Sign in →

Test Code ADIC Disseminated Intravascular Coagulation/Intravascular Coagulation and Fibrinolysis (DIC/ICF) Profile, Plasma


Ordering Guidance


This profile will not detect all bleeding disorders, such as von Willebrand disease. For patients with amyloidosis and bleeding symptoms, obtaining a limited bleeding diathesis profile is suggested.

 

Multiple coagulation profile tests are available. See Coagulation Profile Comparison for testing that is performed with each profile.



Shipping Instructions


Send the 5 aliquot tubes in the same shipping container.



Necessary Information


 



Specimen Required


Specimen Type: Platelet-poor plasma

Patient Preparation: Patient should not be receiving Coumadin or heparin. If so, note on request.

Collection Container/Tube: Light-blue top (3.2% sodium citrate)

Submission Container/Tube: 5 Plastic vials

Specimen Volume: 5 mL in 5 plastic vials, each containing 1 mL

Collection Instructions:

1. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing.

2. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.

3. Aliquot plasma (1 mL per aliquot) into 5 separate plastic vials, leaving 0.25 mL in the bottom of centrifuged vial.

4. Freeze plasma immediately (no longer than 4 hours after collection) at -20° C or, ideally -40° C or below.

Additional Information: Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.


Forms

1. Coagulation Patient Information (T675)

2. If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.

Secondary ID

603306

Useful For

Establishing laboratory evidence of disseminated intravascular coagulation

Profile Information

Test ID Reporting Name Available Separately Always Performed
ADICI DIC/ICF Prof Interpretation No Yes
APTSC Activated Partial Thrombopl Time, P Yes, (order APTTP) Yes
TTSC Thrombin Time (Bovine), P Yes Yes
CLFIB Fibrinogen, Clauss, P Yes, (order FIBTP) Yes
DIMER D-Dimer, P Yes, (order DDITT) Yes
PTSC Prothrombin Time (PT), P Yes, (order PTTP) Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
RTSC Reptilase Time, P Yes No
DRV1 Dilute Russells Viper Venom Time, P Yes, (order DRVI1) No
PNP Platelet Neutralization Procedure No No
PTMSC PT Mix 1:1 No No
APMSC APTT Mix 1:1 No No
DRV2 DRVVT Mix No No
DRV3 DRVVT Confirmation No No
F_2 Coag Factor II Assay, P Yes No
FACTV Coag Factor V Assay, P Yes No
F_7 Coag Factor VII Assay, P Yes No
F8A Coag Factor VIII Activity Assay, P Yes No
F_9 Coag Factor IX Assay, P No No
F_10 Coag Factor X Assay, P Yes No
F_11 Coag Factor XI Assay, P Yes No
F_12 Coag Factor XII Assay, P Yes No
PTFIB PT-Fibrinogen, P Yes No
SOLFM Soluble Fibrin Monomer No No
HEXLA HEX LA, P No No

Testing Algorithm

Initial testing includes prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen, D-dimer, and disseminated intravascular coagulation/intravascular coagulation and fibrinolysis (DIC/ICF) profile interpretation.

 

If PT is greater than 13.9 seconds, then PT mix will be performed at an additional charge.

 

If aPTT is 38 seconds or more, then aPTT mix and dilute Russell's viper venom time (dRVVT) will be performed at an additional charge.

 

If dRVVT ratio is 1.20 or more, then dRVVT mix and dRVVT confirmation will be performed at an additional charge.

 

If fibrinogen is less than 150 mg/dL, or clinically indicated, then PT-fibrinogen will be performed at an additional charge.

 

If D-dimer is greater than 500 ng/mL fibrinogen equivalent units, then soluble fibrin monomer will be performed at an additional charge.

 

If aPTT mix is 38 or more seconds and TT is less than 35.0 seconds (no evidence of heparin), then platelet neutralization procedure will be performed at an additional charge.

 

If TT is 25.0 or more seconds, then reptilase time will be performed at an additional charge.

Method Name

PTSC, APTSC, TTSC: Optical Clot-Based

CLFIB: Clauss

DIMER: Latex Immunoassay (LIA)

ADICI: Medical Interpretation

Reporting Name

DIC/ICF Prof

Specimen Type

Plasma Na Cit

Specimen Minimum Volume

See Specimen Required

Specimen Stability Information

Specimen Type Temperature Time Special Container
Plasma Na Cit Frozen 14 days

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject

Clinical Information

Disseminated intravascular coagulation (DIC) and intravascular coagulation and fibrinolysis (ICF), collectively termed DIC/ICF, is a consumptive hemorrhagic and microthrombotic disorder that manifests as clinical bleeding or thrombosis. Conditions associated with DIC/ICF can include sepsis, trauma (eg, head injury, severe tissue injury), obstetric complications (eg, amniotic fluid embolism, abruptio placentae), malignancies, vascular disorders (eg, hemangiomas, aortic aneurysm), and immunologic disorders.

