Haematology Department, Pathology Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld 4102, Australia.
Int J Lab Hematol. 2011 Feb;33(1):67-78. doi: 10.1111/j.1751-553X.2010.01248.x.
The graphical representation of clotting data can provide useful information. A novel feature of the ACL TOP software allows display of clot reaction curves with superimposed first and second derivative curves. We noted atypical derivative plots associated with normal 'S'-shaped clot reaction curves in some abnormal activated partial thromboplastin time (APTT).
We tested 179 citrate plasmas with four different APTT reagents on the ACL TOP. We documented the prevalence and utility of these APTT atypical derivative curves in these patients.
Ellagic acid APTT reagents commonly produce atypical derivative curves despite normal 'S'-shaped clot reaction curves. Occasionally, these atypical second derivative curves may cause incorrect APTT results. With silica activator APTT reagents, atypical derivative curves were associated with genuine coagulation abnormalities such as single factor deficiencies and lupus anticoagulants (LAs). To our knowledge, this novel finding has not been reported.
Atypical derivative curves seen in ellagic acid APTTs are of limited diagnostic use because of the frequency with which they occur. This may be related to the need to optimize the data reduction utilized on the ACL TOP for these reagents. With silica activator APTTs, the presence of atypical derivative curves proved to be a very simple tool when troubleshooting unexpected abnormal APTT results, commonly predicting a factor deficiency or LA that would warrant further investigation. The cause of these aberrant derivative curves is probably related to abnormal thrombin generation in the APTT test and warrants further study.
凝血数据的图形表示可以提供有用的信息。ACL TOP 软件的一个新特性是可以显示带有叠加的一阶导数和二阶导数的凝血反应曲线。我们注意到在一些异常的活化部分凝血活酶时间（APTT）中，正常“S”形凝血反应曲线伴有不典型的导数图。
我们在 ACL TOP 上用四种不同的 APTT 试剂测试了 179 份柠檬酸盐血浆。我们记录了这些患者中这些 APTT 不典型导数曲线的流行率和实用性。
鞣花酸 APTT 试剂通常会产生不典型的导数曲线，尽管凝血反应曲线呈正常“S”形。偶尔，这些不典型的二阶导数曲线可能会导致不正确的 APTT 结果。在用硅烷激活剂 APTT 试剂时，不典型的导数曲线与真正的凝血异常有关，如单一因子缺乏和狼疮抗凝剂（LA）。据我们所知，这是一个尚未报道的新发现。
鞣花酸 APTT 中所见的不典型导数曲线由于其发生的频率，其诊断用途有限。这可能与需要优化 ACL TOP 上用于这些试剂的数据减少有关。在用硅烷激活剂 APTT 时，不典型导数曲线的存在证明是一种非常简单的工具，可以在解决意外异常 APTT 结果时使用，通常预测因子缺乏或 LA，这需要进一步调查。这些异常导数曲线的原因可能与 APTT 试验中异常的凝血酶生成有关，值得进一步研究。
