Perioperative Evaluation of Bleeding Diathesis

Hematology ◽  
2006 ◽  
Vol 2006 (1) ◽  
pp. 457-461 ◽  
Author(s):  
Lawrence L.K. Leung
Keyword(s):  
Differential Diagnosis ◽  
Prothrombin Time ◽  
Bypass Surgery ◽  
Clotting Factor ◽  
Factor V ◽  
Bleeding Diathesis ◽  
Factor Deficiency ◽  
Cardiac Bypass

AbstractThe differential diagnosis of a long APTT with a normal prothrombin time can be due to either a clotting factor deficiency or the presence of an inhibitor, which can be distinguished by using a plasma-mixing study. The various clotting factor deficiency states are reviewed. Clinical bleeding following cardiac bypass surgery due to acquired factor V and thrombin antibodies is also reviewed.

Antithrombin III contribution to cholestasis differential diagnosis: its correlation with one stage prothrombin time and factor V

1980 ◽  
Vol 2 (3) ◽  
pp. 185-190
Author(s):  
J. MONASTERIO ◽  
J. JUNCÁ ◽  
J. TORRAS ◽  
B. CLOTET ◽  
M. CERVANTES ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Prothrombin Time ◽  
Antithrombin Iii ◽  
Factor V ◽  
One Stage

scholarly journals Coagulation disorders during treatment with cefazolin and rifampicin: rare but dangerous

2021 ◽  
Vol 6 (5) ◽  
pp. 131-134
Author(s):  
Ines Kouki ◽  
Clémence Montagner ◽  
Wladimir Mauhin ◽  
Jonathan London ◽  
Thierry Lazard ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Vitamin K ◽  
Clotting Factor ◽  
Severe Bleeding ◽  
Coagulation Disorders ◽  
Severe Vitamin ◽  
Digestive Hemorrhage ◽  
Factor Deficiency

Abstract. We describe a 79-year-old man with spondylodiscitis and unknown pathogen, treated with cefazolin and rifampicin. He developed a massive digestive hemorrhage. Prothrombin time was prolonged with severe vitamin-K-dependent clotting-factor deficiency. Severe bleeding can occur during cefazolin and rifampicin use. This deficiency should be assessed before prescribing cefazolin–rifampicin and prothrombin time monitored.

Bovine thrombin-induced inhibitor of factor V and bleeding risk in postoperative neurosurgical patients

1993 ◽  
Vol 78 (5) ◽  
pp. 817-820 ◽  
Author(s):  
Joel A. Spero
Keyword(s):  
Prothrombin Time ◽  
Bleeding Risk ◽  
Clotting Factor ◽  
Neurosurgical Procedures ◽  
Factor V ◽  
Bovine Thrombin ◽  
Content Type ◽  
Surgical Exposure ◽  
Neurosurgical Patients ◽  
Fine Print

✓ Three patients are reported who developed topical bovine thrombin-induced antibodies to clotting factor V following neurosurgical procedures. In each patient the coagulopathy occurred within 8 to 13 days following exposure to topical bovine thrombin at surgery. Two of the three had previously been exposed to bovine thrombin during cardiothoracic surgery. The three patients were identified by detection of a prolonged prothrombin time, ranging from 20.5 to 39.8 seconds. The patient with the highest factor V level (0.12 U/ml) experienced gastrointestinal bleeding, which ceased when the factor V level increased to more than 0.20 U/ml. One patient required a ventriculostomy. In that case the prothrombin time and factor V level failed to improve following administration of vitamin K, 10 units of fresh frozen plasma, and platelet transfusions; the factor V level temporarily increased from 0.03 to 0.32 U/ml following a 2-day course of intravenous gamma globulin (1 gm/kg/day). Plasmapheresis has also been reported to be of transient benefit in the treatment of this coagulopathy. In most patients the factor V level rises and the prothrombin time improves toward normal within 3 to 6 weeks following surgical exposure. The individuals identified likely represent only a fraction of the patients who develop the coagulopathy. The latter either do not bleed or are not sufficiently challenged in the postoperative period for the bleeding risk to be tested. It is concluded that bovine thrombin-induced coagulopathy may occur following surgical exposure to topical bovine thrombin and may result in both postoperative morbidity and mortality in a subset of patients.

