Detecting and Evaluating Coagulation Inhibitors and Factor Deficiencies (Online CE Course)
  (based on 1026 customer ratings)
Author: Leah Beck, MPH, CLS(NCA), MT(ASCP)
Reviewer: Donna D. Castellone, MS, MT(ASCP)SH
What causes a patient's prothrombin time and/or activated partial thromboplastin time to be prolonged when the patient is not on anticoagulant therapy? Is it something that happened as a result of the collection process, is it related to an illness, or is it perhaps related to a factor deficiency or a circulating coagulation inhibitor? This course will acquaint you with several conditions associated with prolonged PT and aPTT test results. You will learn when it is appropriate to perform a mixing study, whether the results suggest a factor deficiency or a coagulation inhibitor, and further testing that can be done to confirm your results.
Continuing Education Credits
- P.A.C.E.® Contact Hours (acceptable for AMT, ASCP, and state recertification): 1 hour(s)
- Florida Board of Clinical Laboratory Science CE - General (Hematology): 1 hour(s)
Objectives
- Determine various causes of an elevated prothrombin time or activated partial thromboplastin time result.
- Evaluate situations in which performing a mixing study would be appropriate.
- List the steps involved in a prothrombin time or activated partial thromboplastin time mixing study procedure.
- Correctly analyze and interpret mixing study results to distinguish a factor deficiency from a circulating inhibitor(s).
- Determine which, if any, further coagulation studies would prove helpful after obtaining mixing study results.
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Course Outline
- Introduction to Coagulation Inhibitors and Factor Deficiencies
- Introduction: Coagulation Inhibitors
- Coagulation Inhibitors
- Introduction: Factor Deficiencies
- Coagulation Inhibitors and Coagulation Screening Tests
- Evaluating prolonged prothrombin time and activated partial thromboplastin time test results
- Coagulation Factors Involved in the aPTT Test
- Elevations in PT or aPTT assays
- Preanalytical Variables That Can Cause Falsely Elevated PT or aPTT Results
- Summary of Initial Elevations in the PT and aPTT
- Which of the following may produce a falsely prolonged aPTT test result?
- Coagulation Factors Monitored By the PT Test
- Performing a mixing study
- When To Perform a Mixing Study
- Mixing studies may help to determine the presence of which of the following?
- Introduction to Mixing Studies
- Mixing Study Test Principle
- What is the MINIMUM percentage of each coagulation factor that must be present in a patient's plasma to produce a normal PT and aPTT test result?
- Mixing Study: Specimen Requirements
- Performance of a Mixing Study
- Performance of a Mixing Study
- Performance of a Mixing Study
- What is the ratio of patient plasma to pooled normal plasma that is usually used in the performance of a mixing study?
- Analyzing and interpreting mixing study results
- Analyzing the Mixing Study Results
- Interpreting the Mixing Study Results
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Initial PT
Immediate Mixing Study PT
Incubated Mixing Study ...
- Analyzing the Mixing Study Results (cont.)
- Mixing Study Methodology Differences
- Analyzing the Mixing Study Results (cont.)
- Case Study 1
- Interpreting the Mixing Study Results: A Case Study
- Interpreting the Mixing Study Results: A Case Study (cont.)
- Interpreting the Mixing Study Results: A Case Study (cont.)
- Which factor level(s) could be deficient in the patient in Case Study I?
- Case Study 2
- Interpreting the Mixing Study Results: Case Study 2
-
Initial aPTT
Immed. aPTT mixing study
Incubated aPTT mixing study
...
- Case Study 3
- Interpreting the Mixing Study Results: Case Study 3
-
Initial aPTT
Immediate aPTT mixing study
Incubated aPTT mixing stu...
- Determination of further coagulation studies
- Further Analyses for Factor Deficiencies
- Further Analyses for Factor Deficiencies (cont.)
- Further Analyses for Factor Deficiences: Factor Activity Curves
- Treatment for Factor Deficiencies
- Lupus Anticoagulant
- Further Analyses for Coagulation Inhibitors- Lupus Anticoagulant
- Further Analyses for Coagulation Inhibitors (cont.)
- Treatment for Coagulation Inhibitors
- References
Additional Information
Level of instruction: Intermediate
Intended Audience: Medical laboratory scientists, medical technologists, and technicians, This course is also appropriate for medical laboratory science students and pathology residents. Author information: Leah Beck, MPH, CLS(NCA), MT(ASCP) is the Director of the Clinical Laboratory Science Program at St. Christopher’s Hospital for Children in Philadelphia, Pennsylvania. She holds a Masters in Public Health from Thomas Jefferson University.
Reviewer information: Donna D. Castellone, MS, MT(ASCP)SH is a Clinical Project Manager in Hemostasis and Hematology for Siemens Healthcare Diagnostics. Previous to 2008, she held the positions of Coagulation Consultant and Research Coordinator: Translational and Applied Laboratory Medicine at Mount Sinai Medical Center in New York. Ms. Castellone holds a Masters Degree in Health Science and Administration from State University at Stony Brook, Stony Brook, New York. She has written over 70 articles, was a contributing author for 3 textbooks, and is a frequent lecturer at laboratory workshops.
Course description: Prolonged PT and aPTT results are caused by many different conditions. It is important for medical technologists to be able to distinguish between preanalytic causes, secondary clinical causes, and important and potentially dangerous causes such as coagulation factor deficiencies and circulating coagulation factor inhibitors. Upon completion of this course, you will be able to identify: the common causes associated with prolonged PT and/or aPTT results, when it is appropriate to perform a mixing study, how to perform and interpret mixing studies, how to differentiate between factor deficiencies and factor inhibitors, and further testing that can be done to confirm mixing study results.
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