Why is APTT prolonged in acute vein thrombosis?

Hello,

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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.

Mixing test for APTT is not corrected, so lupus inhibitor seems to be more likely. For rule out above causes factor 8 and other intrinsic factor coagulation assay, antiphospholipid antibody estimation can be done. For an acute thrombotic event, low molecular weight heparin is prescribed. Then oral anticoagulant like Rivaroxaban can be prescribed as maintenance therapy for two to three months. You should consult a hematologist for examination and coagulation profile workup should be done. Take care.

Hello,

Welcome back to icliniq.com.

Deep vein thrombosis occurs when the disorder of hemostasis occur because of the 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 that include congenital like protein C deficiency, protein S deficiency, factor V Leiden mutation, hemophilia, etc. Acquired cause include lupus inhibitor, post-surgical, liver disease, disseminated intravascular coagulation (DIC), etc.

Disseminated intravascular coagulation is also a possibility but in that PT also prolonged which is normal here. But still, you can do further work up for that with peripheral smear examination, serum LDH estimation, thrombin time (TT), etc. But still, rule out disseminated intravascular coagulation by above work as in that condition consumptive coagulopathy can occur and so platelet count can be low. Lupus inhibitor seems most like a possibility in your case but I suggest you investigate full coagulation profile as the picture is somewhat complicated in your case.

And yes it is better to consult nearby hematologist as well for the examination. Take care.

Hello,

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Hereby I am giving you my further opinion regarding your case.

1. A case of thrombophilia most commonly seems to be because of lupus inhibitor or DIC with thrombocytopenia.
2. Differential diagnosis included are hemophilia A or B, intrinsic factor coagulation pathways defects like factor 8,12,11,9, DIC, liver disease, sometime heparin therapy.
3. Swollen leg and positive Homan sign are because of deep vein thrombosis. So swollen leg is because of thrombosis of deep veins of the leg. Color Doppler USG beneficial to rule it out. A hematoma can occur because of muscular bleeding which is common in hemophilia like condition.
4. To dissolve thrombosis low molecular weight heparin is given which can lyse clot. Then oral anticoagulant can be prescribed like Warfarin or Rivaroxaban, etc. So, although lupus inhibitor that is antiphospholipid antibody syndrome seems most likely diagnosis other causes also need to be ruled out.
5. Peripheral smear examination, serum LDH, bilirubin level, thrombin time need to be checked to rule out disseminated intravascular coagulation as well. DIC is a hemolytic condition so peripheral smear examination will show schistocytes like fragmented RBC and serum LDH will be raised. Take care.

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 antiphospholipid syndrome. Your FDP fibrin degraded product is positive. Hence, DIC also should be ruled out by mentioned investigation in history. Your only APTT is elevated so hemophilia, intrinsic pathway coagulation factor deficiency, DIC also should be ruled out. So, in above answer, I already mentioned all differential diagnosis. Take care.