PROLONGED THROMBIN TIME

1. When using the tilt tube hand method, tubes are tipped only until the clotting time is
60 seconds. Why? Because only very low fibrinogen or excess heparin cause the
clotting times to be greater than 60 seconds.
2. The Thrombin Time test is prolonged when the fibrinogen level is less than 100 mg/dl
(hypofibrinogenema). It is also prolonged in the presence of large quantities of
fibrinogen degradation products (FDPs) or excess heparin.
3. Dysfibrinogenemia (abnormal fibrinogen) or afibrinogenemia (absence of fibrinogen)
may cause a prolonged thrombin time. Pathologic antithrombins may also prolong the
thrombin time.
4. Simply put:
Fibrinogens less than 100 mg/dl will prolong a thrombin time greater than 60
seconds, since the endpoint is a fibrinogen clot.
Since very low fibrinogens are rare, when a thrombin time is greater than 60
seconds, it is presumed to be due to heparin.

SHORTENED THROMBIN TIME

1. The Thrombin Time is only shortened in the presence of Dextrans, which are plasma
expanders used in the operating room.

THROMBIN TIME (TT) TEST

1. The thrombin Time test is performed by mixing prewarmed thrombin solution (usually
bovine thrombin) with prewarmed plasma at 37 degrees C and obtaining the clotting
time in seconds. The thrombin reagent cleaves fibrinogen, forming fibrin polymers
(which are observed as a clot).
2. Different proportions of thrombin solution and plasma can be used, but using 0.2 ml
each makes end points easy to detect.
3. Depending on the thrombin concentration used, "normal values" may vary widely.
Thus, a very low concentration of thrombin might give a "normal value" of 30 seconds,
and a very high thrombin concentration a "normal value" or 2 or 3 seconds.

ADJUSTING THE THROMBIN CONCENTRATION

1. A common practice, however, is to adjust the thrombin concentration to give a clotting

time of 15.0 + or - 1.0 second with pooled normal plasma.
2. With this system, the thrombin concentration is low enough that the test is very
sensitive to the presence of low concentrations of heparin.

PRACTICE QUESTIONS
1. The Thrombin Time test only measures the conversion of fibrinogen to a fibrin clot after
the addition of excess thrombin to undiluted plasma.
True
The Thrombin Time test only measures the conversion of fibrinogen to a
fibrin clot after the addition of excess thrombin to undiluted plasma . It
does not rely on any of the clotting factors located above fibrinogen in the
plasma coagulation scheme.
2. The Thrombin Time test is prolonged:
A. When the fibrinogen level is less than 100 mg/dl
B. In the presence of fibrinogen degradation products (FDPs) or heparin
C. Due to dysfibrinogenemia or afibrinogenemia
D. In the presence of Dextrans

 The correct answers are A, B, and C.

The Thrombin Time test is prolonged when the fibrinogen level is less than
100 mg/dl (hypofibrinogenema).
It is also prolonged in the presence of large quantities of fibrinogen
degradation products (FDPs) or excess heparin. Dysfibrinogenemia
(abnormal fibrinogen) or afibrinogenemia (absence of fibrinogen) may
cause a prolonged thrombin time.
Pathologic antithrombins may also prolong the thrombin time.
3. Depending on the thrombin concentration used, "normal values" may vary widely.
True
Depending on the thrombin concentration used, "normal values" may vary
widely. Thus, a very low concentration of thrombin might give a "normal
value" of 30 seconds , and a very high thrombin concentration a "normal
value" or 2 or 3 seconds.

SUMMARY
1. The Thrombin Time test is one of three tests (along with the Prothrombin Time test and
the Activated Partial Thromboplastin Time test) done as part of the screening for
abnormalities in the plasma coagulation system.
2. The Thrombin Time test only measures the conversion of fibrinogen to a fibrin clot after
the addition of excess thrombin to undiluted plasma. It does not rely on any of the
clotting factors located above fibrinogen in the plasma coagulation scheme.
3. The Thrombin Time test is performed by mixing prewarmed thrombin solution (usually
bovine thrombin) with prewarmed plasma at 37 degrees C and obtaining the clotting
time in seconds. The thrombin reagent cleaves fibrinogen, forming fibrin polymers.
4. Different proportions of thrombin solution and plasma can be used, but using 0.2 ml
each makes end points easy to detect.
5. Depending on the thrombin concentration used, "normal values" may vary widely.
Thus, a very low concentration of thrombin might give a "normal value" of 30 seconds,
and a very high thrombin concentration a "normal value" or 2 or 3 seconds.
6. The Thrombin Time test is prolonged when the fibrinogen level is less than 100 mg/dl
(hypofibrinogenema). It is also prolonged in the presence of large quantities of
fibrinogen degradation products (FDPs) or excess heparin. Dysfibrinogenemia
(abnormal fibrinogen) or afibrinogenemia (absence of fibrinogen) may cause a
prolonged thrombin time. Pathologic antithrombins may also prolong the thrombin
time.

PRINCIPLE

1. Plasma is clotted by the addition of bovine or porcine thrombin which has been
adjusted to give a clotting time of 14-16 seconds with normal plasma.
2. The thrombin time measures the conversion of fibrinogen to fibrin polymer.