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Test Code DRV3 Dilute Russell Viper Venom Time (DRVVT) Confirmation, Plasma


Additional Testing Requirements


Serum anticardiolipin antibody testing (CLPMG / Phospholipid [Cardiolipin] Antibodies, IgG and IgM, Serum) and anti-beta-2 glycoprotein I (B2GMG / Beta-2 Glycoprotein 1 Antibodies, IgG and IgM, Serum) antibody testing should also be performed in conjunction with coagulation-based testing for LA to enhance detection of different types of antiphospholipid antibodies.



Specimen Required


Only orderable as part of a reflex. For more information see:

ALUPP / Lupus Anticoagulant Profile, Plasma

ALBLD / Bleeding Diathesis Profile, Limited, Plasma

AATHR / Thrombophilia Profile, Plasma

APROL / Prolonged Clot Time Profile, Plasma

ADIC / Disseminated Intravascular Coagulation/Intravascular Coagulation and Fibrinolysis (DIC/ICF) Profile, Plasma


Secondary ID

602178

Useful For

Confirming the presence or absence of lupus anticoagulants (LA)

 

Identifying LA that do not prolong the activated partial thromboplastin time (APTT)

 

Evaluating unexplained prolongation of the APTT or prothrombin time clotting tests

 

Distinguishing LA from a specific coagulation factor inhibitor or coagulation factor deficiencies

Method Name

Only orderable as part of a reflex. For more information see:

ALUPP / Lupus Anticoagulant Profile, Plasma

ALBLD / Bleeding Diathesis Profile, Limited, Plasma

AATHR / Thrombophilia Profile, Plasma

APROL / Prolonged Clot Time Profile, Plasma

ADIC / Disseminated Intravascular Coagulation/Intravascular Coagulation and Fibrinolysis (DIC/ICF) Profile, Plasma

Reporting Name

DRVVT Confirmation

Specimen Type

Plasma Na Cit

Specimen Stability Information

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

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject

Clinical Information

Dilute Russell viper venom time (DRVVT) confirmation is only performed when the DRVVT screen is abnormally prolonged. Refer to DRV1 / Dilute Russell Viper Venom Time (DRVVT), Plasma for interpretation of results.

Reference Values

Only orderable as part of a reflex. For more information see:

ALUPP / Lupus Anticoagulant Profile, Plasma

ALBLD / Bleeding Diathesis Profile, Limited, Plasma

AATHR / Thrombophilia Profile, Plasma

APROL / Prolonged Clot Time Profile, Plasma

ADIC / Disseminated Intravascular Coagulation/Intravascular Coagulation and Fibrinolysis (DIC/ICF) Profile, Plasma

 

<1.20

Normal ranges for children: not clearly established, but similar to normal ranges for adults, except for newborn infants whose results may not reach adult values until 3 to 6 months of age.

Interpretation

Dilute Russell viper venom time (DRVVT) screen ratio (<1.20):

A normal DRVVT screen ratio (<1.20) indicates that lupus anticoagulant (LA) is not present or not detectable by this method (but might be detected with other methods).

 

An abnormal DRVVT screen ratio (DRVVT screen ratio >1.20) may suggest presence of LA, however, other possibilities include:

-Deficiencies or dysfunction of factors I (fibrinogen), II, V, or X, congenital or acquired

-Inhibitors of factor V, or occasionally by inhibitors of factor VIII, or other specific or nonspecific inhibitors

-Anticoagulation therapy effects (see Cautions)

 

Further evaluation consists of performing mixing studies with an equal volume of normal pooled plasma (DRVVT 1:1 mix) to investigate the possibility of coagulation factor deficiency (suggested by DRVVT mix ratio <1.20) and to evaluate inhibition (suggested by DRVVT mix ratio ≥1.20) and mixing patient plasma with DRVVT reagent enriched in phospholipid (DRVVT confirmatory reagent) (DRVVT mix and DRVVT confirmation ratios).

 

Possible combination of results include the following:

-DRVVT screen ratio ≥1.20, DRVVT mix ratio <1.20, and DRVVT confirmation ratio <1.20:

No evidence of LA. These data may reflect anticoagulation therapy effects or other (congenital or acquired) coagulopathy.

-DRVVT screen ratio ≥1.20, DRVVT mix ratio ≥1.20, and DRVVT confirmation ratio <1.20:

The prolonged and inhibited DRVVT (DRVVT screen and mix ratios) may reflect presence of a specific factor inhibitor (eg, factor V inhibitor), anticoagulation therapy effects or other nonspecific inhibitors as can be seen with monoclonal protein disorders, lymphoproliferative disease etc. Although LA cannot be conclusively excluded, the DRVVT confirmation ratio of ≤1.20 makes this less likely.

-DRVVT screen ratio ≥1.20, DRVVT mix ratio <1.20, and DRVVT confirmation ratio ≥1.20:

Although mixing study of the prolonged DRVVT screen and mix ratios provides no evidence of inhibition, additional phospholipid shortens the clotting time (DRVVT confirmation ratio), suggesting presence of LA.

-DRVVT screen ratio ≥1.20, DRVVT mix ratio ≥1.20, and DRVVT confirmation ratio ≥1.20:

The data are consistent with presence of LA, provided anticoagulant effect can be excluded (see Cautions).

 

Additional tests to evaluate abnormal DRVVT results include activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time. Abnormalities observed with these tests may be further evaluated with normal plasma mixing studies, the platelet neutralization procedure (for APTT), and coagulation factor assays may sometimes be needed. All of these reflexive testing procedures, together with Coagulation Consultant interpretation, are included in Mayo Clinic's Coagulation Consultation test panels:

ALUPP / Lupus Anticoagulant Profile, Plasma

ALBLD / Bleeding Diathesis Profile, Limited, Plasma

AATHR / Thrombophilia Profile, Plasma

APROL / Prolonged Clot Time Profile, Plasma

ADIC / Disseminated Intravascular Coagulation/Intravascular Coagulation and Fibrinolysis (DIC/ICF) Profile, Plasma

 

DRVVT assays ordered as a single, stand-alone test should be interpreted within patient clinical context and close attention to medication use by patient (see Cautions).

Clinical Reference

1. Proven A, Bartlett RP, Moder KG, et al: Clinical importance of positive test results for lupus anticoagulant and anticardiolipin antibodies. Mayo Clin Proc 2004 April;79(4):467-475

2. Gastineau DA, Kazmier FJ, Nichols WL, Bowie EJ: Lupus anticoagulant: an analysis of the clinical and laboratory features of 219 cases. Am J Hematol 1985 Jul;19(3):265-275

3. Brandt JT, Triplett DA, Alving B, Sharrer I: Criteria for the diagnosis of lupus anticoagulant: an update. On behalf of the Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the ISTH. Thromb Haemost 1995 Oct;74(4);1185-1190

4. Arnout J, Vermylen J: Current status and implications of autoimmune antiphospholipid antibodies in relation to thrombotic disease. J Thromb Haemost 2003 May;1(5):931-942

5. Pengo V, Tripodi A, Reber G, et al: Update of the guidelines for lupus anticoagulant detection. Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost 2009;7:1737-1740. doi: 10.1111/j.1538-7836.2009.03555.x

6. CLSI Laboratory Testing for Lupus Anticoagulant; Approved Guideline. CLSI document H60-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2014

Day(s) and Time(s) Performed

Monday through Friday

Analytic Time

2 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

85613

LOINC Code Information

Test ID Test Order Name Order LOINC Value
DRV3 DRVVT Confirmation 50410-0

 

Result ID Test Result Name Result LOINC Value
RVCR3 DRVVT Confirm Ratio 50410-0