 

These disorders can cause thrombin and fibrin intravascular formation, which can result in widespread fibrin deposition contributing to thrombosis and organ failure or, conversely, can result in bleeding due to consumption of coagulation proteins and platelets. DIC/ICF is not a disease, rather it is a syndrome that is secondary to an underlying disorder.

Reference Values

An interpretive report is provided.

Interpretation

An interpretive report will be provided when testing is completed, noting presence or absence of disseminated intravascular coagulation and intravascular coagulation and fibrinolysis.

Method Description

Prothrombin Time:

The prothrombin time (PT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is incubated and combined with a PT reagent containing recombinant human tissue factor, synthetic phospholipids, calcium chloride, polybrene, and buffer. Tissue thromboplastin (phospholipid and recombinantly-derived human tissue factor) and calcium are added to citrated plasma, bypassing the action of platelets and factors VIII, IX, XI, and XII in the intrinsic procoagulant pathway. The tissue thromboplastin-factor VII/VIIa complex activates factor X. Activated factor X (factor Xa) forms a complex with factor Va, calcium, and phospholipid to activate factor II (prothrombin) to thrombin. Thrombin then acts on fibrinogen (factor I) to form fibrin, which clots, providing the assay endpoint (the "prothrombin time").(Package insert: HemosIL RecombiPlasTin 2G. Instrumentation Laboratory Company; R4, 03/2019)

 

Activated Partial Thromboplastin Time:

The activated partial thromboplastin time (aPTT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is combined and incubated with an aPTT reagent containing phospholipid, a negatively charged contact factor activator, and buffer. After a specified incubation time, calcium is added to trigger the coagulation process in the mixture. Subsequently, the time to clot formation is measured optically using a wavelength of 671 nm. Mixing studies (see APMSC / Activated Partial Thromboplastin Time [APTT] Mix 1:1, Plasma) using normal pooled plasma are performed on samples with a prolonged aPTT to assist in discriminating between factor deficiency states and coagulation inhibitors, unless further testing is not indicated.(Package insert: HemosIL SynthASil. Instrumentation Laboratory Company; R11, 06/2017)

 

Thrombin Time:

The thrombin time (TT) assay is performed on the Instrumentation Laboratory ACL TOP. Patient plasma is combined with a bovine thrombin reagent containing bovine albumin, calcium chloride, and buffer, immediately triggering the coagulation process in the mixture. Time to clot formation is measured optically using a wavelength of 405 nm.(Package insert: HemosIL Thrombin Time. Instrumentation Laboratory Company; R1, 12/2018)

 

Fibrinogen:

The Clauss fibrinogen assay is performed using the HemosIL Fibrinogen-C kit on the Instrumentation Laboratory ACL TOP. Patient plasma, containing fibrinogen, is mixed with reagent containing excess thrombin. The excess thrombin converts the fibrinogen in the patient plasma to fibrin. The amount of time it takes to form a clot is inversely proportional to the amount of fibrinogen present in the patient plasma.(Package insert: HemosIL Fibrinogen-C. Instrumentation Laboratory Company; R7, 06/2017)

 

D-Dimer:

D-dimer is assayed in plasma by adding polystyrene latex particles coated with monoclonal antibodies specific for D-dimer domain. The latex particles agglutinate in the presence of soluble fibrin degradation products containing the D-dimer domain. The degree of agglutination is directly proportional to the concentration of D-dimer in the sample and is determined by measuring the decrease of transmitted light caused by the aggregates (turbidimetric immunoassay).(Package insert: HemosIL D-Dimer HS 500. Instrumentation Laboratory Company; R6, 04/2018)

Day(s) Performed

Monday through Friday

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

See Individual Test IDs

CPT Code Information

85610-PTSC

85730-APTSC

85670-TTSC

85379-DIMER

85384-CLFIB

85390-26-ADICI

85210-Factor II (if appropriate)

85220-Factor V (if appropriate)

85230-Factor VII (if appropriate)

85240-Coagulation factor VIII assay (if appropriate)

85250-Factor IX (if appropriate)

85260-Factor X (if appropriate)

85270-Factor XI (if appropriate)

85280-Factor XII (if appropriate)

85366-Soluble fibrin monomer (if appropriate)

85385-PT-Fibrinogen (if appropriate)

85597-Platelet neutralization for lupus inhibitor (if appropriate)

85598-Hex LA (if appropriate)

85611-PT mix 1:1 (if appropriate)

85613-DRVVT (if appropriate)

85613-DRVVT mix (if appropriate)

85613-DRVVT confirm (if appropriate)

85635-Reptilase time (if appropriate)

85732-APTT mix 1:1 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
ADIC DIC/ICF Prof 98125-8

 

Result ID Test Result Name Result LOINC Value
CLFIB Fibrinogen, Clauss, P 48664-7
TTSC Thrombin Time (Bovine), P 46717-5
603323 Reviewed by 18771-6
DIMER D-Dimer, P 48067-3
APTSC Activated Partial Thrombopl Time, P 14979-9
PTSEC Prothrombin Time (PT), P 5902-2
INRSC INR 6301-6
603182 DIC/ICF Prof Interpretation 69049-5