From Deborah Whetzel, Children’s Hospital of the King’s Daughters, Norfolk, VA: We’ve had a couple patients lately that demonstrated inhibition but their factor VIII results are within normal limits or even elevated. The result values differ 30–40% typically between dilutions but as they’re diluted more, the values go up to 300 or 400%. FVIII values that high seem really odd to me. We dilute to 1:160, as I’ve seen recommended, with results to that point continuing to get higher. Have you seen this occur and is there something that we should be doing? Thanks for your help.
Category: Bleediing Disorders
A message from Vilas Hiremath:
Dear George, hello. Female 30 yrs underwent laparoscopy, started bleeding. Prothrombin time (PT) and partial thromboplastin time (APTT, PT) prolonged, both mixing study 1:1 corrected. Normal fibrinogen and thrombin time (TT). Factor X, VIII. II normal, factor V is 6.0%. Dilute Russell viper venom time (DRVVT) screen and confirm both prolonged, unable to get ratio. My question is 1) why DRVVT is sensitive to factor V deficiency being snake venom, and 2) whether antiphospholipid antibody (APL) involved with activated protein C (resistance?) APC (R?) (resistance and “R” added by Geo.) Whether a case of thrombosis presented with bleeding. Your comments please.
From Ning Tang: Hi, George, I come from a clinical laboratory in China. We met a confusing case today and want to get your suggestion: A patient had a prolonged prothrombin time (PT, 20s), partial thromboplastin time (APTT, PTT, 52s) and thrombin time (TT, 127s). Fibrinogen activity is within reference interval (by both Clauss method and TEG), also the patient shows slight bleeding symptoms, is this dysfibrinogenemia? How to confirm it? Thanks for your help!
From Saravanan Vinayagam: We are trying to set up the factor VIII inhibitor assay on our ACL TOP analysers. Has anyone got an SOP or previous experience in validating inhibitor assay in an automated analysers? Thank you.
Hello, Saravanan Vinayagam, and thank you for your post. I’m hoping that an IL technical representative will see this and offer some assistance. Geo.
From Annette Gaskill, Estes Park Medical Center:
I’m a MT at a small critical care hospital and also am part of our facility’s trauma committee. In our discussions of trauma cases involving patients already anticoagulated, our surgeon has asked me about thromboelastograms. Our coagulation menu is PT, PTT, and D-dimer; anything else is sent out. We only keep packed RBC’s in our blood bank, but are in process of bringing FFP in-house. I don’t foresee us ever keeping platelets or factors here. Our surgeon liked how the TEG gave not only coagulation values, but recommendations on what to give as far as blood products and factors. Just wondering if you could share any insights about coag testing for a small facility like ours, particularly trauma/surgical patients that are already anticoagulated.
This provocative post appeared October 12, 2011, but attracted no comments at the time, thus I am re-posting today.
Hi George! As always, I enjoy this educational resource very much! My question is: Why do healthy women who experience post-partum hemorrhage (PPH) seem to “autocorrect” their coagulopathy with very little help from component therapy? I have noted that once the bleeding site has been tended to, the patient requires relatively little support with factor/fibrinogen replacement, with respect to the hemorrhagic loss. Thanks for your input!
Crystal Azevedo, Affiliated Laboratory, Inc.