For Tomorrow!

COAGULATION FACTORS
Factor I Fibrinogen
Factor II Prothrombin
Factor III Tissue Factor
Factor IV Calcium
Factor V Proaccelerin
Factor VII Proconvertin
Factor VIII:C Antihemophilic Factor
Factor IX Plasma thromboplastin
Factor X Stuart-Prower factor
Factor XI Plasma thromboplastin antecedent (PTA)
Factor XII Hageman Factor
DESCRIPTION: The coagulation proteins respond to blood vessel injury in a chain of events. The intrinsic
and extrinsic pathways of secondary hemostasis are a series of reactions involving the substrate protein
fibrinogen, the coagulation factors (also known as enzyme precursors or zymogens), nonenzymatic
cofactors (Ca2), and phospholipid.
INDICATIONS:
• Identify the presence of inherited
bleeding disorders
• Identify the presence of qualitative or
quantitative factor deficiency
RESULT
Decreased in:
• Congenital deficiency
• Disseminated intravascular coagulation
• Liver disease
Nursing Implications and Procedure
Pretest:
➤ Obtain a history of the patient’s complaints, including a list of known
allergens.
➤ Obtain a history of the patient’s hematopoietic and hepatobiliary systems, any bleeding disorders,
and results of previously performed tests and procedures, especially bleeding time, clotting time,
complete blood count, partial thromboplastin time, platelets, and prothrombin time. For related tests,
refer to the hematopoietic and hepatobiliary system tables.
➤ Obtain a list of medications the patient is taking, including anticoagulant therapy, acetylsalicylic acid,
herbals, and nutraceuticals known to affect coagulation. It is recommended that use of these substances
be discontinued 14 days before dental or surgical procedures. The requesting health care practitioner
and laboratory should be advised if the patient regularly uses these products so that their effects can be
taken into consideration when reviewing results.
➤ There are no food, fluid, or medication restrictions unless by medical direction.
➤ Review the procedure with the patient.
➤ Inform the patient that specimen collection takes approximately 5 to 10 minutes.
Intratest:
➤ Direct the patient to breathe normally and to avoid unnecessary movement.
➤ Observe standard precautions and follow the general guidelines. Perform a venipuncture, and collect
the specimen in a 5-mL blue-top tube. Important note: Two different concentrations of sodium citrate
preservative are currently added to blue-top tubes for coagulation studies: 3.2% and 3.8%. The National
Committee for Clinical Laboratory Standards (NCCLS) guideline for sodium citrate is 3.2. Laboratories
establish reference ranges for coagulation testing based on numerous factors, including sodium citrate
concentration, test equipment, and test reagents. It is important to inquire from the laboratory which
concentration it recommends, because each concentration will have its own specific reference range.
When multiple specimens are drawn, the blue-top tube should be collected after sterile (i.e., blood
culture) and red-top tubes. When coagulation testing is the only work to be done, an extra red-top tube
should be collected before the blue top tube to avoid contaminating the specimen with tissue
thromboplastin.
➤ Label the specimen, and promptly transport it to the laboratory. The NCCLS recommendation for
processed and unprocessed samples stored in unopened tubes is that testing should be completed
within 1 to 4 hours of collection.
Post-test:
➤ Observe venipuncture site for bleeding or hematoma formation. Apply pressure bandage.
➤ Instruct the patient to report immediately any signs of unusual bleeding or bruising.
➤ Inform the patient with decreased factor levels of the importance of taking precautions against
bruising and bleeding. These precautions may include the use of a soft bristle toothbrush, use of an
electric razor, avoidance of constipation, avoidance of acetylsalicylic acid and similar products, and
avoidance of intramuscular injections.
➤ Evaluate test results in relation to the patient’s symptoms and other tests performed. Related
laboratory tests include alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase,
clot retraction, copper, plasminogen, protein C, prothrombin time, activated partial thromboplastin
time, and vitamin K.
HOMOCYSTEINE
DESCRIPTION: Homocysteine is an amino acid formed from methionine. Normally homocysteine is

