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Plasmatic factors
Intrinsic pathway
Extrinsic pathway
Specimen
PPP preparation
PT, INR
APTT
TT
Vitamin K
Liver disease
Factor deficiency
Circulating inhibitors
Heparin
Coumarin
Lupus inhibitor
Factor assay
Mixing and substitution
studies
5M urea test
Lee-White clotting time
Plasmatic Factors
Intrinsic pathway activated by contact to
collagen: HMWK, prekallikrein, XII, XI, IX, VIII
Extrinsic pathway activated by tissue
thromboplastin: VII
Common pathway: X, V, II, I
Fibrin Formation
Inhibitors
Anti-thrombin III with heparin: II, IX, X, XI, XII
Protein C and protein S: slow down VIII and V
Heparin: quick acting but short lived and need
AT-III
Coumarin: vitamin K antagonist
Specimen
Instrumentation
Electro-mechanical (e.g., Fibrometer)
Physical detection of clot
Cannot be automated
Vascular integrity
Bleeding time
Tourniquet test
Others
FDP, D-dimer
Factor assays
Anti-thrombin III
Proteins C and S
Factor V Leiden
Other Tests
Factor assay: reconstitute patient plasma with
known deficient plasma and determine
clotting time
FDP and D-dimer tests for fibrinolysis
Fibrinogen assay: modified TT
5M urea test for factor XIII
Plasma protamine-sulfate paracoagulation test
(3P) for fibrin monomers
Abnormal APTT
Abnormal PT
Coumarin therapy
Vitamin K deficiency, especially in newborn
More sensitive to common pathway factors
than APTT
Heparin
Abnormal TT
Dysfibrinogenemia
Afibrinogenemia
Hypofibrinogenemia
Heparin
FDP: forms abnormal complex
Hyper-coagulable State
Deep vein thrombosis due to inappropriate
coagulation
Protein C and protein S deficiency
Anti-thrombin III deficiency
Factor V Leiden mutation: does not respond
to protein C (activated protein C resistance,
APCR)