Does APTT bleed if it continues to prolong? How many people have been misled

Preface

Activated partial thromboplastin time (APTT) is at 37 °C, white clay activates XII.

APTT prolongation has broad clinical implications and, therefore, is used as a routine monitoring program

Case passed

The patient, a 69-year-old male, was admitted to the hospital on August 3, 2022 for "weakness of the left limb and unclear speech for 1 day", diagnosed with large-scale cerebral infarction, previous manic psychosis for more than 40 years, and was treated with

After admission, the patient repeatedly rechecked the coagulation function abnormally, mainly APTT prolongation, and the APTT results were shown in Figure 1 below

Figure 1 APTT results of patients at different time periods

Patients send a full set of coagulation factors: coagulation factors V.

Figure 2 MDT consultation records

Case studies

It was an honor to be invited by the Director of the Department of Critical Care Medicine (NICU) of the Department of Neurology to participate in the clinical MDT, of course, before the MDT consultation, I also did a little homework, that is, to make up for the patient's correction test, the APTT correction test showed Rosner index (RI) = (A-B) ×100/C=43, RI>15, uncorrected, indicating the presence of an immediate effect of coagulation inhibitors (such as lupus anticoagulants, factor inhibitors, etc.

Figure 3 Results of the patient APTT correction test

According to the "Procedure of Activated Partial Thromboplastin Time Extension Mixed Plasma Correction Test and Interpretation of the Results of Chinese Experts"[1], the results of the correction test indicate the presence of lupus anticoagulants or factor inhibitors

Figure 4 Correction test results and clinical significance

Through corrective trials, I found that the patient was most likely APTT prolonged

Case summary

So look back and think about what exactly causes lupus anticoagulant positive, autoantibody positive, immunoglobulin abnormalities, autoimmune diseases, or long-term antipsychotic use? By consulting Zhang Fuyong, a teacher from the Affiliated Hospital of Guangxi Medical University, he told me that he had seen in the literature that antipsychotic depressants had been reported to induce the production of lupus anticoagulants, and later Teacher Zhang also found out the literature, it was reported that chlorpromazine drugs can increase IgM- anticardiolipin antibodies [2], Davis et al.

So whether it is caused by this chlorpromazine drug in the end, it is not yet known, and more clinical studies are needed to confirm

Expert reviews

Xu Zhengmin is a professor at the School of Medicine of Xiangyang Vocational and Technical College

Coagulation routine test is a compass for clinicians to determine whether the patient has a thrombosis or bleeding risk, once there is APTT or PT prolongation, the first thing that the clinic thinks of is the bleeding risk, but if the APTT is prolonged, there will be bleeding? Today this case is a continuous extension of APTT, can not be corrected, but the patient has not been bleeding case, through the correction of the trial initially determined that the patient is lupus anticoagulant caused by APTT prolongation, while the patient has coagulation factor antibodies, so the infusion of new plasma and cryoprecipitation can not correct the APTT results, this case has been tested and clinical MDT, the patient has been correctly treated, the importance of clinical cooperation between the visible test and the clinic, so we advocate the test to the clinical, participate in clinical consultation, Participating in MDT, although the distance is far away, the process is difficult, and there is still a lot of clinical knowledge that we need to learn, but as long as we bravely take the first step, the road is under the feet, the hope is ahead, and the step by step is down-to-earth, it will be closer and closer to the destination

Thanks

Thanks to Professor Zhang Fuyong of the First Affiliated Hospital of Guangxi Medical University for his analysis and guidance of this case, as well as the subsequent literature reference

References

[1] Thrombosis and Hemostasis Committee of the Chinese Society of Research Hospitals.

Liu Yan,Deng Hongyu,Gao Zheshi.

[3] Davis S， Kern HB， Asokan R.