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A Practical Guide to Laboratory Haemostasis

 

Reptilase Time



Introduction

The Reptilase time is a modification of the thrombin time in which the purified enzyme Reptilase is used to replace thrombin. Reptilase is isolated from the snake Bothrops atrox. Reptilase cleaves fibrinogen releasing fibrinopeptide A (FpA) generating fibrin. In contrast thrombin cleaves both fibrinopeptide A and fibrinopeptide B from fibrinogen to generate the fibrin clot.

Ancrod a similar enzyme from Agkistrodon rhodostoma can also be used to replace thrombin in the thrombin clotting time test.

Principles

Reptilase is added to platelet poor plasma and the clotting time measured. The test requires no added phospholipid or calcium.

Method

Components Explanation
Platelet poor plasma

See pre-analytical variables

Reptilase solution

Reptilase re-constituted according to the manufacture's instructions.

 

Interpretation

The reptilase time is rarely performed in isolation and therefore, the results of this test should be considered together with other tests and in particular the thrombin time. A prolonged reptilase time is seen in:

ID Name
Inherited and Acquired Hypofibrinogenaemia A low fibrinogen (usually <1.0g/L) will lead to a prolongation of both the thrombin time and the reptilase time.
Inherited Dysfibrinogenaemia Most dysfibrinogenaemias will lead to a prolongation of both the thrombin time and the reptilase time. However, in some cases depending upon the site of the mutation - only one or other of the two tests may be abnormal.
Following thrombolytic therapy due to the high levels of FDPs.
DIC with elevated levels of FDPs

High levels of FDPs lead to defective fibrin polymerisation and therefore, prolongation of the both the thrombin and reptilase times. The thrombin and reptilase times may also be prolonged in DIC due to hypofibrinogenaemia.
Hypoalbuminaemia A low serum albumin may be associated with a prolongation of both the thrombin time and reptilase time. This appears to be due to an in vitro phenomenon and correction of the low albumin either in vitro or in vivo corrects the abnormality.
This problem was originally reported in patients with nephrotic syndrome but has also been reported in patients with HIV.
Liver disease The thrombin time and reptilase time are often prolonged in patients with liver disease due to both hypofibrinogenaemia, elevated FDPs, and an acquired dysfibrinogenaemia due to abnormalities of fibrinogen sialic acid content.
Neonate Neonatal fibrinogen differs from adult fibrinogen in its sialic acid content. As a consequence the reptilase and thrombin times may be physiologically prolonged.
A similar finding is seen in some patients with liver disease.

Myeloma Some paraproteins can interfere with fibrin polymerisation and lead to a prolonged thrombin and reptilase time.


Reference Ranges

The reference range for the reptilase time is similar to the thrombin time and is generally in the range of 13-15s.

What Test Next

The following table summarises the abnormalities of the thrombin time and reptilase time. This can guide the the most appropriate investigation.

  Thrombin Time Reptilase Time
Presence of unfractionated heparin

↑  

Normal

Presence of LMWH May show some prolongation Normal
Presence of direct thrombin inhibitors Normal
Warfarin Normal Normal
Decreased/absent fibrinogen
Dysfibrinogenaemia
DIC
Liver disease
Heparin-like anticoagulants Normal
Paraproteinaemias
Thrombolytic therapy
Neonate
Amyloid
Hyperfibrinogenaemia
Hypoalbuminaemia

 

Data Interpretation

Click HERE to go to the Data Interpretation Exercises.