Coagulation Screening tests

For the screening of coagulation abnormality, the following tests are advised.

1. Platelets count  (140,000 to 340,000 /cmm).
2. Bleeding time  (Ivy method <4 min and Duke method 1 to 4 min).
3. Clot retraction qualitative begins in 30 to 60 minutes, completed within 24 hours but usually within 6 hours.
4. Coagulation time or clotting time (5 to 15 minutes in glass tubes and 19 to 60 minutes in the siliconized tube).
5. Fibrinolysins are negative.
6. Prothrombin time, one stage  (same as control and should be 11 to 16 seconds).
7. Thromboplastin generation time (compared to normal control).
8. To measure  the intrinsic system, advise:
   1. Activated partial thromboplastin APTT.
9. To measure the extrinsic system, advise:
   1. One stage prothrombin time PT.

The tests advised for coagulation workup with their normal and panic values (Coagulation Screening Tests):

Test	Normal values	Normal values source (4)	Critical values   (source 3)
Platelets count	150.000 to 450,000 /cmm		<100,000   (20,000 /cmm)
Activated partial thromboplastin time (APTT)	25 to 35 seconds		>40 seconds.
Prothrombin time  (PT)	10 to 13 seconds		>15 seconds
Thrombin time  (TT)	17 to 25 seconds
Bleeding time (BT)	2 to 8 minutes
Clotting time (CT)	2 to 6 minutes (glass tube 10 to 15 minutes)
Fibrinogen	2.0 to 4.0 g/L		<100 mg/dL
Fibrinogen degradation products (FDP)	< 10 mg/L	Negative at 1:4 dilution <10 mg/dL
Plasma D-dimer	< 200 mg/L	<250 µg/L
Coagulation factors	500 to 1500 U/L
Factor V%			<35%
Factor VII			<10%
Factor VIII			<100%  and >160%
Factor IX			<30%
Protein C	70 to 1400 U/L
Protein S total	70 to 1400 U/L

Critical values of blood coagulation screening test:

•  Platelets = <50,000/cmm  or > 1 million/cmm.
• APTT        = >70 seconds.
• PTT          = >100 seconds.
• Fibrinogen = <100 mg/dL.

Differential diagnoses of bleeding disorders:

APTT	PT	Platelets count	Causes of bleeding disorders
Increased	Normal	Normal	Heparin therapy Factor VIII, IX, and XI deficiencies Lupus anticoagulant von Willibrand’s disease
Normal	Increased	Normal	Early coumadin therapy Factor VII deficiency or inhibitor Early vitamin K deficiency Early liver diseases
Increased	Increased	Normal	Heparin therapy Coumadin therapy Malabsorption Liver diseases DIC (acute) Gall bladder diseases
Normal	Normal	Normal	Chronic compensated DIC von Willebrand’s disease Factor XIII deficiency Aspirin Uremia Fibrinogen disorder (dysfibrinogenemia) Vasculitis Scurvy Colonic carcinoma
Normal	Normal	Increased	Proliferative disorders CML Polycythemia rubra vera Essential thrombocythemia
Normal	Normal	Decreased	Hemodilution Platelets disorders (destruction)
Increased	Increased	Decreased	Acute DIC Liver diseases Heparin-induced thrombocytopenia Hypersplenism Thrombotic thrombocytopenic purpura Hemolytic uremic syndrome

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