Case Studies in Coagulation: Objectives

1. List the significant medical facts needed to assess patients for abnormalities in coagulation. a. Medical History b. Physical Examination (like bruises) c. Laboratory Tests: i. CBC: to get a whole platelet count ii. PT: extrinsic and common pathway 1. Factors VII, and X, V (common pathway) iii. aPTT: intrinsic and common pathway 1. Factors XII, XI, IX, VIII (12, 11, 9,8) and X, V (common pathway) iv. TCT: Thrombin Clotting Time or Fibrinogen function v. Whole Blood Platelet Functioning Screening: vi. ** Factor XIII is NOT included in these tests! (end of the common pathway, past fibrinogen, going into fibrin) 2. List the physical findings in patients with disorders of coagulation. a. Low platelet count (disease: ITP) b. Prolonged aPTTmale, so did a measurement of Factor VIII clot time (prolonged) (disease: hemophilia) c. Normal CBC, aPTT prolongedwoman, so did whole blood platelet functioning screening, measured specifically von Wilderbrands level (disease: von Wilderbrands) i. Von Wilderbrands travels with factor VIII d. Prolonged PT and aPTT after surgeries and antibiotic use.disease: Vitamin K Deficient i. Factors X, IX, VII, II are all vit K dependent 1. Affects PT and aPTT times (intrinsic and extrinsic pathways) e. History of blood clotting problems, wants to go onto BCPwhich test to perform? aPTT (possible Factor XII deficiency?) and Protein C Resistance Ration (associated with factors V and VIII) i. Most common blood disorder is Factor V mutation 1. Especially in those with german ancestory f. Patient is on warfarin. Which test need to perform to assess the dosage is appropriate? i. Prothrombin Time (PT) 1. Only useful purpose of this test is to moniter warfarin use!!! g. Liver failure patient will have normal or slightly elevated levels of which factors? i. Factor VIII (because it is made in endothelial cells and not the liver) 3. Describe the initial laboratory testing to consider in evaluating patients with disorders of coagulation. a. See #1.