Should children with adenoid hypertrophy have abnormal coagulation?

foreword

In our daily work, we often encounter clinicians who come to the laboratory to consult the results of testing ite.

case after

A 3-year-old child, male, was reported by his family members that the child started snoring during sleep 2 years ago without obvious incentives, accompanied by coughing, occasional suffocation, and mouth breathi.

On the day of admission, the blood routine was normal, including HGB 128×10^9/L, PLT: 434×10^9.

So, what is the reason for the prolongation of APTT in this child? As usual, when encountering abnormal coagulation results, we first observe whether the sample is abnormal in blood collection and whether there is cl.

Subsequently, we immediately carried out the APTT correction test, and the results showed that the immediate correction test and the incubation at 37°C for 2 hours were not correct.

Through the APTT correction test, we preliminarily judged that the child's APTT was prolonged due to the interference of lupus anticoagulant and other substances; at the same time, we suggested that the child should be clinically tested for lupus anticoagulant and related antiphospholipid antibodies, and the test results showed lupus Anticoagulant was positive (SCT ratio 44), and the remaining antiphospholipid antibodies were negati.

Subsequently, the patient was further tested for coagulation factors, and the results showed that except for the slight decrease in the activity of factors X and XII, other related coagulation factors were normal, which further proved that the prolongation of APTT in this child was not caused by the lack of coagulation facto.

So, is this child suitable for surgery? In vitro APTT assays rely on the participation of phospholipids, and lupus anticoagulant is a type of antiphospholipid antibody that can neutralize phospholipids and interfere with in vitro assays, resulting in prolonged responses and ultimately falsely prolonged AP.

Diagnosis and treatment: Before the operation of the child, there was no clinical infusion of relevant blood products for the chi.

case analysis

Why do children have lupus anticoagulant positive? There are related reports that children who have been infected by the virus may have positive lupus anticoagulants in their bodi.

Summarize

When encountering unexplained APTT prolongation, we should start the APTT correction test to preliminarily determine whether it is the interference of antiphospholipid antibodies such as lupus anticoagulant or the lack of facto.

references

[1] Tang Ni.