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Probable Cause for Problem
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Action
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heparin
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add protamine sulfate
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increased fibrinolytic activity
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add epsilon aminocaproic acid (EACA, Amicar)
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delayed clotting from other cause
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add thrombin
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agitate separated serum with small glass beads
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Protamine sulfate:
(1) solution of 10 mg/mL protamine sulfate in saline (1% w/v solution)
(2) add 1-2 drops of solution to 4 mL of whole blood
(3) incubate 5-10 minutes at 37°C
Tpsilon aminocaproic acid:
(1) solution of 250 mg/mL EACA in saline
(2) add 0.1 mL of solution for each 4 mL of whole blood
Thrombin:
(1) use dry human or bovine thrombin on the tip of an applicator stick, OR
(2) use 1 drop of a solution with 50 units per mL saline for each mL of whole blood
Agitation with small glass beads:
(1) place beads in tube with separated serum and agitate at 37°C for several minutes
(2) centrifuge and separate off supernatant
An alternative approach is to test whole blood anticoagulated with lithium heparin when possible.
