Euglobulin Clot Lysis Time
ECLT is a specialized laboratory test used to assess the overall function of the fibrinolytic system, particularly useful in pediatric cases of suspected fibrinolysis disorders.
Key Points
- Gold standard for assessing global fibrinolytic capacity
- Measures the balance between fibrinolytic activators and inhibitors
- Essential for diagnosing fibrinolytic disorders
- Valuable in monitoring antifibrinolytic therapy
Scientific Principles
- Basic Concept:
- Precipitation of fibrinolytic factors from plasma
- Isolation of plasminogen, plasminogen activators, and fibrinogen
- Removal of fibrinolysis inhibitors
- Measurement of clot dissolution time
- Components Measured:
- Tissue Plasminogen Activator (tPA)
- Plasminogen
- Fibrinogen
- Factor XIII
Methodology
Sample Collection:
- Citrated plasma required
- Proper temperature control essential
- Time-sensitive processing needed
- Fasting sample preferred
Test Procedure:
- Precipitation Phase:
- Dilution of plasma with acetic acid
- pH adjustment to precipitate euglobulin fraction
- Centrifugation to isolate precipitate
- Clot Formation:
- Resuspension in buffer
- Addition of thrombin
- Formation of uniform clot
- Lysis Monitoring:
- Regular observation of clot
- Recording of complete lysis time
- Temperature-controlled environment
Clinical Applications
Primary Indications:
- Suspected hyperfibrinolysis
- Unexplained bleeding tendency
- Monitoring of antifibrinolytic therapy
- Pre-operative assessment in specific cases
- Research purposes
Specific Pediatric Conditions:
- Congenital fibrinolytic disorders
- Post-operative bleeding evaluation
- Liver disease assessment
- DIC monitoring
- Alpha-2-antiplasmin deficiency
Result Interpretation
Normal Values:
- Typical range: 90-240 minutes
- Age-specific variations exist
- Laboratory-specific ranges important
Abnormal Results:
- Shortened ECLT:
- Hyperfibrinolysis
- DIC
- Severe liver disease
- Prolonged ECLT:
- Antifibrinolytic therapy
- Congenital PAI-1 excess
- Inflammatory conditions
Pediatric-Specific Considerations
- Age-related normal variations
- Sample volume challenges
- Developmental hemostasis impact
- Technical modifications may be needed
- Interpretation requires pediatric expertise
Quality Control
- Temperature monitoring critical
- Time standardization important
- Regular calibration needed
- Control samples required
Limitations and Pitfalls
- Time-consuming procedure
- Technical expertise required
- Pre-analytical variables critical
- Limited standardization
- Interference from medications
Modern Developments
- Automated methods available
- Modified techniques emerging
- Integration with global assays
- Point-of-care developments