rapidly remetabolized in a biochemical pathway that requires vitamin B12 and folate, preventing the
buildup of homocysteine in the blood. Excess smooth muscle cells lining the arterial wall to multiply,
promoting atherosclerosis.
INDICATIONS:
• Evaluate inherited enzyme deficiencies that result in homocystinuria
• Evaluate the risk for cardiovascular disease
• Evaluate the risk for venous thrombosis
RESULT
Increased in:
• Chronic renal failure
• Folic acid deficiency
• Homocystinuria
• Vitamin B12 deficiency
• Coronary artery disease
Nursing Implications and Procedure
Pretest:
➤ Obtain a history of the patient’s complaints, including a list of known allergens.
➤ Obtain a history of the patient’s cardiovascular and hematopoietic systems, as well as results of
previously performed tests and procedures. For related tests, refer to the cardiovascular and
hematopoietic system tables.
➤ Obtain a list of the medications the patient is taking, including herbs, nutritional supplements, and
nutraceuticals. The requesting health care practitioner and laboratory should be advised if the patient
regularly uses these products so that their effects can be taken into consideration when reviewing
results.
➤ There are no food, fluid, or medication restrictions unless by medical
direction.
➤ Review the procedure with the patient.
➤ Inform the patient that specimen collection takes approximately 5 to 10 minutes.
Intratest:
➤ Direct the patient to breathe normally and to avoid unnecessary movement.
➤ Observe standard precautions and follow the general guidelines in . Perform a venipuncture,
and collect the specimen for combined methylmalonic acid and homocysteine studies in two 5-mL
red-, tiger-, or lavender-top tubes. If only homocysteine is to be measured, a 5-mL red-, tiger-, or
lavender top tube is acceptable.
➤ Label the specimen, and promptly transport it to the laboratory.
Post-test:
➤ Observe venipuncture site for bleeding or hematoma formation. Apply pressure bandage.
➤ Increased homocysteine levels may be associated with atherosclerosis and coronary artery disease.
Nutritional therapy is recommend in individuals identified to be at high risk for developing coronary
artery disease. If overweight, these patients should be encouraged to achieve a normal weight.
➤ Diets rich in fruits, grains, and cereals, in addition to a multivitamin containing B12 and folate, may be
recommended for patients with elevated homocysteine levels. Processed and refined foods should be
kept to a minimum.
➤ Evaluate test results in relation to the patient’s symptoms and other tests performed. Related
laboratory tests include C-reactive protein, complete blood count, creatine kinase and isoenzymes,
folate, lactate dehydrogenase and isoenzymes, myoglobin, troponin, and vitamin pres

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COAGULATION FACTORS

Factor III Tissue Factor

Factor VII Proconvertin

Factor VIII:C Antihemophilic Factor

Factor IX Plasma thromboplastin

Factor X Stuart-Prower factor

Factor XI Plasma thromboplastin antecedent (PTA)

Factor XII Hageman Factor

• Identify the presence of inherited

• Identify the presence of qualitative or

quantitative factor deficiency

• Disseminated intravascular coagulation

Nursing Implications and Procedure

➤ Obtain a history of the patient’s complaints, including a list of known

➤ There are no food, fluid, or medication restrictions unless by medical direction.

➤ Review the procedure with the patient.

➤ Inform the patient that specimen collection takes approximately 5 to 10 minutes.

➤ Direct the patient to breathe normally and to avoid unnecessary movement.

DESCRIPTION: Homocysteine is an amino acid formed from methionine. Normally homocysteine is

• Evaluate inherited enzyme deficiencies that result in homocystinuria

• Evaluate the risk for cardiovascular disease

• Evaluate the risk for venous thrombosis

• Chronic renal failure

• Folic acid deficiency

• Vitamin B12 deficiency

• Coronary artery disease

Nursing Implications and Procedure

➤ Obtain a history of the patient’s complaints, including a list of known allergens.

➤ There are no food, fluid, or medication restrictions unless by medical

➤ Inform the patient that specimen collection takes approximately 5 to 10 minutes.

➤ Direct the patient to breathe normally and to avoid unnecessary movement.

➤ Label the specimen, and promptly transport it to the laboratory.

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