Prolonged Activated Partial Thromboplastin Time Research Articles

Comparison of PPT and APTT in Pre and Post-Hemodialysis Patients as the Heparin-Exposed Effect

Evaluations on Plasma Prothrombin Time (PPT) and Activated Partial Thromboplastin Time (APTT) are required in patients with Chronic Kidney Disease (CKD) stage V to determine the risk of bleeding after hemodialysis (HD) using heparin as the anticoagulant. This study aimed to compare the results of PPT and APTT in pre and post-hemodialysis patients with minimum dose of heparin. This was an observational-analytical study with cross-sectional design. The samples were collected in HD wards of Dr. Soetomo Hospital, Surabaya. There were 50 PPT and APTT samples collected from June to August 2017. The samples were evaluated using the tool CoaDATA 501. The examination of coagulation study was conducted in Clinical Pathology Laboratory of Dr. Soetomo Hospital, Surabaya. Paired t-test and Wilcoxon signed-rank test were performed in this study. In the 50 samples, pre-hemodialysis PPT ranged between 10.2-17.6 with the mean of 12.6±2.03 seconds, while for post-hemodialysis, the range was 10.1-20.9 with the mean of 13.41±2.43 seconds. Pre-hemodialysis APPT ranged between 19.5-75.2 with the mean of 30.32±10.43 seconds, while in post hemodialysis the range was 22.21-175 with the mean of 37.52±26.40 seconds. The results of PTT evaluation in pre and post-HD showed no significant difference (p=0.083), while those of APTT showed a significant difference (p=0.035 or p<0.05). Prolongation of APTT in post-HD is due to the use of heparin as an anticoagulant that increases PPT and APTT by inhibiting antithrombin III. HD procedures cause decreased activity of coagulation factors II, IX, X, XII leading to APTT prolongation in post-HD. A significant APTT prolongation was found in post-HD patients with CKD V.

Prolonged APTT of unknown etiology: A systematic evaluation of causes and laboratory resource use in an outpatient hemostasis academic unit

BackgroundA prolonged activated partial thromboplastin time (APTT) of unknown cause is one of the most frequent reasons why outpatients are referred for hemostasis consultation. Nevertheless, very few data are available on the relative contribution of individual causes of this common clinical scenario. Here, we present a systematic evaluation of all causes of APTT prolongation in a consecutive population of outpatients referred for specialized hemostasis consultation during a 14‐year period. MethodsAll cases referred to an academic specialized hemostasis outpatient unit due to APTT prolongation of unknown etiology whose prolonged APTT was confirmed in the first visit were included in the study. Data were obtained from the electronic medical records. ResultsAmong 187 consecutive patients, the most frequent causes were antiphospholipid antibodies in 22.6%, contact pathway factor deficiencies in 17.4%, other coagulation factor deficiencies in 11.6%, and vitamin K deficiency/liver disease in 11.6%. A definite cause was not identified in 22.1% of patients. Presence of antiphospholipid antibodies, and absence of bleeding symptoms were both associated with significantly longer APTT values compared to other categories/clinical scenarios. The investigation of each case required a mean of 18.2 additional tests per patient, with estimated costs ranging from US$191.60 to US$1055.60. ConclusionsOur results describe the main causes of APTT prolongation in outpatients, as well as estimates of resource use required to investigate this condition, thus providing evidence supporting the importance of measures to minimize the indiscriminate use of this assay.

Coagulative biomarkers on admission to the ICU predict acute kidney injury and mortality in patients with septic shock caused by intra-abdominal infection.

