Prothrombin Time (PT)

Prothrombin Time: PT
Measures the function of the Extrinsic
Pathway.
Sensitive to Factors II, IV, V, VII, X.
PT reagent contains Calcium ions and
Thromboplastin from brain tissue (Rabbit).
Thromboplastin (Tissue Factor) proteinlipid complex found in tissues outside
blood vessels.

When is it ordered?
Used to monitor oral anticoagulant therapy
(Warfarin / Coumadin).
When a patient who is not taking anti-coagulant
drugs has signs or symptoms of a bleeding
disorder
When a patient is to undergo an invasive
medical procedure, such as surgery, to ensure
normal clotting ability.

PT Reagent Calibration
Reagents are calibrated against standard PT reagent
established by the WHO.
ISI = International Sensitivity Index.
ISI is assigned by the manufacturer for each lot of
reagent using reference material from WHO.
The lower the ISI the more sensitive the Reagent
ISI of 1.8 to 2.4 = Low sensitivity
ISI of 1.4 to 1.8 = Average sensitivity
ISI 1.0 to 1.4 = High Sensitivity

PT: INR Values

INR = International Normalized Ratio.
MNP = Mean Normal Plasma.

INR = (PT / MNP)ISI

An INR of 1.0 means that the patient PT is
normal.
An INR greater than 1.0 means the clotting time
is elevated.

Expected PT Values
Mean Normal Plasma = 10 to 14 seconds.
Mean Normal Plasma value varies with PT
sensitivity.
A high sensitivity (Low ISI) PT will give a high
normal PT value (13 to 15 seconds).
Oral anticoagulant monitoring = Target INR of
2.0 to 3.0.
INR of greater than 5 or 5.5 = unacceptable high
risk of bleeding.

Performing a PT test

Pre-warm PT reagent and sample to 37 oC

Add 100 L sample to tube
Add 200 L of PT reagent to tube
Start timer
Record time to clot in seconds
Calculate INR