Coagulation studies
See Table 17.3
· APTT:
principally assesses the
‘intrinsic’ path of the coagulation cascade.
· PT
or INR (monitoring warfarin therapy): assesses ‘extrinsic’ pathway.
· Thrombin
time (TT): only
used to differentiate between heparin contamination,
dysfibrinogenaemia and DIC. This test is not used routinely and needs to be
requested specifically.
· Serum
fibrinogen: useful
if DIC or haemophagocytic lymphohistiocytosis (HLH) is suspected.
· PFA:
In vitro test of platelet
function. This test is easy to perform provided
the platelet count >100 × 109/L. Ranges in children have been
produced.
· Bleeding
time: tests platelet
function. Now virtually obsolete.
· Fibrin
degradation products (FDPs): Components released into the
blood following clot degradation. Levels rise after any thrombotic event.
Can be used to test for DIC. The most notable subtype of FDPs is D-dimer.
· D-dimer:
principally used to screen adults
for thrombotic disorders, e.g. deep
vein thrombosis (DVT). Rarely used in children except possibly to help monitor
management of DIC (possibly along with FDPs). Note: DIC is a clinical diagnosis and is not made my measuring
D-dimers or FDPs.
Other specific tests include
screening tests of coagulation inhibitor, e.g. lupus anticoagulant, or
individual clotting factor level
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