Differential dx of deranged PT/INR/aPTT: More than what meets the eye✨
Based on what I have learned from my colleagues
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@rabihmgeha @DxRxEdu @DrCindyCooper @AaronGoodman33 @CPSolvers @sargsyanz @AnnKumfer @ASanchez_PS @MatthewHoMD @nihardesai7 #hematology
Based on what I have learned from my colleagues
Follow this 🧵
@rabihmgeha @DxRxEdu @DrCindyCooper @AaronGoodman33 @CPSolvers @sargsyanz @AnnKumfer @ASanchez_PS @MatthewHoMD @nihardesai7 #hematology
1.) Isolated Elevation of PT/INR
- Deficiency of or inhibitors against Factors lII, VII
- Early Vitamin K deficiency
- Warfarin (PT/INR>aPTT)
#hematology
- Deficiency of or inhibitors against Factors lII, VII
- Early Vitamin K deficiency
- Warfarin (PT/INR>aPTT)
#hematology
2.) Isolated elevation of aPTT
- Deficiency of or inhibitors against Factors XII (asymptomatic), XI, IX, VIII.
- Heparin (aPTT>PT/INR)
- vWD type 2N & Acq vWD
- Antiphospholipid antibodies (further evaluation will dRVVT and phospholipid-based mixing studies)
#hematology
- Deficiency of or inhibitors against Factors XII (asymptomatic), XI, IX, VIII.
- Heparin (aPTT>PT/INR)
- vWD type 2N & Acq vWD
- Antiphospholipid antibodies (further evaluation will dRVVT and phospholipid-based mixing studies)
#hematology
3.) Elevation of PT/INR and aPTT
- DIC & Liver failure (low factor VIII in DIC vs NL in the latter)
- Warfarin and heparin
- Severe Vitamin K deficiency
- DOACs
#hematology
- DIC & Liver failure (low factor VIII in DIC vs NL in the latter)
- Warfarin and heparin
- Severe Vitamin K deficiency
- DOACs
#hematology
4.) Unique and elegant causes ⭐
- aPTT elevation in Mastocytosis (endogenous Heaprin excess)
- PT/INR/aPTT elevation in Amyloidosis due to Factor X sequestration by fibrils (similarly fibrils can trap beta blockers and CCBs in the heart worsening the block)
#hematology
- aPTT elevation in Mastocytosis (endogenous Heaprin excess)
- PT/INR/aPTT elevation in Amyloidosis due to Factor X sequestration by fibrils (similarly fibrils can trap beta blockers and CCBs in the heart worsening the block)
#hematology
5.) Rare causes ✨✨
- Factor V trapping by myeloid cells in MPNs
- Acquired vWD (hypothyroidism, MM, MPNs, Valvular stenosis, Heyde syndrome)
- Cefoxitin, Cefotetan, Cefoperazone (hypoprothrombinemia and low vitamin K levels by indirectly altering gut flora)
#hematology
- Factor V trapping by myeloid cells in MPNs
- Acquired vWD (hypothyroidism, MM, MPNs, Valvular stenosis, Heyde syndrome)
- Cefoxitin, Cefotetan, Cefoperazone (hypoprothrombinemia and low vitamin K levels by indirectly altering gut flora)
#hematology
6.) Fascinating causes of DIC/DIC-like states 💫💫
- Fat/amniotic fluid embolism
- Acute fatty liver of pregnancy
- APML
- HLH
- Kasabach Merritt syndrome
- Purpura fulminans (Protein C/S/ATIII def, Meningococci, Rickettsia)
- Trousseau
- Snakes
- catastrophic APLA
#hematology
- Fat/amniotic fluid embolism
- Acute fatty liver of pregnancy
- APML
- HLH
- Kasabach Merritt syndrome
- Purpura fulminans (Protein C/S/ATIII def, Meningococci, Rickettsia)
- Trousseau
- Snakes
- catastrophic APLA
#hematology
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