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Coagulation Testing

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31 views29 pages

Coagulation Testing

Uploaded by

Ro Ry
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Coagulation Pathways

Prof. M S Motswaledi, PhD,


MT(ASCP)
Conventions
• Use capital Roman numerals
• Arabic factors for platelet factors
• Activated factors are indicated by suffix “a”
eg Xa
Factor Families
• Fibrinogen Family
– I, V, VIII, XIII
• Prothrombin Family
– II, VII, IX, X
• Contact Factors
– XI, XII, HMWK, Kallikrein
Inhibitors of Coagulation
• Antithrombin III (ATIII)
• Other Protease inhibitors
– α1-antitrypsin
– α2-macroglobulin
– α2-antiplasmin
Factor Inactivation
Fibrinolysis
Activated Partial Thromboplastin
Time
• Contact activator
• Platelet phospholipid substitute
• Calcium Chloride (Recalcification)
• Evaluates extrinsic pathway
APTT
APTT Principle
• Contact activator in the form of ellargic
acid or kaolin
• Phospholipid substitute
• 0.02 M Calcium chloride
• Time to form clot measured (s)
• Normal 25 – 40 s
Prothrombin
Time
APTT
Prothrombin Time (PT)
• Tissue factor (Brain thrombopalstin)
• Calcium Chloride
• Evaluates extrinsic pathway
Coumarin
Snake venoms

Heparin

DIC
Protein C Lupus
anticoagulant
Mixing Studies
• Purpose: to identify missing factors
• Always start with normal plasma, it
contains all factors
• Make 1:1 mixture then retest to see if PT or
APTT improves, if not corrected, suspect
circulating anticoagulant
Reagent Plasmas
• Easy to Prepare
• Adsorbed Plasma contains I, V, VIII, XI
XII
• Aged Serum contains VII, IX, X, XI, XII
• Specific Factor deficient plasmas
An Example
Factors N plasma Patient APlasma A Serum
I Y Y Y
II Y Y
IV Y Y
V Y Y Y
VII Y Y Y
VIII Y Y
IX Y Y Y
X Y Y Y
XI Y Y Y Y
Thrombotic Disorders
• May manifest in the form of stroke,
miscarriages, DVT, pulmonary emboli
– Lupus anticoagulant
– Activated Protein C Resistance
Lupus Erythematosus
• Anti-platelet phospholipid antibody
• Activates platelet aggregation, therefore
thrombosis
• Inhibits phospholipid procoagulant
reactivity, therefore prolongs APTT
Activated protein C Resistance
• Abnormal factor V molecule
• Protein C can’t bind it
• Therefore continued Va presence leads to
thrombosis
Factor inhibitors
• Mostly antibodies
• Abnormal PT or APTT or both
• No correction with normal plasma
Haemophilia
• sex-linked
• bleeding disorder
• defect is on one X-chromosome
• lacks a normal gene for production of either
factor IX or VIII
• frequent transfusions, hence the name,
haemophilia, meaning "blood loving
Clinical manifestations
• Haemarthrosis
• Purpura
• Excessive hemorrhage following trauma
Haemophilia A and B
• Classical Haemophilia
• factor VIII
• haemophilia B (Christmas Disease) is due
to that of Factor IX
Pathogenesis
• absence of the relevant factor
• structurally abnormal factor
• APTT is prolonged but the PT, TT are
normal
Diagnosis
• APTT is prolonged but the PT, TT are
normal
• Mixing studies
• specific factor assays
Treatment
• Factor VIII concentrates
• cryoprecipitate
• Cryoprecipitate is a rich source of factor
VIII, fibrinogen, factor XIII and von
Willebrand Factor
• desmopressin, which increases release of
factor VIII from platelets
Treatment Cont’d
• Factor IX concentrates

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