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Coagulation:- part 2 – Coagulation Screening, Work up of Bleeding Disorder

September 17, 2022HematologyLab Tests

Table of Contents

  • Coagulation Screening
        • Sample
        • Definition of bleeding disorders:
        • Table to differentiate hemostasis:
      • The Coagulation Screening profile consists of:
        • Platelets abnormality is seen in :
        • Abnormal PTT alone is seen in:
        • Abnormal PT alone is seen in:
        • Abnormal PTT + PT is seen in:
        • Interpretations of the blood coagulation screening profiles:

Coagulation Screening

Sample

  1. If plasma is needed, take 5 ml of venous blood and add sodium citrate as the anticoagulant.
  2. Perform the assay immediately or as soon as possible.
  3. For factors II, V, VII, and X,  place the citrated plasma on ice immediately, and the sample is stable for 2 hours.
    1. Freeze if it is delayed >2 hours.

Definition of bleeding disorders:

  1. Before we start work up of bleeding disorders, we should understand two systems of bleeding.
  2. Bleeding disorders may be of two types:
    1. Primary hemostasis, related to:
      1. Platelets.
      2. Vascular defects.
    2. Secondary hemostasis related to:
      1. Coagulation factors defects.

Table to differentiate hemostasis:

Clinical feature Primary Hemostasis Secondary Hemostasis
Onset time
  • Immediately after trauma
  • Occurs Late after trauma
Clinical presentation
  1. Petechiae
  2. Ecchymosis
  • Hematoma
Sites
  1. Mucous membrane
  2. skin
  1. Deep Tissue
  2. Joints and muscles
  3. CNS
Mucous membranes
  1. Nasal
  2. Oral
  3. GI
  4. Urinary
  • Less common
Examples
  1. Thrombocytopenia
  2. Willebrand disease
  3. Platelets defects
  1. Factors deficiency
  2. Liver diseases
  3. Acquired inhibitors

The Coagulation Screening profile consists of:

1. Platelets.
2. Bleeding time.
3. Clotting time.
4. APTT.
5. PTT.
6. PT.
7. Clotting factor assay.

Platelets abnormality is seen in :

  1. Idiopathic thrombocytopenia.
  2. Low due to drugs.
  3. Hypersplenism.
  4. SLE.
    • (See more in Platelets)

Abnormal PTT alone is seen in:

  • Bleeding due to a defect in factors VIII, IX, and XI  (8, 9, 11).

Abnormal PT alone is seen in:

  • Bleeding due to a defect in Factor VIII (8).

Abnormal PTT + PT is seen in:

  1. Anticoagulant therapy.
  2. DIC.
  3. Vit. K deficiency.
  4. Liver diseases.
  5. Rarely dysfibrinogenemia.
  6. Rarely due to factor X, V, and II defects.

Interpretations of the blood coagulation screening profiles:

Coagulation tests Result of coagulation tests Causes of possible diseases
  1. APTT (Activated partial thromboplastin time)
  2. PT (Prothrombin time)
  3. TT (Thrombin time)
  1. Abnormal
  2. Abnormal
  3. Normal
  1. Vitamin K deficiency
  2. Liver diseases
  3. Factor deficiency in a common pathway  (X, V, II)
  1. APTT
  2. PT
  1. Abnormal
  2. Normal
  1. Lupus anticoagulant
  2. Specific factor inhibitor
  3. Factor deficiency in the intrinsic pathway
  1. APTT
  2. PT
  1. Normal
  2. Abnormal
  1. Specific factor inhibitor
  2. Factor deficiency in the extrinsic pathway
  1. APTT
  2. PT
  3. TT
  1. Abnormal
  2. Abnormal
  3. Abnormal
  1. Severe liver disease
  2. DIC
  3. Factor (I) deficiency
  4. Potent inhibitor
  5. Dysfibrinogenemia
  6. Hypofibrinogenemia

Coagulation screening for bleeding disorders:

Coagulation screening test Cause of the disease Possible mechanism
Prothrombin test (PT)
  1. Liver diseases
  2. DIC
  3. Warfarin therapy
Deficiency or inhibitors of:

  1. Factor VII
  2. Factor X
  3. Factor V
  4. Factor II
  5. Fibrinogen
Thrombin test (TT)
  1. DIC.
  2. Heparin therapy
Deficiency or abnormality of:

  1. Fibrinogen
  2. Inhibition of thrombin by heparin
  3. FDP (Fibrinogen degradation products)
Activated partial thromboplastin test (APTT)
  1. Hemophilia
  2. Christmas disease
  3. Liver diseases
  4. DIC
  5. Warfarin therapy
Deficiency or inhibitors:

  1. Factor XII
  2. Factor XI
  3. Factor IX
  4. Factor VIII
  5. Factor X
  6. Factor V
  7. Factor II
  8. Fibrinogen
Fibrinogen
  1. DIC
  2. Liver diseases
  • Fibrinogen deficiency
Coagulation Screening: Coagulation pathways

Coagulation Screening: Coagulation pathways


Possible References Used
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