Partial thromboplastin time (PTT)

Alternative names

How the test is performed

Blood is drawn from a vein, usually on the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and an elastic band is placed around the upper arm to apply pressure and restrict blood flow through the vein. This causes veins below the band to fill with blood.

A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the band is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

For an infant or young child:
The area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. Cotton or a bandage may be applied to the puncture site if there is any continued bleeding.

How to prepare for the test

• infant test or procedure preparation (birth to 1 year)
• toddler test or procedure preparation (1 to 3 years)
• preschooler test or procedure preparation (3 to 6 years)
• schoolage test or procedure preparation (6 to 12 years)
• adolescent test or procedure preparation (12 to 18 years)

How the test will feel

Why the test is performed

Normal Values

• APTT: 25 to 35 seconds

The normal value will vary between laboratories.

• Patients receiving anticoagulant therapy: 1.5 to 2.5 times control values

What abnormal results mean

• cirrhosis
• disseminated intravascular coagulation (DIC)
• factor XII deficiency
• hemophilia A (factor VIII deficiency)
• hemophilia B (factor IX deficiency)
• hypofibrinogenemia
• malabsorption (inadequate absorption of nutrients from the intestinal tract)
• von Willebrand's disease
• lupus anticoagulant

This test may be used in the evaluation of a wide variety of disorders.

What the risks are

• excessive bleeding
• fainting or feeling light-headed
• hematoma (blood accumulating under the skin)
• infection (a slight risk any time the skin is broken)
• multiple punctures to locate veins

Special considerations

Coagulation (blood clotting) results from a sequence of reactions involving several proteins known as coagulation factors. Some of these factors have other names. For example, Factor I is also called fibrinogen, Factor II is prothrombin, and Factor XII is Hageman factor. The liver produces these proteins and secretes them into the blood. In addition, vitamin K is important to blood clotting because your body converts it into prothrombin.

Some people take warfarin to keep their blood from clotting. Warfarin inhibits prothrombin, thus interrupting the clotting cascade. Because of the link between vitamin K and prothrombin, people who take warfarin need to have consistent levels of vitamin K in their diet, as instructed by their doctor.

Coagulation begins when some of the coagulation factors contact damaged tissue. Each factor reaction triggers the next reaction, in a cascade. The final product of the coagulation cascade is the blood clot .

Factor X can be activated by two separate sequences of chemical reactions. The factors involved in the two sequences are referred to as the intrinsic system and the extrinsic system. The intrinsic system involves activation of Hageman factor by tissue not normally in contact with blood, followed by sequential activation of factors XI, IX, and X, in the presence of factor VIII.

Update Date: 6/1/2003