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Basic Coagulation Workup - 1

PT, aPTT, Fibrinogen, TT, Plt Ct

Subselect and type


Prolonged PT
additional text here
Other studies normal

Prolonged aPTT
Other studies normal

Prolonged PT, aPTT


Other studies normal

PT 1:1 mix

aPTT 1:1 mix

PT, aPTT 1:1 mix

Full correction

Partial
correction

Factor VII
Deficiency

Lupus
anticoagulant
workup

Factor levels,
if needed

No correction

Factor
inhibitor
workup

Coumadin

Full correction

vWD

Factor
Deficiency

vWD
workup, if
needed

Factor
levels, if
needed

Adapted from: Coagulation Guidelines for Unexplained Bleeding Disorders


University of Washington Clinical Laboratory Advisory Council

Partial
correction

No correction

Full correction

Partial
correction

Lupus
anticoagulant
workup

Factor inhibitor
workup

Factor
Deficiency

Lupus
anticoagulant
workup

Factor levels,
if needed

No correction

Factor
inhibitor
workup

Coumadin

Basic Coagulation Workup - 2


PT, aPTT, Fibrinogen, TT, Plt Ct

Prolonged aPTT, TT
Other studies normal

Normal Studies /
Bleeding Patient

Low Fibrinogen, Plt Ct

Diffuse or joint
bleeding

Hepzyme treatment
D-dimer

Factor VIII
Correction

Heparin
contamination

Normal

Low
Normal

Antibody to
bovine
thrombin

Dysfibrinogen

DIC

FDP

Low or
normal

High

Dysfibrinogen

DIC

Factor XI

Mild
hemophilia B

vWD workup

Mild
hemophilia C

Abnormal

vWD

Normal

Low

Fibrinolytic
workup

Factor XIII
deficiency

PAI-1
deficiency

Low

Low

Factor XIII

Alpha-2-antiplasmin
deficiency

Normal

Normal

Normal

TPA
excess

Abnormal

Mild
hemophilia
A

Factor IX

Prolonged

Recommend workup
for Thrombocytopenia

High

Reptilase time

Normal

Petechiae or
Mucosal bleeding

Workup for Platelet


dysfunction

No correction
Low or
normal

Low Plt Ct
Other studies normal

Platelet
dysfunction

vWD workup

Normal

Abnormal

vWD

Basic Thromboembolism (Hypercoagulability) Workup

APC resistance assay

Factor V
Leiden

Abnormal

Normal

APC resistance

Protein C Ag &
activity

Factor II
G20210A

MTHFR

Prothrombin

Antiphospholipid
antibodies

Factor VIII, XI
levels

? elevated

Anticardiolipin
antibodies

Anti-B2glycoprotein
antibodies

Abnormal

Normal

Protein C
deficiency

Protein S Ag &
activity

Lupus
anticoagulant
workup

Abnormal

Normal

Protein S
deficiency

AT III Ag &
activity

Abnormal

Normal

AT III
deficiency

Fibrinogen
level & activity

Normal

Abnormal

Homocysteine
levels

Dysfibrinogen

? high

Hyperhomocysteinemia

Lupus Anticoagulant Workup

Screening
Tests

Mixing Studies

aPTT

1:1 mixing study

Normal

DRVVT

Abnormal

Confirmatory
Testing

Failure to correct

Corrects

Incubated 1:1
mixing study

Hexagonal
platelet
neutralization
study

Negative

Corrects

Factor assays

Normal
Specific factor
deficiency or
inhibitor
Negative

Positive

Lupus
anticoagulant