Why is APTT prolonged in acute vein thrombosis?

Hello,

Welcome to icliniq.com.

The APTT (activated partial thromboplastin time) test is positive (attachment removed to protect patient identity). So three causes should be ruled out:

1. Hemophilia A or B.
2. Intrinsic factor coagulation factor deficiency. That is factor 12,11,9,8.
3. Lupus inhibitors.

The mixing test for APTT is not corrected, so lupus inhibitor seems to be more likely.

To rule out the above causes, factor 8 and other intrinsic coagulation factors, the coagulation assay, and antiphospholipid antibody estimation can be done.

For an acute thrombotic event, low molecular weight Heparin is prescribed. Then an oral anticoagulant like Rivaroxaban can be prescribed as maintenance therapy for two to three months. You should consult a hematologist for examination, and a coagulation profile workup should be done.

I hope this information helps you.

Feel free to ask further queries.

Thank you.

Hello,

Welcome back to icliniq.com.

Deep vein thrombosis occurs when a disorder of hemostasis develops due to an underlying cause. It is called thrombophilia. So, in thrombophilia, there is a tendency to form a clot.

There are many causes of deep vein thrombosis, including congenital conditions such as protein C deficiency, protein S deficiency, and the factor V Leiden mutation, as well as hemophilia. Acquired causes include lupus anticoagulant, post-surgical, liver disease, and disseminated intravascular coagulation (DIC), among others.

Disseminated intravascular coagulation is also a possibility; however, the PT is prolonged, which is normal in this context. However, you can still conduct a further workup with peripheral smear examination, serum LDH estimation, and thrombin time (TT), among other tests.

But still, rule out disseminated intravascular coagulation by the above work, as in that condition, consumptive coagulopathy can occur, and so the platelet count can be low. Lupus inhibitors seem most likely a possibility in your case, but I suggest you investigate a complete coagulation profile, as the picture is somewhat complicated.

And yes, it is better to consult a nearby hematologist for the examination as well.

I hope this information helps you.

Feel free to ask further queries.

Thank you.

Hello,

Welcome back to icliniq.com.

I will give you my opinion regarding your case.

1. A case of thrombophilia most commonly seems to be caused by lupus inhibitors or DICs associated with thrombocytopenia.
2. Differential diagnosis includes hemophilia A or B, intrinsic factor coagulation pathway defects (such as factor 8, 12, 11, and 9), DIC, liver disease, and sometimes heparin therapy.
3. A swollen leg and a positive Homan's sign are indicative of deep vein thrombosis. A swollen leg is caused by thrombosis of the deep veins of the leg. Color Doppler USG is beneficial to rule it out. A hematoma can occur because of muscular bleeding, which is common in a hemophilia-like condition.
4. To dissolve thrombosis, low-molecular-weight heparin is administered, which can lyse the clot. Then, an oral anticoagulant can be prescribed, such as Warfarin or Rivaroxaban. So, although lupus anticoagulant, which is a type of antiphospholipid syndrome, seems the most likely diagnosis, other causes also need to be ruled out.
5. Peripheral smear examination, serum LDH, bilirubin level, and thrombin time should also be checked to rule out disseminated intravascular coagulation. DIC is a hemolytic condition, so a peripheral smear examination will show schistocytes, which are fragmented RBCs, and serum LDH will be elevated.

I hope this information helps you.

Feel free to ask further queries.

Thank you.

Hello,

Welcome back to icliniq.com.

Deep vein thrombosis is called thrombophilia, and there are many causes of deep vein thrombosis, but antiphospholipid syndrome seems most likely.

You can investigate further with anticardiolipin antibody estimation by ELISA for the diagnosis of antiphospholipid syndrome. Your FDP fibrin-degraded product is positive.

Hence, DIC should also be ruled out by the mentioned investigation in history. Your only APTT is elevated, so hemophilia, intrinsic pathway coagulation factor deficiency, and DIC should also be ruled out. As mentioned in the above answer, I have already listed all differential diagnoses.

I hope this information helps you.

Feel free to ask further queries.

Thank you.