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Case Study in Hematology-Coagulation

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  • Case Study in Hematology-Coagulation

    Case Study:

    A 36 yrs old woman is referred by her physcian for evaluation of a prolonged PT and APTT prior to a lymph node biopsy. The patient is suffering from a mild lymphoadenopathy (swelled lymph nodes), fatigue, and intermittent low grade fevers; she denies any bleeding symptoms. Medical history reveals that she had mild thrombocytopenia and a positive Coombs' test in the past. Her PT is 16.2 seconds (normal 12.1-14.6) and her APTT is 48 seconds (normal 24.5-34.5); the PT is 14.6 secondswith 1:1 mix with normal plasma, and the APTT is 36.8 seconds with an immediate 1:1 mixing study that increases by 1 second after 60 minutes at 37C. Her platelet count is 105,000/cumm. WHAT TESTS should be performed next
    ????
    من طلب العلا سهر الليالي

  • #2
    a prolonged PT and PTT indicates a deficiency of one of the common factors, X, V, prothrombin (II), and fibrinogen

    قياس مستوى فيتامين K

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    • #3
      اختبار D-Dimer لان المريض يعاني من نقص الصفائح الدموية مع زيادة اختباري PT - PTT

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      • #4
        أتوقع أن يكون T.T مع أني لا أفقه كثيرأ في الهيماتولوجي
        بالتوفيق للجميع
        http://www10.0zz0.com/2011/07/21/15/241483904.jpg

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        • #5
          بما اننا عملنا (MIX STUDY ) وكانت النتيجة مرتفعة بالنسبة لل(PTT ) فاتوقع انه علينا عمل اختبار LUPUS ANTICOAGULANT

          هذه اخر اجابة لي

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          • #6
            ولقد اصبت بالاجابة ------------------ مبروك
            ونعمل ايضا: Anticardiolipin antibodies.

            EXCELLENT
            من طلب العلا سهر الليالي

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            • #7
              please with more explaination
              http://www10.0zz0.com/2011/07/21/15/241483904.jpg

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              • #8
                Mr. Adam since PT and APTT both are prolonged, we do mixing studies with a variety of plasmas to detect the problem. These plasmas include: 1- Normal plasma, that contain all coagulation factors in a suffiecient amount.
                2- Adsorbed plasma that is deficient in Vitamin K dependent factors (10,9,7,2).
                3- Aged plasma or serum that is deficient in factors 5 and 8
                Mixing studies are done by mixing 0.5 ml patient plasma and 0.5 ml of the desired plasma (from 1 to 3).
                When you do mixing studies and the test is not totally corrected with the normal plasma then you suspect an inhibitor is present (inhibitor=antibodies to coagulation factors). Inhibitor of two forms either they are immediate action or time dependent. Immediate action will cause prolongation instantly with no need for incubation for one hour or two hours. Immedite action inhibitor one of the most common inhibitor is the Lupus anticoagulant. The inhibitor that needs time (2 hours) to act is called time dependnet inhibitor and the famous inhibitor is anti factor 8 (anti FVIII).
                since the inhibitor is acted in an immediate action mode then Lupus anticoagulant is highly suspected!
                If have any question we are ready to answer you>
                Best regards
                Ashraf
                من طلب العلا سهر الليالي

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                • #9
                  دكتور اشرف كيف حالك اتمنا انك تكون بصحه جيدة
                  اذا ماعليك كلفة كنت اريد مواضيع مرتبطة ب Mixing studies تشرح التجربه بالتفصيل من الالف الى الياء لاني ماقدرت افهمها مع نفسي
                  الي اعرفه انه الهدف :To differentiate between factoer deficincy & coagulat.Inhibiter
                  Example:
                  PATIENT PTT=50 SEC
                  NORMAL PTT=25 SEC
                  DIFFERENTIAT BTWEEN THIS =25 SEC= نصفها 12.5(لم افهمها ليش اخذنا النص
                  1:1PTT OF MIXED SAMPLE= 40 SEC
                  Addetion of normal plasma to patient.plasma corrected PTT 10 sec. will is less than50% of the difference between the patient PTT & normal plasma
                  PTT 10 sec< 12.5
                  so there is coagulation inhibetor


                  but if it mixed sample Ptt=30 sec
                  corrected PTT by 20 sec
                  will 20>12.5
                  so there is factor deficincy

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                  • #10
                    يعني اذا في معلومات زياده واكثر تفصيل تخليني استوعب الفكره بشكل مفصل اكثر اكون لك من الشاكرين

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                    • #11
                      ولا حاجة اخت رحاب العملية سهلة خالص خالص وخالية من التعقيدات
                      Mixing studies are done for two reasons:
                      1- To differentiate between factor deficiency and coagulation inhibitor
                      2- to know which factor is deficienct that you subsequently do specific factor assay.
                      You have many types of plasmas used in this test, notably:
                      1- Normal control plasma that contains all coagulation facvtors in suffieicnt amounts.
                      2- Adsorbed plasma, that is adsorbed by Al(OH)3 or BaSo4, which removes vitamin K dependent factors (10,9,7,2) or what is called 1972.
                      3- Aged plasma or aged serum, that is prepared by collecting blood in potassium oxalate and then plasma is separated and we put it in water bath or two days, this plasma is deficienct in the labile factor 5 and 8.
                      For differentiation between factor deficiency and coagulation inhibitor you will mix 0.5 ml of patient plasma with 0.5 ml of normal plasma, then you will perform PT or APTT or both.
                      If the original patient PT or APTT is corrected to almost normal then you will have factor deficiency if not then you will have coagulation inhibitor.
                      The other plasmas asre used to know which factor/factors are deficient
                      If you have any enquiry do not hasitate to ask
                      thank you
                      من طلب العلا سهر الليالي

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                      • #12
                        مشكور يادكتور اشرف يعطيك ربي الف عافيه....ممكن الموضوع محتاج تطبيق عشان توصل الفكره بسهوله
                        تقبل تحياتي وفائق احترامي

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                        • #13
                          واااااااااو جداً ممتع ..

                          الله يعطيك العافية دكتور أشرف بس عندي كم سؤال ازا ممكن

                          اول شي .. ايش اسم التست دا .. mixing study??!! ؟؟ .. (الاسم دا جنرال!! .. ما لو اسم محدد)؟

                          و تانيا .. العينة الثالثة (aged plasma or aged serum) قد ايش نحطها في الـ water bath ولا انــت تقصد اننا نحطها في الواتر باث لمدة يومين بعدين نستعملها؟؟؟


                          و اخيرا

                          For differentiation between factor deficiency and coagulation inhibitor you will mix 0.5 ml of patient plasma with 0.5 ml of normal plasma
                          دي العينة عشان نفرق بين factor deficiency and coagulation inhibitor

                          و باقي العينات ..كيف حنستخدمها؟؟


                          و آسفة اسئلتي كتيييييرة .. يمكن ما فهمت التست مضبوط



                          و شكــــــراً يا دكتووور.. الله يزيدك علم على علم ..

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