Low Prevalence of the Factor V Leiden Mutation Among “Severe” Hemophiliacs with a “Milder” Bleeding Diathesis

1995 ◽  
Vol 74 (05) ◽  
pp. 1255-1258 ◽  
Author(s):  
Arnaldo A Arbini ◽  
Pier Mannuccio Mannucci ◽  
Kenneth A Bauer
Keyword(s):  
Hemophilia A ◽  
Factor V Leiden ◽  
Protein S ◽  
Factor Ix ◽  
Hemophilia B ◽  
Factor V ◽  
Bleeding Diathesis ◽  
Mutation Site ◽  
Spontaneous Bleeding ◽  
Factor V Leiden Mutation

SummaryPatients with hemophilia A and B and factor levels less than 1 percent of normal bleed frequently with an average number of spontaneous bleeding episodes of 20–30 or more. However there are patients with equally low levels of factor VIII or factor IX who bleed once or twice per year or not at all. To examine whether the presence of a hereditary defect predisposing to hypercoagulability might play a role in amelio rating the hemorrhagic tendency in these so-called “mild severe” hemophiliacs, we determined the prevalence of prothrombotic defects in 17 patients with hemophilia A and four patients with hemophilia B selected from 295 and 76 individuals with these disorders, respectively, followed at a large Italian hemophilia center. We tested for the presence of the Factor V Leiden mutation by PCR-amplifying a fragment of the factor V gene which contains the mutation site and then digesting the product with the restriction enzyme Mnll. None of the patients with hemophilia A and only one patient with hemophilia B was heterozygous for Factor V Leiden. None of the 21 patients had hereditary deficiencies of antithrombin III, protein C, or protein S. Our results indicate that the milder bleeding diathesis that is occasionally seen among Italian hemophiliacs with factor levels that are less than 1 percent cannot be explained by the concomitant expression of a known prothrombotic defect.

Recombinant Tissue Factor as Substitute for Conventional Thromboplastin in the Prothrombin Time Test

1992 ◽  
Vol 67 (01) ◽  
pp. 042-045 ◽  
Author(s):  
Armando Tripodi ◽  
Arnaldo Arbini ◽  
Veena Chantarangkul ◽  
Pier Mannuccio Mannucci
Keyword(s):  
Prothrombin Time ◽  
Tissue Factor ◽  
Oral Anticoagulant Therapy ◽  
Clotting Factor ◽  
Rabbit Brain ◽  
Sensitivity Index ◽  
Clotting Factors ◽  
Wide Range ◽  
Reference Preparation ◽  
Time Test

SummaryRelipidated recombinant tissue factor (r-TF) has been assessed in comparison with conventional rabbit brain thromboplastin (Manchester Reagent) for its suitability for measurement of prothrombin time (PT). The International Sensitivity Index (ISI) of r-TF calibrated against the International Reference Preparation BCT/253 (human plain) was found to be 0.96 and 1.12 with instrumental and manual techniques. Our study of plasmas from patients with congenital deficiencies of clotting factors covering a wide range of severity demonstrates that r-TF is able to detect even minor deficiencies of factors involved in the extrinsic and common coagulation pathways. Patients with liver diseases were correctly diagnosed with a prevalence of abnormal results comparable for both reagents. Between-assay reproducibility expressed as coefficient of variation was 2.3 % and 3.9 % at normal and abnormal PT levels.In conclusion, our evaluation shows that relipidated r-TF possesses the necessary requisites of sensitivity, diagnostic accuracy and reproducibility which make it a suitable candidate for PT determination both for monitoring oral anticoagulant therapy and diagnosing congenital and acquired clotting factor deficiencies. Moreover, being a highly defined reagent it may constitute a step forward in the standardization of PT testing.

The Lupus Inhibitor: A Study of Its Heterogeneity

1981 ◽  
Vol 46 (04) ◽  
pp. 734-739 ◽  
Author(s):  
M C Coots ◽  
M A Miller ◽  
H I Glueck
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Inhibitory Activity ◽  
Inhibition Test ◽  
Clotting Factor ◽  
Factor Xii ◽  
Factor V ◽  
Systemic Lupus ◽  
Factor Xi ◽  
Factor Specificity

SummaryThe plasmas of six patients with prolonged activated partial thromboplastin times were studied in detail. In five of the six, the Russell’s viper venom and prothrombin times were likewise prolonged. Five of the patients had documented systemic lupus erythematosus; one lacked the necessary criteria for this diagnosis. On quantitation, factor XI was decreased in all six; factors X and XII were diminished in five of the six. When tested for inhibitory activity, plasma from each of the patients prolonged the celite eluate inhibition test for factor XII and/or XI inhibition. In the formation of the Xa-V-phospholipid-Ca2+ complex (prothrombinase), factors X and Xa were inhibited to a greater degree than factor V or the phospholipid. Finally, each plasma was isofocused, the inhibitory fractions were identified and the clotting factor specificity of each inhibitory peak was determined.Fractions inhibitory against factors XI and XII isofocused with the IgG in each patient’s plasma. Based on the data presented from these six patients, the “lupus inhibitor” is in fact a heterogeneous collection of inhibitors directed against factors XII, XI and X rather than a homogeneous entity.