PurposeSepsis-associated coagulopathy (SAC) contributes to the development of multiple organ failure (MOF) and increasing mortality. The present study was conducted to investigate whether coagulative biomarkers on admission to the intensive care unit (ICU) can predict acute kidney injury (AKI) and mortality in patients with septic shock caused by intra-abdominal infection (IAI).Patients and methodsAn observational retrospective study was conducted in the surgical ICU. We studied patients who met the criteria of septic shock (Sepsis-3) caused by IAI between January 1, 2013, and December 31, 2016. By adjusting for baseline characteristics, multivariate regression analyses were employed to identify independent risk factors for predicting AKI and mortality.ResultsOf the 138 enrolled patients, 65 patients developed AKI. The patients who developed AKI exhibited a dramatically higher Sequential Organ Failure Assessment (SOFA) score (median, 12), Acute Physiology and Chronic Health Evaluation (APACHE) II score (median, 27.5) and mortality rate. In both models, we found that activated partial thromboplastin time (APTT) (odds ratio (OR)=1.074, 95% confidence interval (CI) 1.030–1.120, p=0.001), prothrombin time (PT) (OR=1.162, 95% CI 1.037–1.302, p=0.010) and D-dimer level (OR=1.098, 95% CI 1.002–1.202, p=0.045) on admission to the ICU were significant risk factors for AKI. Moreover, Cox regression analysis showed that prolonged APTT (OR=1.065, 95% CI 1.025–1.107, p=0.001) was independently associated with high mortality.ConclusionIn patients with septic shock caused by IAI, APTT, PT and D-dimer level on admission to the ICU were significantly associated with AKI. Furthermore, APTT was an independent predictor of 30-day mortality.

Стан системи згортання крові щурів за умов впливу лазерного випромінювання у різних часових параметрах

The influence of different terms of laser irradiation on vascular-platelet and coagulation units of blood coagulation system is investigated. The rats were irradiated with a laser diode in the red spectrum (650 nm) with a power of 50 mW. Rats were divided into two groups: group I - rats, which were irradiated daily for 2 minutes; group II - rats, which were irradiated daily for 4 minutes. Euthanasia of animals was performed on the 7th and 14th days after the onset of irradiation. For the study of the blood coagulation system of rats used biochemical coagulogram with the analysis of the following indicators - the content of fibrinogen, thrombin and prothrombin time, activated partial thromboplastin time (APTT), platelet count. The content of lymphocytes and erythrocyte sedimentation rate were determined also. In the work used blood plasma with sodium citrate. It has been found that daily four-minute laser irradiation in the abdominal area for two weeks leads to a decrease in the concentration of factor I blood clotting (fibrinogen) and an increase in thrombin time. At the same time, prolongation of prothrombin time and APTT was detected, indicating a deficiency of other factors of blood coagulation - II, V, VII-XII, and the presence of anticoagulant status, which may be associated with inhibition of the internal pathway of clotting. Thrombocytopenia is probably caused by the increased destruction of platelets or their insufficient formation as a result of dysfunction of hematopoietic organs. The two-minute effect of laser irradiation does not affect the clinical and biochemical parameters of the blood coagulation system of rats after a weekly daily action of the laser diode. Two weeks irradiation is accompanied by processes of hypocoagulation, as evidenced by a decrease in fibrinogen levels, platelet counts, and a simultaneous increase in APTT, thrombin and prothrombin time.

Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study

The aim of this study was to compare the safety of tooth extraction in patients receiving direct oral anticoagulants (DOACs) or warfarin without cessation of their antithrombotic treatment. This prospective observational study included 367 patients undergoing tooth extraction (119 receiving DOACs and 248 receiving warfarin). All extractions in DOAC patients were performed 6–7h after taking DOACs in consideration of the half-life in blood under continued antithrombotic treatment. To examine the potential postoperative bleeding risk related to the time of extraction and the drug concentration of blood, activated partial thromboplastin time (APTT) in dabigatran and prothrombin time (PT) in rivaroxaban were measured three times after administration. A total of 390 tooth extractions were performed: 128 in the DOAC patients and 262 in warfarin patients. Postoperative bleeding occurred in four extractions (3.1%) in the DOAC group and in 23 (8.8%) in the warfarin group. There was no statistically significant difference between the two groups (odds ratio: 2.362, 95% confidence interval (CI) 0.819–6.815, p=0.112). APTT and PT prolongation in almost all cases decreased with time after taking the medicine. Our findings suggest that interruption of DOAC therapy is not necessary for tooth extraction if the procedure is performed at least 6h after the last dose.

