Article Figures & Data
Figures
- Figure 1
Approach to a patient with bleeding diathesis and prolonged activated partial thromboplastin time (aPTT).
Based on information from reference 2.
Tables
Laboratory test (reference range) After hip surgery Hospital day 30 White blood cell count (3.7–10.4 × 109/L) 10.3 4.3 Platelet count (150–400 × 109/L) 155 215 Hematocrit (35.5%–44.9%) 17.9 34.2 Hemoglobin (12–16 g/dL) 6.3 11.5 Laboratory test (reference range) After hip surgery Hospital day 30 Discharge (hospital day 50) Prothrombin time (10.6–13.6 seconds) 12.9 < 10 11.4 International normalized ratio (0.88–1.16) 0.98 Fibrinogen (230–510 mg/dL) 319 330 Activated partial thromboplastin time (27.5–35.5 seconds) 61.5 98.6 Baseline 92.4 1:1 immediate 43.4 1:1 after 1 hour 75.9 Diluted thrombin time (16.0–25.0 seconds) 15.4 D-dimer (< 0.5 μg/mL) 0.65 2.09 Factor II (79%–135%) 90 Factor IX (72%–184%) 122 Factor XI (58%–135%) 70 Factor XII (46%–196%) 77 Factor VIII inhibitor assay (0.0–0.5 Bethesda units/mL) 80 21.4 57.6 Laboratory test (reference range) Result Prothrombin (G20210A) gene mutation Negative Factor V Leiden mutation Negative Protein C functional (70%–150%) 101 Protein S functional (70%–160%) 69 Antithrombin (80%–120%) 85 Anticardiolipin antibody, immunoglobulin M (< 12.5 MPL U/mL) 2.0 Anticardiolipin antibody, immunoglobulin G (< 15 GPL U/mL) 4.1 Beta-2 glycoprotein I antibody, immunoglobulin M (≤ 20 SMU U/mL) 1.9 Beta-2 glycoprotein I antibody, immunoglobulin G (≤ 20 SGU U/mL) 4.9 Partial thromboplastin time-lupus anticoagulant screen (33.8–46.1 seconds) 68 Dilute Russell’s viper venom time screen ratio (≤ 1:20) 1:30 Hexagonal phase confirmation (≤ 40 seconds) 22.8 Study Risk factors for thrombosis At diagnosis Hematologic treatment Immunosuppression regimen Activated partial thromboplastin time, seconds Factor VIII, U/dL Inhibitor, Bethesda units/mL 1. Poli et al18 Pregnancy 57 at deep vein thrombosis diagnosis and on anticoagulation 1.9 NA Vitamin K Prednisone 1 g/kg/day (4 weeks) 2. Deitcher et al19 Idiopathic 54.3 (24–33) 5.3 57 Factor VIII concentrate and desmopressin NA Lymphoma 61.4 (22–33) 2 47 Factor VIII concentrate and desmopressin NA Postoperative 54.8 (22–33) 2 5 Factor VIII concentrate and desmopressin NA 3. Spencer et al20 Pregnancy 3.01 2 35 Recombinant activated factor VII Prednisolone 1 mg/kg/day (6 weeks) and cyclophosphamide 100 mg/day (6 months) 4. Paudel et al21 Trauma or surgery > 100 < 1 12 Vitamin K, fresh frozen plasma, recombinant activated factor VII Methylprednisolone 120 mg/day, then rituximab 375 mg/m2/weekly for 4 doses 5. Wool et al22 Idiopathic 76.9 (24–34) 4 27 Factor VIII concentrate (2 days), then recombinant activated factor VII (30 μg/kg/dose), then therapeutic plasma exchange Dexamethasone 8 mg/12 hours, therapeutic plasma exchange days 5 and 6, then rituximab 375 mg/m2/week (2 doses) 6. Maral et al23 Malignancy 107 (22–34) 3 350 NA Prednisolone 1 mg/kg/day and cyclophosphamide 500 mg/week 7. Chhabra et al24 Idiopathic 78.6 < 1 82 Recombinant activated factor VII Prednisolone 1 mg/kg/day and cyclophosphamide 100 mg/day 8. Aslam et al25 Addison disease 81.8 < 6 NA Activated prothrombin complex concentrate, vitamin K Intravenous methylprednisolone 30 mg/12 hours NA = not available
Expanded Table 4
Summary of patients with acquired hemophilia A and thrombosis
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- Expanded Table 4 - Table summary of patients with acquired hemophilia A and thrombosis
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