Calibration of a Lyophilized Pooled Plasma as Candidate Reference Plasma for Standardization of the Prothrombin Time Ratio

1993 ◽  
Vol 13 (02) ◽  
pp. 96-105 ◽  
Author(s):  
H. Beeser ◽  
U. Becker ◽  
H. J. Kolde ◽  
E. Spanuth ◽  
P. Witt ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
International Study ◽  
International Normalized Ratio ◽  
Measurement Methods ◽  
Factor V ◽  
Diagnostic Instruments ◽  
Plasma Pool ◽  
Normal Plasma ◽  
German Association ◽  
Prothrombin Time Ratio

SummaryThe prothrombin time (PT), obtained from a fresh normal plasma pool (FPP), is the basis both for the establishment of the 100% activity (normal plasma) and for the ratio calculation used in the International Normalized Ratio (INR) according to the recommendations of the ICSH/ICTH (6). Today the PT of lyophilized normal plasma pools are successfully used as reference for the assessment of samples in proficiency studies. However, a lack of comparability is to be recognized. Therefore the Committee of Hematology of the German Association of Diagnostics’ and Diagnostic Instruments’ Manufacturers (VDGH) decided to produce a candidate reference plasma (VDGH Reference Plasma) which was calibrated against fresh normal plasma pools in an international study.The basic calibration was performed by using the same certified BCR thromboplastin (BCT/099) by all participants. The endpoint was determined manually and by using the coagulometer Schnitger-Gross. In additional testings each participant used his own routine thromboplastins and methods. Calculating the ratio [PT VDGH Reference Plasma (sec)/PT fresh normal plasma pool (sec)] the VDGH Reference Plasma showed a deviation from the average fresh normal plasma pool of 1.05 both with the BCT/099 and with all thromboplastins. There were obtained some statistical differences between “plain” and “combined’’ (added factor V and fibrinogen) thromboplastins. No statistical difference was found between the different endpoint measurement methods (manual, mechanical, optical).In spite of these statistical deviations the VDGH Reference Plasma can be used for the standardization of the PT-normal (100%) value with different ratios for plain (1.06) and combined (1.02) thromboplastins. The manufacturers will use this VDGH Reference Plasma for the calibration of their commercially available calibration plasmas, which allows the user of such a material to calculate a calibrated 100% PT value.

Spectrophotometric Assays of Prothrombin in Plasma of Patients Using Oral Anticoagulants

1979 ◽  
Vol 42 (04) ◽  
pp. 1296-1305 ◽  
Author(s):  
R M Bertina ◽  
W van der Marel-van Nieuwkoop ◽  
E A Loeliger
Keyword(s):  
Prothrombin Time ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Factor V ◽  
Anticoagulant Treatment ◽  
Factor Ii ◽  
K Deficiency

SummaryTwo spectrophotometric assays for prothrombin have been developed and compared with a one stage coagulant and an immunological assay. One of these assays (called the XAPC assay) uses a combination of factor Xa, phospholipid, Ca2+ and factor V as activator of prothrombin, and measures only normal prothrombin. The second (the ECAR assay) uses Echis carinatus venom as activator. This assay measures both normal prothrombin and PIVKA II (protein induced by vitamin K antagonists/absence). Combination of the results obtained by the XAPC and ECAR assays provides rapid and reliable information on the degree of “subcarboxylation” of prothrombin (oral anticoagulation, vitamin K deficiency).For patients on long term anticoagulant treatment the prothrombin time (Thrombotest) shows better correlation with the ratio prothrombin/prothrombin plus PIVKA II (XAPC/ ECAR) than with the factor II concentration. For patients starting the anticoagulant treatment there is no correlation between the Thrombotest time and the XAPC/ECAR ratio.It seems doubtful that (a) spectrophotometric factor II assay(s) will be as useful as the prothrombin time in the control of oral anticoagulation.

Studies on the Pathogenesis of the Generalized Shwartzman Reaction

1964 ◽  
Vol 12 (02) ◽  
pp. 471-483 ◽  
Author(s):  
F Rodríguez-Erdmann
Keyword(s):  
Clotting Factor ◽  
Factor V ◽  
Clotting System ◽  
Platelet Factor ◽  
Trigger Mechanism ◽  
Haemorrhagic Diathesis ◽  
Shwartzman Reaction ◽  
Ca Ions

SummaryThe rôle of the clotting system in the pathogenesis of the generalized Shwartzman reaction (gSr) has been stressed in recent years. The clotting system is activated ubiquitously and as a result of it, fibrin is deposited intravascularly and a haemorrhagic diathesis develops. Evidence is presented herein, that endotoxin does not activate purified prothrombin, nor does endotoxin influence the convertion of prothrombin when it is activated in the presence of purified platelet-factor 3 (or caephalin) purified Ac-G (factor V) and Ca-ions.The trigger mechanism of the gSr also seems to be in the so-called prephase of clotting mechanism. Data are presented, which show that endotoxin activates the Hageman factor in vitro. The importance of this clotting factor and of platelet-factor 3 is discussed. Also the rôle played by the RES and cardiodynamic and vascular components are taken in consideration in the discussion.

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