How to Optimize Activated Partial Thromboplastin Time (APTT) Testing: Solutions to Establishing and Verifying Normal Reference Intervals and Assessing APTT Reagents for Sensitivity to Heparin, Lupus Anticoagulant, and Clotting Factors.

The activated partial thromboplastin time (APTT) assay is a very common coagulation test, used for several reasons. The test is conventionally used for assessing the contact factor (intrinsic) pathway of blood coagulation, and thus for screening deficiencies in this pathway, most typically factors VIII, IX, and XI. The APTT is also sensitive to contact factor deficiencies, including factor XII, prekallikrein, and high-molecular-weight kininogen. The APTT may also be elevated in a variety of conditions, including liver disease, vitamin K deficiency, and disseminated intravascular coagulation. The APTT can also be used for monitoring unfractionated heparin (UFH) therapy, as well as for screening lupus anticoagulant (LA) or for assessing thrombosis risk. Which of these separate uses is important to a given laboratory or clinician depends on the laboratory and the clinical context. For example, UFH sensitivity is important in hospital-based laboratories, where UFH therapy is used, but not in hospital-based laboratories where low-molecular-weight heparin (LMWH) is largely employed or where UFH may be assessed by anti-factor Xa testing, or in private/community laboratories not associated with a hospital system. High sensitivity to (low levels of) factors VIII, IX, and XI is generally preferred, as their deficiencies are clinically significant. Also preferred, but not usually achieved, is low sensitivity to factor XII and other contact factors, as these deficiencies are usually asymptomatic. Nevertheless, a good knowledge of factor sensitivity is usually needed, if only to help explain the reasons for a prolonged APTT in a given patient, or whether factor testing or other investigation is required. A good working knowledge of reagents sensitivity to LA is also advisable, especially when the reagent is used as part of a LA test panel, or else as a "general-purpose screening reagent." The current report is aimed at providing some guidance around these questions, and is intended as a kind of "how to" guide, that will enable laboratories to assess APTT reagents in regard to their sensitivity to heparin, LA, and clotting factors. The report also provides some advice on generation of normal reference ranges, as well as solutions for troubleshooting prolonged APTTs, when performing factor testing or searching for inhibitors.

Risk factors of early death in adult patients with secondary hemophagocytic lymphohistiocytosis: a single-institution study of 171 Chinese patients

ABSTRACTBackground: Adult secondary hemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome characterized by excessive activation of mononuclear-phagocytic system resulting in hyperinflammatory response. To date, the factors influencing early death of HLH are still not fully elucidated.Patients and Methods: We did a retrospective study of 171 adult patients with newly diagnosed HLH at our institution from January 2012 to April 2018. All patients’ clinical features, laboratory findings, treatments and prognosis were reviewed.Results: The median age was 49 years (range, 18–88 years), and 110 (64.3%) were male. The major underlying trigger of HLH was malignancy (88/171, 51.5%), especially non-Hodgkin lymphoma. In a multivariate analysis, age ≥54 years (P = 0.002), platelet ≤39.5 × 109/L (P = 0.028), activated partial thromboplastin time (APTT) ≥54 sec (P = 0.048), triglyceride ≥3.23 mmol/L (P < 0.001), lactate dehydrogenase (LDH) ≥1300 U/L (P = 0.012) and malignancy (P = 0.001) were significantly associated with early death in HLH. Then, patients were classified into four groups according to the number of risk factors at the time of diagnosis: low risk (zero, one or two risk factors), low intermediate risk (three risk factors), high intermediate risk (four risk factors) and high risk (at least five risk factors), with the 30-day overall survival (OS) of 92.4%, 58.8%, 30.0% and 4.8%, respectively (P < 0.001).Conclusions: Patients with old age, thrombocytopenia, prolonged APTT, hypertriglyceridemia, elevated LDH and malignancy had inferior survival. It is important to identify those patients at risk of early death, which may guide treatment and reduce mortality.

