Test Catalog

Test Id : A2PI

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Alpha-2 Plasmin Inhibitor, Plasma

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosing congenital alpha-2 plasmin inhibitor deficiencies (rare)

 

Providing a complete assessment of disseminated intravascular coagulation, intravascular coagulation and fibrinolysis, or hyperfibrinolysis (primary fibrinolysis), when measured in conjunction with fibrinogen, fibrin D-dimer, fibrin degradation products, soluble fibrin monomer complex, and plasminogen

 

Evaluating liver disease

 

Evaluating the effects of fibrinolytic or antifibrinolytic therapy

Method Name
A short description of the method used to perform the test

Chromogenic

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Alpha-2 Plasmin Inhibitor, P

Aliases
Lists additional common names for a test, as an aid in searching

Alpha 2 Plasmin Inhibitor

Antiplasmin

Antiplasmin, Functional, Plasma

Functional Antiplasmin

Plasmin Inhibitor

Specimen Type
Describes the specimen type validated for testing

Plasma Na Cit

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Specimen Type: Platelet-poor plasma

Collection Container/Tube: Light-blue top (3.2% sodium citrate)

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions:

1. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing.

2. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.

3. Aliquot plasma into a plastic vial leaving 0.25 mL in the bottom of centrifuged vial.

4. Freeze plasma immediately (no longer than 4 hours after collection) at -20 degrees C or, ideally, -40 degrees C or below.

Additional Information:

1. Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.

2. Each coagulation assay requested should have its own vial.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Plasma Na Cit Frozen 14 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosing congenital alpha-2 plasmin inhibitor deficiencies (rare)

 

Providing a complete assessment of disseminated intravascular coagulation, intravascular coagulation and fibrinolysis, or hyperfibrinolysis (primary fibrinolysis), when measured in conjunction with fibrinogen, fibrin D-dimer, fibrin degradation products, soluble fibrin monomer complex, and plasminogen

 

Evaluating liver disease

 

Evaluating the effects of fibrinolytic or antifibrinolytic therapy

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Alpha-2 plasmin inhibitor (antiplasmin) is synthesized in the liver with a biological half-life of approximately 3 days. It inactivates plasmin, the primary fibrinolytic enzyme responsible for remodeling the fibrin thrombus, and binds fibrin together with factor XIIIa making the clot more difficult to lyse. Absence of alpha-2 plasmin inhibitor results in uncontrolled plasmin-mediated breakdown of the fibrin clot and is associated with increased risk of bleeding.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Adults: 80-140%

Normal, full-term, and premature infants may have mildly decreased levels (> or =50%) that reach adult levels within 90 days postnatal.*

*See Pediatric Hemostasis References section in Coagulation Guidelines for Specimen Handling and Processing.

Interpretation
Provides information to assist in interpretation of the test results

Patients with congenital homozygous deficiency (with levels of <10%) are clinically affected (bleeding). Heterozygous individuals having levels of 30% to 60% of mean normal activity are usually asymptomatic.

 

Lower than normal levels may be suggestive of consumption due to activation of plasminogen and its inhibition by alpha-2 plasmin inhibitor.

 

The clinical significance of high levels of alpha-2 plasmin inhibitor is unknown.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Alpha-2 plasmin inhibitor results are potentially affected by the following:

-Heparin, unfractionated or low-molecular-weight >4 U/mL

-Alpha-2-macroglobulin >7 mg/mL; potentially leading to a falsely increased result

-Hemoglobin >200 mg/dL

-Bilirubin >20 mg/dL

-Triglycerides >1000 mg/dL

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Lijnen HR, Collen D. Congenital and acquired deficiencies of components of the fibrinolytic system and their relation to bleeding or thrombosis. Blood Coagul Fibrinolysis. 1989;3(2):67-77. doi:10.1016/0268-9499(89)90034-9

2. Francis RB Jr. Clinical disorders of fibrinolysis: A critical review. Blut. 1989;59(1):1-14

3. Aoki N. Hemostasis associated with abnormalities of fibrinolysis. Blood Rev. 1989;3(1):11-17

4. Singh S, Saleem S, Reed GL. Alpha2-antiplasmin: The devil you don't know in cerebrovascular and cardiovascular disease. Front Cardiovasc Med. 2020;7:608899

Method Description
Describes how the test is performed and provides a method-specific reference

This assay is performed using the HemosIL Plasmin Inhibitor Kit on the Instrumentation Laboratory ACL TOP Family. Patient plasma, containing alpha-2 plasmin inhibitor, is mixed with reagent containing excess plasmin. Plasmin activity in the reagent is rapidly inhibited by alpha-2 plasmin inhibitor. Residual plasmin activity is then measured using an amidolytic activity assay, in which residual plasmin lyses a synthetic chromogenic substrate and subsequently releases para-nitroanline (detected at 405 nm) to a level that is inversely proportional to the amount of alpha-2 plasmin inhibitor in the sample.(Teger-Nilsson AC, Friberger P, Gyzander E. Determination of a new rapid plasmin inhibitor in human blood by means of a plasmin specific tripeptide substrate. Scand J Clin Lab Invest. 1977;37(5):403-409; package insert: HemosIL Plasmin Inhibitor. Instrumentation Laboratory; 11/2019)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

3 to 7 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

7 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

85410

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
A2PI Alpha-2 Plasmin Inhibitor, P 27810-1
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
A2PI Alpha-2 Plasmin Inhibitor, P 27810-1

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports