advantage of being easily automated. However, there are many analysers on the market, each with varying sensitivity to coagulation defects and it is important to keep this in mind when interpreting results.

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The Partial Thromboplastin Time with Kaolin: A Simple Screening Test for First Stage Plasma Clotting Factor Deficiencies

Cited by 952 publications

References 2 publications

Clotting Changes, Including Disseminated Intravascular Coagulation, during Rapid Renal-Homograft Rejection

Clotting Changes, Including Disseminated Intravascular Coagulation, during Rapid Renal-Homograft Rejection

How to report results of prothrombin and activated partial thromboplastin times

Considerations in the laboratory assessment of haemostasis

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