Blood Clot Identification Procedures in Clinical Laboratory Sampling.

Monitoring of anticoagulation therapy is based on screening tests: prothrombin time (PT) and activated partial thromboplastin time (APTT). The accidental presence of a clot in the coagulation samples determines a false prolongation of PT by fibrinogen (FI) consumption and the false or delayed prolongation of APTT, depending on FI consumption or activation. The purpose of this study is to document from the present data re-garding procedures used to exclude the accidental presence of clot in the sample. For a more efficient approach, we conducted a study based on research from the main databases that included original and peer-reviewed studies. We have reported studies in which pre-analytical procedures have been recommended and studies that have also presented post-analytical protocols. A correlation between the efficiency of the procedures in terms of additional laboratory costs has been performed, as well. Focusing on patient safety, it remains a continuous challenge for each laboratory to be able to establish its own pre-analytical and post-analytical procedure for highlighting accidental clot presence, thus ensuring provision of results with maximum confidence to the clinicians.

Acquired haemophilia A in an elderly patient related to relapsed cervix carcinoma

Abstract Acquired haemophilia A (AHA) is a rare, autoimmune disease, presenting as sudden haemorrhages without any personal or family history. Anti-factor VIII (FVIII) is the most commonly recognised autoantibody resulting in decreased factor activity. The aetiology and pathophysiology of these antibodies remains unclear. Approximately 50% of reported cases are idiopathic; the rest are associated with other conditions, mainly underlying malignancies, autoimmune diseases (eg rheumatoid arthritis (RA), systemic lupus erythematosus), drug administration and postpartum period. A 74-year-old woman presented to our institution with haematochezia and haematuria. She had a medical history of cervix carcinoma; total abdominal hysterectomy and bilateral salpingo-oophorectomy with postoperative chemoradiotherapy was performed in 2011. She had also been followed up for 20 years for deforming and severe RA, which was in low-disease activity with methotrexate and corticosteroid. Laboratory investigations for abnormal bleeding revealed prolongation of activated partial thromboplastin time (APTT). APTT prolongation was not corrected by 50:50 plasma mixing studies, and a confirmatory factor assay demonstrated FVIII deficiency (1.4 IU/dL; normal range 50-150 IU/dL). Positive FVIII antibodies on Bethesda testing confirmed a diagnosis of AHA. A rectosigmoid mass and fistula between rectum and bladder were discovered by computed tomography (CT). Bleeding was controlled with recombinant activated factor VII (rFVIIa) after two weeks. Eradication of the inhibitor was achieved with high-dose pulse methylprednisolone for two days and then 2mg/kg daily over four weeks.

Anti-Phospholipid Antibody Syndrome with Subdural Hematoma: A Case Report

A 33-year-old man with anti-phospholipid antibody syndrome associated with Budd Chiari syndrome and subdural hematoma. He developed venous thrombosis in his hepatic vein (stenting done) when laboratory studies demonstrated prolongation of activated partial thromboplastin time (APTT). Subdural hematoma demonstrated with Computed tomography (CT) of brain. Laboratory studies revealed thrombocytopenia, prolonged bleeding time and APTT, positive antinuclear antibody and positive test results for both lupus anticoagulant and an anti-cardiolipin antibody, namely antiphospholipid antibodies. Based on these findings, we consider that the tendency of this bleeding may have been due to antiphospholipid antibodies, attacking the platelet membranes and that the bridging veins in the subdural space may be the site at which the bleeding tendency easily appears. Antiphospholipid antibody syndrome accompanied by hemorrhagic complications had rarely been reported. We suggest that special attention should be given to hemorrhagic complications in patients with antiphospholipid antibody syndrome associated with fragility of the vessels and/or platelet dysfunction and on anticoagulant (warfarin).Pulse Vol.10 January-December 2017 p.25-28

Clinical analysis of hereditary coagulation factor Ⅴ deficiency

Objective: To analyze the clinical characteristics of hereditary coagulation factor Ⅴ deficiency (FⅤD) and to improve the diagnosis and treatment ability of hereditary FⅤD. Methods: A total of 17 patients with hereditary FⅤD admitted to the Department of Hematology, Peking University People's Hospital from February 2013 to January 2018 were selected, and their clinical characteristics, laboratory examination, treatment and prognosis were retrospectively analyzed. Results: There were 9 males and 8 females patients with FⅤD, the median age was 36 (1-72 ) years. The median age of men was 39 (1-72)years, and the median age of women was 33 (8-56)years. There was no significant difference between them (P=0.793). The median prothrombin time(PT) and activated partial thromboplastin time(APTT) values were 21.0(13.0-39.6) s and 54.6(38.2-121.2) s, and the median level of plasma FⅤ was 8.2% (0.9%-39%). Thirteen cases (13/17) were mild, 3 cases (3/17) were moderate, and only 1 case (1/17) was severe according to the FⅤ level. Five cases (5/17) had bleeding, including 3 cases with skin ecchymosis, 1 case with vaginal bleeding, and 1 case with gastrointestinal bleeding. According to the severity of bleeding, 1 case (1/17) had severe bleeding, and the other 4 cases (4/17) were mild bleeding. Conclusions: Patients with hereditary FⅤD either have or do not have bleeding symptoms, with prolonged PT and APTT and decreased plasma of FⅤ activity. There is no need for treatment for those without bleeding symptoms. Fresh frozen plasma is the first choice for patients who have bleeding, and the overall prognosis is good.

How can we deal with an unexpected preoperative prolongation of the activated partial thromboplastin time (APTT)? —a real world experience

Background: This article describes a tentative diagnostic algorithm for investigating patients with unexpected prolongation of activated partial thromboplastin time (APTT), detected during preoperative laboratory testing. Methods: The study population consisted of all patients undergoing preoperative laboratory testing (thus including APTT) during a 3-month period. Whenever prolonged APTT results were observed, abnormal data were investigated according to an algorithm combining familiar history of bleeding (yes/no), personal history of bleeding (yes/no) and signs/symptoms of bleeding with results of hemostasis testing, including mixing test, lupus anticoagulant (LAC) and clotting factor assays. Results: Overall, 1,433 patients underwent preoperative APTT testing throughout the 3-month study period, 76 (5.3%) of whom had prolonged values (i.e., >36.5 s). The remaining 1,357 (94.7%) patients underwent successful surgery, without further investigation. According to the algorithm, 55/76 (72.4%) of patients with prolonged APTT were excluded from supplementary laboratory testing. In the remaining 21/76 (27.6%) patients, a mixing test was scheduled. In 5/21 (23.8%) of these patients the mixing test was positive (i.e., no normalization), so that LAC testing was planned. In all these five patients LAC testing was positive. In the remaining 16/21 (76.2%) patients, mixing test was negative (i.e., normalization), so that clotting factors assays were scheduled. Seven patients were finally diagnosed with factor (F)XII deficiency, two patients with mild FXI deficiency (i.e., FXI activity of 47% and 51%), whilst 5 had clinically insignificant decreased values of one or more clotting factors and 2 patients had no identifiable explanation for APTT prolongation. The sensitivity and specificity of the algorithm for detecting clinically significant conditions (i.e., FXI deficiencies or LAC) were 1.00 and 0.99, respectively. Conclusions: The results of this study suggest that a preoperative algorithm including clinical and laboratory data may be a reasonable and sustainable approach for identifying patients at enhanced risk of perioperative bleeding or thrombosis.

Anti-Coagulation Activities of Malaysian Mikania cordata Leaves

The majority of the current anticoagulant drugs are chemically synthesised and to date, very limited sources are taken from natural-based agents. The objective of this study was to investigate the in vitro effect of the leaves extract of Mikania cordata (Selaput Tunggul) on basic coagulation activities and to identify its bioactive compounds. In this study, blood donors were divided into two groups where twenty-six blood samples were collected from healthy volunteers for prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) tests, whilst for the evaluation of the effect of Mikania extracts on factor levels, another twenty-seven healthy donors were recruited. Five factor levels namely factor VII, IX, X, II and I were measured in citrated plasma treated with two different aqueous leaves concentration at 12.5 and 25.0 mg/mL. The control used was normal saline (untreated). Identification of bioactive compounds were analysed using gas chromatography mass spectrometry (GCMS) in aqueous solution. Significant prolongation of both APTT and TT in a concentration-dependent manner (p < 0.01) was observed. In PT assay, a significant reduction of clotting time (p < 0.01) at 3.13 mg/mL and a significant prolongation of clotting time (p < 0.01) at 12.5 and 25.0 mg/mL were recorded. Percentage of factors (VII, IX, X, II and I) in untreated and treated plasma with 12.5 and 25.0 mg/mL of M. cordata extracts were significantly reduced compared to control. The GCMS has identified 16 and 15 constituents in the ethanol and aqueous extract; subsequently and supports the finding of a strong anticoagulant effect of the extract. In conclusion, the results of this study show that the aqueous extract of Mikania cordata leaves has anticoagulant effects in a concentration-dependent manner. The GCMS results showed that the aqueous extract contains many bioactive constituents that contribute to its anticoagulant activities. Thus, Mikana cordata can be explored further to be used as an ingredient for anticoagulant drugs in the future.

Characterization, sulfated modification and bioactivity of a novel polysaccharide from Millettia dielsiana

Millettia dielsiana is a traditional herb medicine to treat rheumatic arthritis and gynecological diseases. In this study, a novel polysaccharide (MDP1) with a molecular weight of 139.54 kDa was isolated from Millettia dielsiana by DEAE-52 cellulose chromatography. Its sulfated derivative (S-MDP1) was prepared by the chlorosulfonic acid-pyridine method. Structural analysis indicated that MDP1 was a pectic polysaccharide and did not exhibit a triple helical conformation. In vitro, MDP1 and S-MDP1 had protective effect on H2O2-induced PC12 cells death. Immunological assay showed that MDP1 and S-MDP1 significantly stimulated NO production and phagocytic activity in RAW264.7 cells, and promoted lymphocyte proliferation. Anticoagulant assay indicated that S-MDP1 effectively prolonged activated partial thromboplastin time (APTT) and thrombin time (TT), but not prothrombin time (PT), and MDP1 prolonged APTT and TT weakly. These results implied that MDP1 and S-MDP1 had the potential to be used as antioxidant, immunomodulatory and anticoagulant agents.

Does rotational thromboelastometry accurately predict coagulation status in patients with lupus anticoagulant?

Rotational thromboelastometry (ROTEM) is increasingly used as a tool for monitoring coagulation status. However, ROTEM is susceptible to misinterpretation due to particular coagulation abnormalities. Here, we report the effects of lupus anticoagulant (LA) on ROTEM. A prospective observational analysis was performed on 16 children with prior studies indicating the presence of LA or antiphospholipid antibodies. ROTEM analysis was performed, and samples were further analyzed by adding phospholipids (PL) to repeat ROTEM analysis if clotting time (CT) abnormalities were discovered with comparison to ROTEM using an equal volume of isotonic saline. Prothrombin time (PT), activated partial thromboplastin time (APTT), dilute Russell's viper venom test (DRVVT), hexagonal phase phospholipid neutralization test (StaClot LA), and factor II activity studies were additionally performed. Eighteen samples were analyzed by ROTEM. Prolonged CT on INTEM and EXTEM was observed for 11 samples. Samples with CT prolongation had high DRVVT ratios and prolonged APTT. Further, the addition of PL partially reversed this effect, demonstrating PL-dependent inhibition as the cause of CT prolongation. No factor II deficiencies were identified, excluding LA hypoprothrombinemia syndrome as a cause of these findings. Strongly positive LA can prolong the CT on ROTEM studies and lead to erroneous conclusions regarding coagulation status in this patient population.

