Hematology 2 – LECTURE (1st SEMESTER)

Instructor: Dr. Gio L. Plete, RMT

Transcribed by: FRANCIS ANDREI H. MIRA

LECTURE 1: MIXING STUDIES

COAGULATION DEFICIENCIES AGED SERUM

Deficiency Coagulopathy Inheritance • Factors 1, 2, 5, 8, and 13 are consumed during coagulation
I Afibrinogenemia AR thus are absent in serum. 13 is not detected with PT and
Dysfibrinogemia APTT so not detected using mixing studies. Thus, leaves
II Prothrombin Deficiency AD only 7, 9, 10, 11, 12 in the serum.
V Parahemophilia AR
VII FVII deficiency AR PRINCIPLES
VIII Hemophilia A AR • In a patient with abnormal PT or APTT or both, Patient
VWD sample is mixed with Adsorbed Plasma and Aged Serum
IX Hemophilia B X-linked and PT and APTT is tested to check if it is corrected.
Christmas Disease
X Factor X Deficiency AD • Corrected: Result became normal
XI Hemophilia C X-linked • Not Corrected: Result remained Abnormal
Rosenthal Syndrome
XII Factor XII Deficiency AR (No bleeding Results Deficiency Specific Deficiency
tendency) Abnormal APTT Common Either Factors 10, 5,
XIII Factor XIII Deficiency AR & PT Pathway 2 or 1 is missing.
PreKall Fletcher Trait AR (No bleeding Abnormal PT, Extrinsic Factor VII Deficiency
tendency) Normal APTT Pathway
HMWK Fitzgerald Trait AR (No bleeding Abnormal APTT Intrinsic Either Factor 12, 11,
tendency) Normal PT Pathway 9 or 8 is missing.
• Usually, Deficiency of Factor 12, PreK, and HMWK do not
Deficiency BT PT APTT TT Stypven Duckert’s show bleeding tendency.
Primary
P N N N N N
Hemostasis PROBABLY COAGULATION DEFICIENCIES BASED ON
I P/N P P P N N THE APTT AND PT SUBSTITUTION TEST RESULTS
II N P P N P N
Adsorbed
V N P P N P N Aged Serum Probable
Plasma
Deficiency
VII N P N N N N APTT PT APTT PT APTT PT
N N - - - - None
VIII N N P N N N A N C - C - 11 or 12
VWF P N P N N N A N NC - C - 9
IX N N P N N N A A NC NC C C 10
A A C C NC NC 5
X N P P N P N N A - NC - C 7
XI N N P N N N A N C - NC - 8
XII/PK/ A A NC NC NC NC 2
N N P N N N
HMWK
XIII NOTE: N = Normal; A = Abnormal (prolonged); C = Corrected;
N N N N N Soluble
NC = Not Corrected
DIC P P P P P Soluble
TABLE 2 (Legend: P-Present; X-Absent)
MIXING / SUBSTITUTION STUDIES Factor Adsorbed Plasma Aged Serum
• Since APTT and PT are only screening tests, the factor 1 (C) P X
deficiency cannot be readily identified. 2 (C) X X
• A specific factor deficiency may be Identified by mixing 5 (C) P X
correction reagents with patient's plasma and the repeat 7 (E) X P
performing APTT and PT. 8 (I) P X
9 (I) X P
CORRECTION REAGENTS FOR MIXING STUDIES 10 (C) X P
• 1. Adsorbed Plasma [ plasma with BaSO4 or Al(OH)3 ] 11 (I) P P
• 2. Aged Serum 12* (I) P P
*Does not show bleeding; E: Extrinsic; C: Common; I: Intrinsic
Adsorbed Plasma Factors I, V, VIII, XI, XII
Aged Serum Factors VII, IX, X, XI, XII

ADSORBED PLASMA
• Vitamin K-dependent (Factors 2,7,9,10) are adsorbable
factors thus are absent in Adsorbed plasma, which leaves
only 1, 5, 8, 11, 12.

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 HEMATOLOGY 2 – LECTURE (FINALS)

PROBLEM SOLVING

1. Patient’s APTT and PT is Prolonged. Substitution study is

done:
Results are as follows:
APTT and PT on PX sample with Adsorbed Plasma: NC
APTT and PT on PX sample with Aged Serum: C
What is the factor deficiency?

RATIONALE:
If both APTT and PT, thus, the problem is under the common
pathway. Based on Table 2, the factors under this pathway that
could be deficiency are Factors 1, 2, 5, and 10. Since we cannot
rule out, that is why substitution/mixing study was performed.

PT and APTT was corrected and results shows that the results
are corrected in the addition of Aged Serum and not in Adsorbed
plasma. This denotes that the factor that is missing is present in
the Aged serum that is why the result was corrected, but absent
in the adsorbed plasma that is why result was not corrected.

To determine the factore deficiency, here is the way to do it:

let's limit the factors to I, II, V and X since the Probable
deficiency is only in the common Pathway according to the
problem.

Since result was not corrected in adsorbed plasma, refer to

TABLE 2 and write the factors that is ABSENT (since NC) that
belongs to the common pathway.

Adsorbed Plasma (ABSENT FACTORS): II, VI, IX, X

So, only II and X are common

Since in Aged Serum the results were corrected, list the factors
that are PRESENT in the Adsobed plasma that belongs to the
common pathway (refer again to table 2).

Aged Serum (Present Factors): VII, IX, X, XI, XII.

ONLY X is part of the common pathway

So, check what is common:

• Ads plasma (A)- II, X
• Aged Serum (P)-X
o Then the factor deficiency is factor X.

THE HOMIES <3 | MLS-3C 2