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Specimen Collection Manual and Test Catalog

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APTT, HEPARIN NEUTRALIZED

Geisinger Epic Procedure Code:  LAB1773    Geisinger Epic ID:  31808

SPECIMEN COLLECTION
Specimen type: 

Platelet-poor plasma


Preferred collection container: 
Alternate collection container: 
Other size blue-top (3.2% sodium citrate) tubes (e.g., 1.8 mL, 4.5 mL)
Specimen required: 

1 mL


Special notes: 
  • If the patient’s hematocrit (HCT) is >55%, the volume of anticoagulant in the tube must be adjusted. Contact a performing location for sodium citrate adjusted tubes or instruction for how to adjust the sodium citrate.
  • When possible, use fresh venipuncture.
  • Avoid prolong tourniquet time (< 1 minute) and hemolysis during collection as this will alter results.
  • If indwelling catheter or butterfly collection device must be used, draw sample from a non-heparinized lumen or flush the line with 5 mL of saline and discard the first 10 mL of blood.
  • Tubes should be >90% filled.
  • Immediately mix gently after collection by inverting the tube end over end 5 to 6 times. Avoid vigorous mixing or additional inversion. Observe for the presence of clots or hemolysis and recollect if observed.


SPECIMEN PROCESSING
Processing instructions: 

Centrifuge specimen immediately at designated time and speed to obtain platelet-poor plasma (<10,000/µL). Using a plastic pipette, carefully remove plasma from cells, avoiding platelet/buffy layer by leaving a thin layer of plasma on top the cells. The centrifuged plasma should be aliquoted (1 mL per aliquot) into clearly labeled polypropylene tubes. The number of tests ordered will determine the aliquots needed. Check the residual specimen for clot and if present discard sample and redraw specimen. If plasma is icteric, lipemic or hemolyzed a lab comment should be generated to notify staff. Freeze upright in non-thaw freezer.


Transport temperature: 

Plasma (on or off packed cells): room temperature 
Plasma off cells: Frozen on dry ice


Specimen stability: 

Room temperature: 1 hour if heparin therapy 
Frozen (plasma) -20°C: 2 weeks 
Frozen (plasma) -70°C: 6 months


Rejection criteria: 

Clotted, hemolyzed, improperly filled tubes, improper anticoagulant ratio (HCT >55% and citrate not adjusted), refrigerated specimens, or stability exceeded. 

Note: Specimen suspected of thawing in transport, indicated by slant in aliquot or specimen in lid of tube, will have testing performed, and the comment “interpret results with caution as thawing suspected” added to results.



TEST DETAILS
Reference interval: 

21-38 seconds


Critical values/courtesy alerts: 
Greater than 120 seconds
Additional information: 

Anticoagulation Impact on Coagulation Tests


CPT code(s):  85730, 85525
Note: The billing party has sole responsibility for CPT coding.  Any questions regarding coding should be directed to the payer being billed.
The CPT codes provided by GML are based on AMA guidelines and are for informational purposes only.

Test includes: 

APTT


Methodology: 
Mechanical clot-based
Synonyms: 

APTT, PTT, Heparin absorption, Heparin neutralization


Clinical significance: 

Heparin neutralized APTT is used evaluate the intrinsic and common clotting pathways in sample containing high doses of heparin. If APTT is abnormal and heparin neutralized APTT is normal or partially corrects, it indicates heparin was present in the plasma sample. It is ordered on patients that are known to be receiving heparin and may need an accurate assessment of APTT. It is also added on to other coagulation testing (lupus profile, mixing study, etc.) if heparin is suspected in the plasma sample.


Doctoral Director(s): 
Michelle Grant DO
Review Date:  03/04/2025

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