The prothrombin time test belongs to a group of blood tests that assess the clotting ability of blood. The test is also known as the pro time or PT test.
Purpose
The PT test is used to monitor patients taking certain medications as well as to help diagnose clotting disorders.
Diagnosis
Patients who have problems with delayed blood clotting are given a number of tests to determine the cause of the problem. The prothrombin test specifically evaluates the presence of factors VIIa, V, and X, prothrombin, and fibrinogen. Prothrombin is a protein in the liquid part of blood (plasma) that is converted to thrombin
bin as part of the clotting process. Fibrinogen is a type of blood protein called a globulin; it is converted to fibrin during the clotting process. A drop in the concentration of any of these factors will cause the blood to take longer to clot. The PT test is used in combination with the partial thromboplastin time (PTT) test to screen for hemophilia and other hereditary clotting disorders.
Monitoring
The PT test is also used to monitor the condition of patients who are taking warfarin (Coumadin). Warfarin is a drug that is given to prevent clots in the deep veins of the legs and to treat pulmonary embolism. It interferes with blood clotting by lowering the liver's production of certain clotting factors.
Description
A sample of the patient's blood is obtained by venipuncture. The blood is collected in a tube that contains sodium citrate to prevent the clotting process from starting before the test. The blood cells are separated from the liquid part of blood (plasma). The PT test is performed by adding the patient's plasma to a protein in the blood (thromboplastin) that converts prothrombin to thrombin. The mixture is then kept in a warm water bath at 37°C for one to two minutes. Calcium chloride is added to the mixture in order to counteract the sodium citrate and allow clotting to proceed. The test is timed from the addition of the calcium chloride until the plasma clots. This time is called the prothrombin time.
Preparation
The doctor should check to see if the patient is taking any medications that may affect test results. This precaution is particularly important if the patient is taking warfarin, because there are a number of medications that can interact with warfarin to increase or decrease the PT time.
Aftercare
Aftercare consists of routine care of the area around the puncture mark. Pressure is applied for a few seconds and the wound is covered with a bandage.
Risks
The primary risk is mild dizziness and the possibility of a bruise or swelling in the area where the blood was drawn. The patient can apply moist warm compresses.
Normal results
The normal prothrombin time is 11-15 seconds, although there is some variation depending on the source of the thromboplastin used in the test. (For this reason, laboratories report a normal control value along with patient results.) A prothrombin time within this range indicates that the patient has normal amounts of clotting factors VII and X.
Abnormal results
A prolonged PT time is considered abnormal. The prothrombin time will be prolonged if the concentration of any of the tested factors is 10% or more below normal plasma values. A prolonged prothrombin time indicates a deficiency in any of factors VII, X, V, prothrombin, or fibrinogen. It may mean that the patient has a vitamin K deficiency, a liver disease, or disseminated intravascular coagulation (DIC). The prothrombin time of patients receiving warfarin therapy will also be prolonged—usually in the range of one and one half to two times the normal PT time. A PT time that exceeds approximately two and a half times the control value (usually 30 seconds or longer) is grounds for concern, as abnormal bleeding may occur.
BOOKS
Jandl, J. H. Blood: Textbook of Hematology. New York: Little, Brown and Co., 1996.
Merck Manual of Medical Information, ed. Robert Berkow, et al. Whitehouse Station, NJ: Merck Research Laboratories, 1997.
