Case Study

Question 1

What is impacted if PT/INR and APTT Both Prolonged

Answer 1

-Intrinsic and extrinsic pathways

-single factor deficiency in common pathway (FX, V, II, or severe Fibrinogen deficiency)

Question 2

What conditions are associated with PT/INR and APTT Both Prolonged

Answer 2

Congenital especially if PT and APTT are prolonged and TT/FIB are normal
Single factor deficiency FX, V, II (Prothrombin) or Fibrinogen

Acquired
Multiple factor deficiency in Intrinsic & Extrinsic pathways
Severe Liver Disease
Severe Vitamin K Deficiency
DIC
Specific inhibitor directed to common pathway factor
Hypofibrinogenemia/Dysfibrinogenemia

Question 3

How would we assess both PT/INR and APTT Both Prolonged

Answer 3

TT/Fibrinogen assay
Mixing Studies
Factor Assays
Factor Inhibitor Assays
D-Dimer
Liver Enzymes
CBC + PBF Morphology
Liver Disease – Macrocytes & Targets
DIC – Thrombocytopenia (PLT estimate ↓ & Fragments)
Vitamin K levels

Question 4

What will happen if PT/INR Prolonged and APTT Normal

What could be the conditions

Answer 4

Probable cause related to FVII

What are the conditions?
Congenital -
Single Factor deficiency of FVII

Acquired-
Early Liver Disease
Early Vitamin K Deficiency
Early Coumadin therapy (or initial dose)
Specific inhibitor to FVII (rare)

Question 5

PT/INR Prolonged APTT Normal

How do we assess?

Answer 5

Mixing Studies
Factor Assays
Factor Inhibitor Assays
Liver Enzymes
CBC + PBF Morphology
Liver Disease – Macrocytes & Targets
Vitamin K levels

Question 6

APTT Prolonged PT/INR Normal

cause

Answer 6

Probable cause related to intrinsic pathway FVIII, IX, XI, or the contact factors

Question 7

What are the conditions?
Congenital -

APTT Prolonged PT/INR Normal

Answer 7

-Single factor Deficiency of FVIII, IX, and XI with accompanying bleeding - indicates Hemophilia A, B, or C

-VWD (can lead to FVIII deficiency)

-Deficiency of FXII, Pre-K, HMWK (contact factors)
- prolongs APTT but does not result in clinically significant bleeding

Question 8

Acquired condition due to

APTT Prolonged PT/INR Normal

Answer 8

-Non-specific inhibitor - antiphospholipid antibodies (such as, Lupus anticoagulant in patients with SLE)
-Specific inhibitor directed against intrinsic -factors
-Hemophilic patients can develop anti-FVIII or IX due to treatment
-Acquired Hemophilia or Acquired VWD
Heparin therapy