Importance of Quick, partial thromboplastin time, and Co

Abstract

The Quick test and activated partial thromboplastin time (aPTT) are so-called global assays used to characterize different steps in plasmatic hemostasis. They reflect hemostasis in its classical differentiation into extrinsic and intrinsic pathways. However, they do not cover physiological aspects of cell-based hemostasis. Results are not necessarily congruent with a specific clinical situation and do not replace a complete medical history. Patients suffering from hemophilia A or B, for example, have normal Quick test results. Severe factor XII deficiency reveals an extreme aPTT prolongation without a significant bleeding tendency. In Lupus patients, aPTT is also prolonged with clinically a rather increased thrombotic risk. Fibrinogen as a substrate of coagulation discloses pathological results in both global tests in case of considerable reduction. In case of positive bleeding history and a normal global assay, disorders in platelets, von Willebrand factor and factor XIII must be considered. Reduced Quick test results may be expected in factor VII, II, V, or X deficiency. Disorders of liver synthesis of coagulation factors as well as vitamin K deficiency will be indicated by the Quick test rather than by aPTT. The most frequent hereditary reasons for a prolonged aPTT are hemophilia A and B as well as von Willebrand disease. In case of an acquired bleeding tendency, the diagnostic strategy must include autoantibodies. The sensitivity of the aPTT reagent varies widely. Low-molecular weight heparin and pentasaccharides do not influence the test. Oral direct inhibitors may reveal pathological results in a reagent-dependent manner.