Inhibitor screen (1:1 mix), plasma
Fill tube completely.
Test is useful for evaluating a prolonged PTT and/or PT. (Presence of heparin should first be excluded.)
Patient’s plasma is mixed with pooled normal plasma (1:1 mix) and PTT and/or PT are performed. If the patient has a factor deficiency, the post-mixing PTT/PT will be normal (correction). If an inhibitor is present, the post-mixing PTT/PT will remain prolonged (no correction) immediately and/or after incubation (at 37°C for 1 or 2 hours).
Positive in: Presence of inhibitor: Antiphospholipid antibodies (lupus anticoagulant, LAC), factor-specific antibodies, or both.
Negative in: Factor deficiencies.
See evaluation of isolated prolongation of PTT (Figure 9–28).
Lupus anticoagulant is a nonspecific inhibitor, which prolongs PTT on inhibitor screen (1:1 mix study) both immediately and after 1–2 hours' incubation. 1-hour to 2-hour incubation period is often needed to detect factor-specific antibodies with low in vitro affinities (eg, post-mixing PTT is normal immediately, but is prolonged after incubation).
Dependent on the result of the 1:1 mix study, follow-up testing is often performed, ie, dilute Russell’s viper venom time (DRVVT) if lupus anticoagulant is suspected or factor assays if factor deficiency is considered.
Ortel TL. Antiphospholipid syndrome: laboratory testing and diagnostic strategies. Am J Hematol 2012;87:S75. [PMID: 22473619]
Sakurai Y et al. Acquired hemophilia A: a frequently overlooked autoimmune hemorrhagic disorder. J Immunol Res 2014;2014:320674. [PMID: 24741588]
Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Learn more.