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A Practical Guide to Laboratory Haemostasis

 

Data Interpretation: Fibrinolytic Tests



Introduction

This section covers many of the test that were outlined in the section on Fibrinolytic assays - some questions do cross over into some of the other sections.


Question 1
A 56-year-old woman with a long history of Rheumatoid Arthritis is seen in the Emergency Department with a suspected Deep Vein Thrombosis [DVT.] She has a D-dimer performed which is elevated at 2400ng/mL [Normal <250 ng/ml]

Comment upon the results of this test.
What would you do next?

Question 2
A 19-year-old Japanese student is investigated for a life-long history of bleeding. He had bled for several weeks after removal of 2 wisdom teeth and had a history of intermittent haemarthroses affecting primarily his hips and knees. He had been treated elsewhere with blood transfusions which he felt alleviated some of the problems.

Examination was normal apart from bruising and joint arthropathies related to previous haemarthroses.

1. What would you do next?

Click here for Part 2


1. There is no family history of note and the parents are not related other than by marriage.

Test Patient Reference Range
PT 12s  
APTT 32s  
Fibrinogen 3.6 g/L  
FBC Normal  

1. What additional tests might you request and why?


Click here for Part 3
Shown below are the results of additional investigations on this patient:


Assay Patient Reference Range
VWF:Ag 0.89 IU/mL 0.48 - 1.55 IU/mL
VWF:Act 0.91 IU/mL 0.50 - 1.50 IU/mL
FVIII:C 0.99 IU/mL 0.45 - 1.49 IU/mL
FIX:C 0.97 IU/mL 0.45 - 1.49 IU/mL
Renal & LFTS
Normal  

What are you going to do next?


Click here for Part 4
Shown below are the results of additional investigations on this patient:

Assay Patient Reference Range
Platelet function testing No defect identified using a panel of agonists  
Platelet nucleotides Normal - no evidence of stroage pool disorder  

1. Are there any additional tests you might request?

 

Click here for Part 5
You request a TEG which rather surprisingly shows evidence of hyperfibrinolysis. What tests in the light of this finding together with clinical history are you going to suggest?





Question 3
A 34-year-old woman is 32 weeks pregnant and is seen in the Emergency Department with a suspected Deep Vein Thrombosis [DVT]. She has a D-dimer test performed which is elevated at 780ng/mL.

Comment upon the results of this test.
What would you do next?

 


Click HERE for the Answers

Try to avoid looking at the answers until you have worked through the questions.