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2 out of 9

Which of the following may present with isolated prolongation of prothrombin time (PT) (AIIMS May 08):

A Factor VIII deficiency
B Factor VII deficiency

C Factor XII deficiency
D Factor IX deficiency

Ans. B

Factor VII deficiency

PTT is prolonged with deficiency of factors : XII, XI, IX, VIII, II, I and thrombin

PT is prolonged with deficiency of factors : VII, V, II, I and thrombin

Isolated elongation of aPTT with bleeding manifestations

Isolated prolongation of aPTT without bleeding manifestations

Factor VIII defect

Factor IX defect

Factor XI defect

Factor XII defect

Prekallikrein defect

HMW kininogen defect

A prolonged bleeding time in a patient with a normal platelet count is indicative of a qualitative platelet abnormality, von Willebrand disease, or afibrinogenemia. (AIPG 2011)

Hemostatic disorders and coagulation test abnormalities

1. Prolonged activated partial thromboplastin time (aPTT)

a. No clinical bleeding –factors XII, high-molecular-weight kininogen, protein kinase

b. Variable, but usually mild, bleeding –factor XI, mild FVIII and FIX

c. Frequent, severe bleeding – severe deficiencies of FVIII and FIX

d. Heparin

2. Prolonged prothrombin time (PT)

a. Factor VII deficiency c. Vitamin K deficiency – early

b. Warfarin anticoagulation

3. Prolonged aPTT and PT

a. Factor II, V or X deficiency c. Vitamin K deficiency – late

b. Direct thrombin inhibitors

4. Prolonged thrombin time

a. Heparin or heparin-like inhibitors c. Mild or no bleeding – dysfibrinogenemia

b. Frequent, severe bleeding – afibrinogenemia

5. Prolonged PT and/or aPTT not correct with mixing with normal plasma

a. Bleeding – specific factor inhibitor

b. No symptoms, or clotting and/or pregnancy loss – lupus anticoagulant

c. Disseminated intravascular coagulation

d. Heparin or direct thrombin inhibitor

6. Abnormal clot solubility

a. Factor XIII deficiency

b. Inhibitors or defective cross-linking

7. Rapid clot lysis

a. Deficiency of α2-antiplasmin or plasminogen activator inhibitor 1

b. Treatment with fibrinolytic therapy

Hematology Flashcard List

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