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Learning CenterSunday, April 5, 2009
APRIL CASE STUDY
A 68 year old women has hematuria. A PT and APTT are performed results are as follows:
PT= 34.7 APTT =88.5 1:1 mix PT = 32.2 APTT= 89.0 Thrombin Time = 12.1 (11.5-19.0) What would be the next line of testing, possible diagnosis and treatment?
posted by Donna Castellone at
2:27 PM
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PT= 34.7
APTT =88.5
1:1 mix PT = 32.2
APTT= 89.0
Thrombin Time = 12.1 (11.5-19.0)
What would be the next line of testing, possible diagnosis and treatment
Okay, here we have a prolonged APTT, which clearly doesn't correct, so you think inhibitor-
First and foremost, we need to eliminate the possibility of heparin- so we do a thrombin time, that is normal, so no heparin on board. (remember in a mix, the presence of heparin will look like an inhibitor)
So now what? APTT based, so check VIII, IX, XI- can it be Lupus, might, but the patient is bleeding so not likely, unless due to platelets-
CLues her include:
Prolonged APTT,
No Correction of mix
No Heparin on board,
Bleeding
Older patient-
Looks like an inhibitor,
go to factor assays,
Find the VIII is
<1%- Oh no!
Will do a Bethesda Titer, to see how much of an inhibitor is present to determine the course of treatment.
This is urgent, and must be treated.
Any Questions?
Presence of Inhibitor