Quick's test

Quick's test, also known as the prothrombin time (PT) test, is a diagnostic blood test that measures how long it takes for blood to clot. The test is named after Armand Quick, an American physician and biochemist who first described the procedure in 1935. Quick's test is primarily used to assess the extrinsic pathway of coagulation and is crucial in monitoring patients on anticoagulant therapy such as warfarin. It is also used in the diagnosis and management of disorders affecting blood clotting.

Overview

Quick's test involves adding a reagent to the patient's plasma to initiate the clotting process. The time from the addition of the reagent to the formation of a clot is measured and reported in seconds. This measurement is known as the prothrombin time. Since the sensitivity of the PT test can vary based on the reagent used, the results are often converted to the International Normalized Ratio (INR) to standardize the results across different laboratories.

Clinical Significance

Quick's test is essential in several clinical scenarios:

• Monitoring Anticoagulant Therapy: Patients on anticoagulant therapy, particularly those taking warfarin, require regular monitoring to ensure that their blood is not too thin or too thick. The INR allows clinicians to adjust the dose of warfarin to maintain it within a therapeutic range.
• Liver Function Assessment: Since clotting factors are produced in the liver, an extended PT can indicate liver dysfunction.
• Vitamin K Status: Vitamin K is necessary for the synthesis of several clotting factors. A prolonged PT may suggest a vitamin K deficiency.
• Disseminated Intravascular Coagulation (DIC) and Other Coagulopathies: Quick's test can help in diagnosing DIC and other conditions that affect the clotting cascade.

Procedure

The procedure for Quick's test is straightforward:

1. A blood sample is collected from the patient, typically from a vein in the arm.
2. The plasma is separated from the blood cells.
3. A reagent containing tissue factor (also known as thromboplastin) and calcium is added to the plasma.
4. The time until clot formation is measured.

Interpretation

The normal range for PT varies depending on the laboratory and the reagents used. However, a PT result is often converted to an INR to standardize the results. A normal INR is typically between 0.8 and 1.2 for individuals not on anticoagulant therapy. For patients on warfarin, the therapeutic range is usually between 2.0 and 3.0, depending on the condition being treated.

Limitations

While Quick's test is valuable in many clinical settings, it has limitations:

• It only assesses the extrinsic and common pathways of the coagulation cascade, not the intrinsic pathway.
• The test's sensitivity can vary based on the reagent and equipment used, necessitating the use of INR for standardization.
• It does not provide information on platelet function or the fibrinolytic system.