case study :: A 60-year-old man is scheduled to undergo an open surgery to remove his...

case study :: A 60-year-old man is scheduled to undergo an open surgery to remove his gallstones. His haemostasis screening test shows a prolonged PT. Plasma mixing studies does not correct the PT test.

Question: Discuss what further investigations you would do and justify the reasons for doing the investigations ?

Expert Solution

Prolonged prothrombin time (PT) can occur due to deficiencies of one of the clotting factors involved in the extrinsic or common pathway of coagulation. Isolated prolongation of PT with normal aPTT (activated partial thromboplastin time) indicates abnormality of the extrinsic pathway, i.e factor VII deficiency.

Mixing studies are done to find out if the prolonged PT / APTT is due to deficiency of clotting factor or due to the presence of inhibitors against the clotting factor in patient's serum.

In mixing study we mix the patient serum with normal serum and then repeat the test. Now, if the PT / APTT becomes normal, it means that the patient serum lacked some clotting factor which was now supplimented by the normal serum.

However, if the PT / APTT are abnormal even after mixing studies, it means that there is some inhibiting substance in the patients serum against the clotting factor.

Now, further study will have to be conducted to identify this inhibitors. Inhibitors are measured using a test called the Bethesda assay. This quantitative assay gives the inhibitor levels in Bethesda units per milliliter (BU/mL).

gladiator answered 2 years ago

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