individual tests Includes anticardiolipin Panel IgG, IgM & IgA plus anti-beta 2 glycoprotein I. APTT (1:1 mix) 1 mL frozen plasma call (206) 598-6066 Daily Activated Protein 1 mL frozen plasma negative M, Th Modified Factor V method. C Resistance (APCR) Test plasma not affected by oral anticoagulant therapy, heparin or lupus anticoagulant. Part of venous thrombosis panel. Anticardiolipin 0.5 mL serum Test performed in IgG/IgM Immunology Division, call (206) 598-6066. Antithrombin 1 mL frozen plasma 75 - 125 % M, Th Chromogenic method. Part of Activity 1-29 days 41 - 125% venous thrombosis panel. 1 month 48 - 125% Patient should be off heparin for at least 3 days prior to testing. Arterial Thrombosis 3 mL frozen plasma see individual tests Weekly Panel includes PAI-1, tPA Panel 0.5 mL frozen serum antigen, lupus inhibitor, and C-reactive protein. Collect blood between 0700 and 1000. The patient should not have an ongoing thrombosis and 2 months should have elapsed since the thrombotic event. C-Reactive Protein 0.5 mL frozen serum Test performed in (high sensitivity) Immunology Division, call (206) 598-6066. 17 Chromogenic Factor 1 mL frozen plasma 50 - 150% Part of a Factor VIII Thrombosis panel. Also, used to measure Factor VIII in the presence of a Lupus anticoagulant. D-Dimer 1 mL frozen plasma < 1 U/mL and PAI-1 antigen is 30%. PLATELET AGGREGATION PANEL Method: Platelet aggregometry using whole blood lumiaggregation. The patient should be off aspirin and other NSAID drugs for ten days prior to testing. Platelet aggregation studies are used to assist in the diagnosis of hereditary and acquired qualitative platelet disorders. Platelet aggregation studies are most useful in patients with a platelet-like bleeding syndrome, often characterized by immediate bleeding after trauma or surgery and spontaneous mucosal bleeding with a normal platelet count. Platelet aggregation studies are not useful in the evaluation of patients with low platelet counts or in patients with thrombotic syndromes. Platelet aggregation is tested using arachidonic acid, ADP, collagen and ristocetin. The total amount of aggregation and the rate of aggregation are evaluated. Aggregation is detect as an increased in the impedance of the sample measured by an electrode immersed in the whole blood sample. Storage pool release from platelets is assessed by detecting ATP release using lucipherase. As the platelets aggregate in response to an aggregating agonist the resistance across the electrode increases and is registered as an Ohms reading on the Ohms meter. The granular release function of the platelets is measured by the luminescence of a lumiphore added to the reaction mix. The lumiphore will luminesce when platelets release ATP in response to an aggregation initiating agonist. This luminescence is detected and quantified by a photo-multiplier. The 24 patient Luminescence in the patient sample is compared to that obtained when a standard ATP is introduced into patient blood without platelet activation. This allows the calculation of ATP concentration released during platelet activation. Arachidonic acid aggregation requires normal activity of the cyclooxygenase enzyme in platelets. Aspirin (acetylsalicylic acid) and other cyclooxygenase inhibitors such as NSAID’s block platelet aggregation using arachidonic acid up to 8-10 days. Primary aggregation with ADP and collagen are absent in patients with homozygous thrombasthenia and diminished in heterozygous thrombasthenia. Variable abnormalities in the platelet release function are seen in storage pool disease, aspirin-like defect and in patients who have taken aspirin or related drugs. Decreased response to ristocetin is suggestive of von Willebrand disease or Bernard Soulier disease. If desired epinephrine aggregation may be measured using a photo-optical methodology. Both rate and total amount of aggregation are evaluated. Abnormal response to epinephrine occurs in myeloproliferative disorders but also occurs in 25% of the normal population. Therefore, while the epinephrine aggregation is available it is not a part of the usual Platelet Aggregation Panel. THROMBOELASTOGRAPH PANEL The thromboelastograph is a rapid empirical screen