Early Identification of Intracranial Hemorrhage Using a Predictive Nomogram

To identify predictive signs and symptoms occurring in hospitalized adults with hematologic malignancies with intracranial hemorrhage (IH). . In a National Cancer Institute (NCI)-designated comprehensive cancer center, a retrospective matched case-control design included adult inpatients with hematologic malignancies with (n = 39) and without (n = 39) IH. . Conditional logistic regression, t test, and Fisher's exact tests were used to assess increased risks for IH and the development of a prognostic nomogram with signs, symptoms, and laboratory values relevant to IH. . Composite outcomes for signs, symptoms, and laboratory values were included in a prognostic nomogram that had good discriminative ability to predict IH, with a bootstrap corrected concordance index of 0.766 (95% confidence interval [0.657, 0.866]) and good calibration. Prognostic nomogram predicted patients with prolonged activated partial thromboplastin time (APTT) (greater than 30.6), headache, and systolic blood pressure (SBP) of 140 or greater were more likely to have IH. . Nurses should recognize that patients with the combination of prolonged APTT, SBP of 140 or greater, and headache are more likely to have IH.

Association of Anti Phospholipid Antibodies in The Patients With Ischemic Stroke Under 45 Years of Age In Tertiary Level Hospital: A Case Control Study

Background: Antiphospholipid antibodies have been associated with a clinical syndrome consisting of thrombosis and recurrent, unexplained fetal loss. Stroke may be caused by Antiphospholipid Antibodies (APLA) especially in young persons without other conventional risk factors like Diabetes mellitus, Hypertension, Dyslipidemia, Smoking etc. The aim of this study was to evaluate the association of antiphospholipid antibodies (Anticardiolipin antibody and lupus anticoagulant) in young ischemic stroke patients presenting with sudden neurological deficit. Materials and methods: This was a case-control study performed in Medicine and Neurology department of Chittagong Medical College Hospital, Chittagong, a tertiary care government hospital. A total no. of 195 respondents consisting of 95 consecutive young patients (Age less than 45 years) diagnosed as ischemic stroke and 100 age and sex matched healthy controls were included in this study. The clinical details and related investigations of the respondents were reviewed. Anticardiolipin antibodies (IgM, IgG isotypes) were evaluated by an Enzyme-Linked Immunosorbent Assay (ELISA) and lupus anticoagulant by phospholipid dependent coagulation test Activated Partial Thromboplastin Time (APTT). When APTT was found more than 5 sec prolonged than control value, mixing studies using a 50:50 mixture of patient and normal plasma were performed and the result was considered positive if prolongation of APTT was not corrected which were needed to be confirmed after 12 weeks. The tests of Anticardiolipin antibodies (aCL) were repeated after 12 weeks when prior results were abnormal and the tests were considered positive when both results of aCL were found above normal value (IgM &gt; 7.2 MPL/ml, IgG&gt;14.4 GPL/ml). Results: Anticardiolipin antibodies Anticardiolipin antibodies (aCL) were present in 10.5% of the patients (IgM in 3 cases, IgG in 6 cases, IgM/IgG both in 1 case) and in 1% (IgG type) of control, but none of the study subjects were found LA positive. The odds ratio of aCL was 11.647 (95% Confidence interval= 1.461 – 92.852). Overall, the risk factors profile in cases were, Hypertension (32.6%) Diabetes mellitus (10.5%) Cigarette smoking (26.3%) and Dyslipidaemia (25.3%). Among the 10 aCL positive cases, 3 were Hypertensive, 1 was Diabetic, 2 were Smoker and 2 were Dyslipidemic but anticardiolipin antibody positive group did not differ significantly with respect to distribution of major risk factor frequency from anticardiolipin antibody negative group. Conclusion: Anticardiolipin antibodies are associated significantly with ischemic stroke in young patients less than 45 years of age (p= 0.004). Hence screening for anti-cardiolipin antibodies in young patients with stroke is recommended.&#x0D; JCMCTA 2017 ; 28 (2) : 27-33

Acquired von Willebrand Syndrome due to Aortic Valve Stenosis in a Case with Antiphospholipid Antibody.

