How to Interpret and Pursue an Abnormal Prothrombin Time, Activated Partial Thromboplastin Time, and Bleeding Time in Adults Arif H. Kamal, MD, Ayalew.

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How to Interpret and Pursue an Abnormal Prothrombin Time, Activated Partial Thromboplastin Time, and Bleeding Time in Adults Arif H. Kamal, MD, Ayalew Tefferi, MD, Rajiv K. Pruthi, MBBS Mayo Clinic Proceedings Volume 82, Issue 7, Pages 864-873 (July 2007) DOI: 10.4065/82.7.864 Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Coagulation cascade. a = activated factor; Ca = calcium; PL = phospholipid. Adapted from Biochemistry,2 with permission from American Chemical Society, copyright 1991. Mayo Clinic Proceedings 2007 82, 864-873DOI: (10.4065/82.7.864) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Schematic of coagulation cascade. Factors II, VII, IX, and X are vitamin K-dependent factors. APTT = activated partial thromboplastin time; HMWK = high-molecular-weight kininogen; PK = prekallikrein; PT = prothrombin time; RT = reptilase time; TT = thrombin time. Mayo Clinic Proceedings 2007 82, 864-873DOI: (10.4065/82.7.864) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Schematic showing effect of hematocrit on relative volume of citrate anticoagulant in blood collection tube. Mayo Clinic Proceedings 2007 82, 864-873DOI: (10.4065/82.7.864) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 4 Approach to a prolonged prothrombin time (PT) or activated partial thromboplastin time (APTT)—exclusion of artifactual results. *If original sample was collected through a central venous line or arterial line, testing should be repeated on a sample collected from peripheral venipuncture, and appropriate adjustments made if pretest variables (eg, elevated hematocrit or specimen lipemia) are suspected. Mayo Clinic Proceedings 2007 82, 864-873DOI: (10.4065/82.7.864) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 5 Approach to a prolonged prothrombin time (PT) or activated partial thromboplastin time (APTT)—distinguishing a clotting factor deficiency from a clotting factor inhibitor. *Thrombin time is prolonged and reptilase time is normal; †PT is normal; ‡PT is prolonged and inhibited; §PT is typically normal but may be prolonged and inhibited when a mixing study is performed. Mayo Clinic Proceedings 2007 82, 864-873DOI: (10.4065/82.7.864) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions