Interpretation of Mixing Studies Done on Abnormal Screening Coagulation Test Results in a Tertiary Care Hospital and Correlation with Clinical Conditions: A Descriptive Observational Study
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 3
Abstract
Abstract: Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are common coagulation screening tests in any patient with bleeding or patients taking warfarin or heparin (for therapeutic purpose). Characteristic features of bleeding caused by coagulation pathways defects are large and few skin hemorrhages, deep hematomas and hemarthroses and delayed bleeding is more common. Mixing studies are done to differentiate between factor deficiency and presence of any circulating inhibitors. In present study 150 cases of abnormal coagulations screening results (INR>1.5 and aPTT > 45 sec.) were taken. Mixing studies on PT with 1:1 mix with pooled normal plasma are done and patients divided in three groups based on percentage correction in A, B and C. Various demographic details, clinical profiles and history correlated with three groups and we reviewed the literature. The age range of patients was from 1 day to 78 years. Male to female ratio was 2.06:1. The ratio of patients from medicine side to surgical side was 1.35:1 (8:7). Out of 80 patients from medical side 62.5% showed >75% correction, 32.5% showed <70% correction and 5% showed 70-75% correction. Out of 70 patients from surgery side, 65.7% showed >75% correction, 22.8% showed <70% correction, and 11.5% showed borderline correction. Most patients of DIC or patients taking warfarin or heparin showed >75% correction. Few patients didn’t show expected correction that might be caused by associated metabolic disturbances like acidosis, sepsis, and severe factor deficiencies etc. In the study we conclude that mixing studies may help us to decide that whether the case belongs to factor deficiency or presence of circulating anticoagulant, therefore help to rationalized use of FFP and Vit K. Non correction with known causes/etiologies of factor deficiency needs correction of hidden comorbidities likes acidosis & other metabolic disturbances. Further extensive studies are needed to standardize the cut off criteria for correction so that further treatment plan can be decided in centers where factor assays are not available.
Authors and Affiliations
Dr. Manisha . , Dr. Kishore Khatri, Dr. A R kalla, Dr. Chanda Khatri
Keywords
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