Activated Partial

Thromboplastin Time (APTT)

Coagulation Cascade
Intrinsic Pathway:
Factors VIII, IX, XI, and XII.
Activated on surface of exposed
endothelium.
Complexes form on platelet
phospholipids.

Common Pathway:
Factors X, V, prothrombin and fibrinogen

Activated Partial Thromboplastin Time

APTT test measures
the intrinsic pathway factors
& common pathway factors

Reagent contains phospholipids and a surface activator

Calcium Chloride reagent added to start the reaction.
APTT reagent mimics the surface of a platelet.

Expected APTT Values

Normal Range: 25 to 43 seconds
Slightly Elevated: 45 to 65 seconds
Extremely Elevated > 70 seconds

When is it ordered?
When a patient presents with unexplained
bleeding or bruising,
It may be ordered as part of a pre-surgical
evaluation for bleeding tendencies,
When a patient is on intravenous (IV) or
injection heparin therapy, the APTT is
ordered at regular intervals to monitor the
degree of anticoagulation.

What does the test result mean?

APTT prolongations are caused by either
factor deficiencies (especially of factors
VIII, IX, XI, and/or XII),
Inhibitors (most commonly, lupus
anticoagulants)
Therapeutic anticoagulants such as heparin

Sample
One blue top (citrate) tube; 3.2% citrate
tubes
Ratio of anticoagulant to blood should be
1:9

Procedure
Prewarm sufficient volumes of CaCl2 (0.025 M)
to 37oC
Label 2 test & 2 control tubes
Add 0.1 ml of sample or control to the
appropriate tube
Add 0.1 ml of APTT reagent to each tube
Incubate at 37oC for 5 minutes
Add 0.1 ml of prewarmed CaCl2 & start stop
watch immediately
Record the time at which clot is detected