Abnormal bleeding or bleeding tests:

• clinical comments: Be alert when patient history indicates a notable bleeding tendency spontaneously and/or after challenges such as shaving nicks, dental work, or with menses (or as family history). 

• HUS/TTP information

• tests:

  • global: bleeding time, activated clotting time, Lee-White clotting time, thromboelastography.

  • plasma factors: PT, APTT

  • fibrinogen: fibrinogen, split products, d-dimer

  • platelets: bleeding time & see lab letter, below. (remember that medications can affect tests without neccessarily having presented as clinical problems [e. g., discovering on pre-op screening]; dysproteinemias can "coat" platelets).

  • Fletcher factor: elevated PTT but no bleeding or bleeding history

  • inhibitor screening ("mixing studies"): to globally screen for plasma factor deficiencies or inhibitors.

  • isolated Factor X deficiency: prolonged PT & APTT & may be associated with amyloidosis (amyloid of a type poorly portrayed in special stains adsorbs the factor X out of plasma) acting as a "factor sponge"...which can do similarly with factors V, VII, & IX [CP-04-34] ¹.

  • reference lab tests/testing: 

Hypercoagulation:

• clinical comments: Be alert when patient condition, historical details, or family history indicates a notable hypercoagulation tendency...personal or family history of spontaneous abortions or miscarriages; phlebitis cases; pulmonary emboli cases; malignant case; inflammatory cases; prolonged immobility situations; obesity; pregnancy. "Sticky platelet syndrome". And, in routine surgical pathology specimens, be alert to venous or arterial thromboses that "don't make sense": (right tube & ovary & arterial thrombosis noted [L-05-6350];___).

• tests:

  • global:

  • plasma:

  • fibrinogen:

  • platelets: 

• Laboratory Letters:

  • Nov. 2002 platelet function testing

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References:

1. Rochman H, et. al., textbook: Clinical Pathology in the Elderly...,, 1988, 222 pages.

(posted 14 December 2002; latest addition 16 July 2006)