Hema 2 Lab Module 5: Ethanol Gelation Test and Mixing Studies

Ethanol Gelation Test

Simple and inexpensive test for the screening Disseminated Intravascular Coagulation (DIC).

Detects soluble fibrin monomers

What is the primary usefulness of Ethanol Gelation Test?

room temperature

At what temperature is Ethanol Gelation Test done?

It will inhibit the formation of gel or

precipitate

Prevents false negative result

What happens if Ethanol Gelation test is done at 37C?

Clot or Precipitation formation

What is the positive result of Ethanol Gelation Test?

Disseminated Intravascular Coagulation (DIC)

It is a secondary fibrinolysis disorder

Disseminated Intravascular Coagulation (DIC)

Clotting and bleeding simultaneously happen

50% ethanol and 0.1N NaOH

What is/are the reagent in Ethanol Gelation Test?

Citrated Platelet-poor Plasma (CPPP)

What is the specimen for Ethanol Gelation Test?

Citrated whole blood is spun at 2500 x g for 15 minutes

How to prepare CPPP?

Paracoagulant

What does the ethanol do/ role of ethanol in the ethanol gelation test?

Raises the pH of the plasma to >7.7 to prevent precipitation of fibrinogen (prevent false positive).

What does the 0.1N NaOH do/ role of 0.1N NaOH in the ethanol gelation test?

9

(Ethanol Gelation Test)

Add __ drops of patient's plasma to a test tube

1

(Ethanol Gelation Test)

Add __ drop of 0.1N NaOH to the Citrated PPP

50%

(Ethanol Gelation Test)

Allow mixture to stand at 3 minutes. Add 3 drops of ___% ethanol to the mixture.

- True positive result (screens DIC)

- pH of the plasma upon addition of ethanol have

lowered down < 7.7 or NaOH was exhausted, and

the clot seen at the bottom of the tube is brought

about with the precipitation of the fibrinogen.

(Ethanol Gelation Test)

Clot formation after 10 minutes can be either?

1

(Ethanol Gelation Test)

If clot formation is formed, it is ALWAYS a protocol to add ___ drop of 0.1N NaOH to the clotted mixture.

raise again the pH of the mixture to <7.7.

(Ethanol Gelation Test)

Purpose of adding 1 more drop of 0.1N NaOH?

Clot was brought about by the precipitation of fibrinogen, and the result is reported as negative

(Ethanol Gelation Test)

If clot dissipates after adding 1 more drop of 0.1N when there was a clot formation, what does that mean?

True positive result, there is massive production of soluble fiber monomers (hypercoagulability) and

positively screens for DIC

(Ethanol Gelation Test)

If clot did not dissipate/ it persists after adding 1 more drop of 0.1N when there was a clot formation, what does that mean?

To differentiate a factor deficiency from the presence of a circulating inhibitor/circulating anticoagulant.

What is the main usefulness of Mixing Studies?

Factor Identification Test/Substitution Test/PT and aPTT Substitution Studies

What are the other names of Mixing Studies?

There is a specific factor deficient or missing in the patient's abnormal plasma.

(Mixing Studies)

If there are changes in the result of PT and aPTT after the patient's abnormal plasma was mixed with the reagents for this test, what does that indicate?

plasma that gave prolonged PT or aPTT

(Mixing Studies)

What does abnormal plasma pertain to?

replenish all factors except tissue factor (normally seen in intact sub-endothelium)

(Mixing Studies)

What is normal plasma?

Circulating inhibitor

(Mixing Studies)

If the addition of normal plasma did not correct, what does that indicate?

Proceed to KCT, PNP, dRVVT, dTTI

(Mixing Studies)

If the addition of normal plasma did not correct, what do you do next?

1:1

Normal pooled plasma

Adsorbed plasma

Aged serum

(Mixing Studies)

An APTT and/or PT is performed on the patient's plasma diluted __:__ with?

1 ___

2 ___

3 ____

factors V, VIII, XI, XII

(Mixing Studies)

What factors does the adsorbed plasma replenish?

factors VII, IX, X, XI, XII

(Mixing Studies)

What factors does the aged serum replenish?