Ramakers Christian, van der Heul Cees, van Wijk Eduard M
Sint Elisabeth Ziekenhuis, Afd. Klinisch Chemisch en Hematologisch Laboratorium en Trombosedienst, Tilburg, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(0):A3985.
The first case report describes an extremely prolonged activated partial thromboplastin time (APTT) in a patient with no history of increased bleeding tendency. Heparin use was excluded. The APTT mixing study combined with the medical history suggests a deficiency in one of the non-essential coagulation factors. This was confirmed by factor XII activity of <1%. The second case report describes a prolonged APTT in a patient with no history of increased bleeding tendency. The negative bleeding tendency in combination with a failure of the mixing study to correct the coagulation assay results suggests a factor inhibitor, most probably lupus anticoagulant. Indeed, the lupus anticoagulant was positive and the anti-cardiolipin antibody titre was also positive. Aberrations in the process of haemostasis can be efficiently screened using a platelet count, an APTT, a PT and a thorough physical examination combined with a thorough medical history taking. Common causes of prolonged PT and/or APTT are the use of oral anticoagulants or heparin, vitamin K deficiency and liver disease. Other causes include coagulation factor deficiencies, coagulation factor inhibitors and diffuse intravascular coagulation.
首例病例报告描述了一名既往无出血倾向增加病史的患者出现极长的活化部分凝血活酶时间（APTT）。排除了肝素使用情况。APTT混合试验结合病史提示非必需凝血因子之一缺乏。这通过因子Ⅻ活性<1%得到证实。第二例病例报告描述了一名既往无出血倾向增加病史的患者出现APTT延长。阴性出血倾向与混合试验未能纠正凝血检测结果相结合提示存在因子抑制剂，很可能是狼疮抗凝物。事实上，狼疮抗凝物呈阳性，抗心磷脂抗体滴度也呈阳性。使用血小板计数、APTT、PT以及全面的体格检查并结合详尽的病史采集能够有效地筛查止血过程中的异常情况。PT和/或APTT延长的常见原因包括使用口服抗凝剂或肝素、维生素K缺乏和肝病。其他原因包括凝血因子缺乏、凝血因子抑制剂和弥散性血管内凝血。
