Question

• 3. A 23-year-old woman presents to her GP with menorrhagia. The GP requests a coagulation screen and the results of this are shown below:
• The prolonged PT and APTT correct in a 50:50 mix with normal plasma.

Test	Patient	Reference Range
PT	34s	11-14s
APTT	82s	23-35s
Fibrinogen (Clauss)	2.6g/L	1.5-4.0g/L
Thrombin Time	13s	10-13s

1. What questions might you ask this lady that would be of relevance?

2. How would you proceed with the investigation of this patient?

A 45-year-old man presents with an extensive above knee DVT extending into the iliac veins. He is otherwise well with no past medical history of note.

His pre-anticoagulation screen shows:

Test	Patient	Reference Range
PT	14s	11-14s
APTT	>120s	23-35s
Fibrinogen (Clauss)	3.2g/L	1.5-4.0g/L
Thrombin Time	13s	10-13s

• 1. What is the most likely diagnosis?
• Factor XII:C <1 IU/dl.

• Do you think the FXII deficiency is clinically important?

If you elect to treat this patient with unfractionated heparin how would you monitor this?

Answer 1

Question:A 23-year-old woman presents to her GP with menorrhagia. The GP requests a coagulation screen and the results of this are shown below:

• The prolonged PT and APTT correct in a 50:50 mix with normal plasma.

Test	Patient	Reference Range
PT	34s	11-14s
APTT	82s	23-35s
Fibrinogen (Clauss)	2.6g/L	1.5-4.0g/L
Thrombin Time	13s	10-13s

1. What questions might you ask this lady that would be of relevance?

2. How would you proceed with the investigation of this patient?

Answer: 1 In above case scenario patient had history of menorrhagia with prolonged PT and APTT and normal thrombin time and fibrinogen level. So we should think about bleeding disorder.

• Question ask about history of similar episode in any family member
• Family history of bleeding disorders
• History of previous episodes of similar complaints

answer 2: Here PT and aPTT are prolonged, Thrombin time is in normal range and Fibrinogen in within normal limit. So we done mixing study.

The prolonged PT and APTT correct in a 50:50 mix with normal plasma.

Here the flow chart

In this case scenario most probable diagnosis is clotting factor deficiency (intrinsic pathways factor deficiency FVIII, FIX, FXI, FXII ) or Von Willebrand antigen.

Question:

A 45-year-old man presents with an extensive above knee DVT extending into the iliac veins. He is otherwise well with no past medical history of note.

His pre-anticoagulation screen shows:

Test	Patient	Reference Range
PT	14s	11-14s
APTT	>120s	23-35s
Fibrinogen (Clauss)	3.2g/L	1.5-4.0g/L
Thrombin Time	13s	10-13s

• 1. What is the most likely diagnosis? Factor XII:C <1 IU/dl.
• 2. Do you think the FXII deficiency is clinically important?
• 3. If you elect to treat this patient with unfractionated heparin how would you monitor this?

Answer:

1. In this case there is Isolated prolonged APTT with normal PT, fibrinogen level and thrombin time. After mixing studied done with normal plasma if APTT correct then we go for intrinsic Clotting factor assay. Here factor XII assay is < 1 IU/DL. So most likely diagnosis is Factor XII deficiency.

2. Yes factor XII deficiency is clinically important if we go for any surgical procedure and had family history of bleeding in past. Generally Factor XII deficiency is not known to cause bleeding so factor concentrates or blood products usually not required.

3. APTT ( activated partial thromboplastin time: most widely used assay for monitoring of ununfractionated heparin in patients. It measure anticoagulant effect in the body.

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