Acquired von Willebrand syndrome (AVWS) is a bleeding disorder caused by an acquired deficiency of von Willebrand factor (vWF). Some patients with AVWS show a low bleeding tendency and are diagnosed by the presence of a mild prolongation of activated partial thromboplastin time (APTT) preoperatively. Another cause of APTT prolongation is the presence of antiphospholipid antibody (aPL). We experienced a case of AVWS due to aortic valve stenosis in a patient with aPL in whom aortic valve replacement surgery was successful with vWF replacement. In patients with AVWS-associated disorders who are identified based on APTT prolongation at the preoperative examination, both vWF and aPL screening tests must be performed.

Acquired Hemophilia in Female - A Case Report

Acquired hemophilia is a rare but acquired bleeding diathesis caused by autoimmune depletion of Factor VIII or IX. Diagnosis of Acquired Hemophilia requires clinical acumen. The condition is often under diagnosed as because it is rare and patients usually don’t have any unusual personal or family history of bleeding episodes. Acquired hemophilia has an equal sex distribution. So, clinicians should suspect acquired hemophilia in any patients with unexplained persistent and profound bleeding from uncommon soft tissues and mucosa and having prolonged activated partial thromboplastin time (APTT) without other causes. Here we will report a 50-year-old lady presenting with recurrent spontaneous bruises and joint pain and swelling for 2 years. On examination we found multiple bruises and ecchymosis of different sizes with varying colour changes from bluish to greenish over different parts of her body including face, right shoulder, right elbow joint and 2nd and 3rd PIP joints. Lab findings showed decreased Hemoglobin with prolonged APTT which didn’t correct in mixing study. After exclusion of other possible pathological conditions and on the basis of lab criteria we diagnosed the case as Acquired Hemophilia. She was successfully treated with blood transfusion, recombinant activated factor VIII, Steroid and supportive treatments and was discharged with improving symptoms, stable hematocrit and resolving bruises.J MEDICINE July 2017; 18 (2) : 119-122

Routine coagulation tests on ICU admission are associated with mortality in sepsis: an observational study.

Low platelet count on admission to an intensive care unit (ICU) is associated with increased mortality and is thus included in some severity scoring systems such as the simplified acute physiologic score 3 (SAPS 3); however it is unclear whether other routine coagulation tests also predict mortality. The purpose of this retrospective single-centre study was to investigate whether activated partial thromboplastin time (APTT) or prothrombin time - international normalized ratio (PT-INR) measured on admission to the ICU in patients with severe sepsis or septic shock may be associated with mortality independent of SAPS 3 score. All patients admitted to a tertiary general ICU from 2007 to 2014 diagnosed with severe sepsis or septic shock were eligible. Results from APTT and PT-INR within 1.5h of admission as well as SAPS 3 were used as independent variables in a Cox regression. Of total 5485 ICU admissions during the study period we identified 647 unique patients with severe sepsis or septic shock. APTT and PT-INR were found to correlate significantly with mortality with a hazard ratio (HR) of 1.014 [95% confidence interval of HR (1.006-1.023)] for APTT and 1.422 (1.117-1.811) for PT-INR. HR for SAPS 3 was 1.036 (1.028-1.044). Activated partial thromboplastin time prolongation and raised PT-INR on ICU admission in patients with severe sepsis or septic shock is associated with increased mortality independent of SAPS 3 score. This indicates that APTT prolongation and PT-INR increase represents morbidity that is not accounted for in SAPS 3.