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Medical Forum / General / General / June 2006

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General Question about aPTT/PTT/INR

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REP - 26 Jun 2006 14:37 GMT
I have a general question about aPTT/PTT/INR testing. I don't have all
the reference ranges for the lab, but my results were:

aPTT 33.5 (normal up to 28)
PTT 9.8 (normal; don't know the range)
INR 1.0 (abnormal; not sure if too high or too low)

I am not on coumadin or any blood thinner. I have no known liver disease
or signs of liver disease (no jaundice) or any other reasons (no vitamin
K, no non-stop beef-eating, no recent antibiotic use) for these abnormal
results. I am very nephrotic and my GFR is now 84. Could kidney
disease/nephrotic syndrome cause these unusual results?

I have a call in to my doctor, but I've never failed this test before so
I'm curious as to (very general) things that can cause these results.

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"Did Father shoot him? I will eat Grandfather for dinner."
- Helen Keller, on learning of the death of her grandfather

Robert1 - 26 Jun 2006 19:12 GMT
> I have a general question about aPTT/PTT/INR testing. I don't have all
> the reference ranges for the lab, but my results were:
[quoted text clipped - 15 lines]
> "Did Father shoot him? I will eat Grandfather for dinner."
> - Helen Keller, on learning of the death of her grandfather

Your doctor will go through your history and circumstances that may
apply as obviously he is monitoring your coagulation times for a
reason.  My general comments are as follows.

The initial action is usually a repeat test of the prolonged test in
question.

Prolongation of the PT or PTT are divided into two broad groups. Those
with factor deficiency and those with circulating anticoagulants. The
next step would be to distinguish the two by an additional test called
a mixing study or a 1:1 mix PTT.
Factor deficiencies can be corrected with mixing it with normal plasma
and such correction would yeild a normal PTT. When an anticoagulant is
present then correction is incomplete and not correct the PTT into the
normal range. Once the broad group is determined then specialty testing
detecting which factor and or other additional tests would be needed to
further characterize the abnormality.

Most causes of factor deficiencies are factor production decrease or
factor consumption. Vitamin K factors usually affect the PT and Von
Willebrand's disease the PTT as it is related to factor VIII. The body
produces a natural anticoagulants such as antithrombin III, protein C
and protein S. Some of these may be lost in the urine and thus render
some people with nephrotic syndrome susceptible to clot formation and
thus a form of clotting factor consumption.

Common cause for a circulating anticoagulant is the lupus
anticoagulant. Although invivo a clot thrombotic episodes rather than
bleeding is associated with the invitro prolongation.

Your typo above should be PT and not PTT and the 9.0 is a normal PT
result.
REP - 28 Jun 2006 09:41 GMT
> > I have a general question about aPTT/PTT/INR testing. I don't have all
> > the reference ranges for the lab, but my results were:

[my odd labs]

> Your doctor will go through your history and circumstances that may
> apply as obviously he is monitoring your coagulation times for a
> reason.  My general comments are as follows.

[comments]

Thanks you for the explanation. I had a vague understanding how the test
was done and the usual suspects but had no idea if nephrotic syndrome
with very heavy proteinuria could explain my results, and according to
my doctor a) it probably does and b) I'm not out of range enough to
worry much about. Yay!

Thanks again!

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"Did Father shoot him? I will eat Grandfather for dinner."
- Helen Keller, on learning of the death of her grandfather


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