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Ptt

Ptt

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Published by Fitz Jaminit

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Published by: Fitz Jaminit on Oct 09, 2012
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07/24/2014

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How is it used?
The PTT test is used to investigate unexplained bleeding or clotting. It may be ordered alongwith a PT (Prothrombin Time) test to evaluate hemostasis,the process that the body uses to
 
form blood clots to help stop bleeding. The PTT evaluates the coagulation factors XII, XI, IX, VIII, X, V, II (prothrombin), and I (fibrinogen) as well as prekallikrein (PK) and high molecular weight kininogen (HK). A PT test evaluates the coagulation factors VII, X, V, II, and I(fibrinogen). By evaluating the results of the two tests together, a doctor can gain clues as towhat bleeding or clotting disorder may be present. A PTT is often used to monitor standard (unfractionated, UF) heparin anticoagulant therapy.
 
Heparin is a drug that is givenintravenously (IV) or by injection to prevent and to
 
treat thromboemboli.When it is administered for therapeutic purposes, it must be closely monitored. If too much is given, the treated person may bleed excessively; with too little, thetreated person may continue to clot.
 
If the PTT is prolonged and the cause is not anticoagulant therapy or heparin contamination,then a second PTT test is performed by mixing the patient's plasma with pooled normal plasma
 
(a collection of plasma from a number of normal donors). If the PTT time returns to normal("corrects"), it suggests a deficiency of one or more of the coagulation factors in the patient'splasma. If the time remains prolonged, then the problem may be due to the presence of anabnormal factoinhibitor  (autoantibody). Further studies can then be performed to identify what factors may be deficient or determine if an inhibitor is present in the blood. Nonspecificinhibitors, such as lupus anticoagulant and anticardiolipin antibodies,are associated with clotting episodes and with recurrent miscarriages, especially those that occur in the second or third trimester. For this reason, PTT testing may be performed to help investigate recurrentmiscarriages.Based on carefully obtained patient histories, the PTT and PT tests are sometimes selectivelyperformed as pre-surgical procedures to screen for potential bleeding tendencies.Other testing that may be done along with a PTT includes:
 
 –
should always be monitored during heparin therapy to promptly detect anyheparin-inducedthrombocytopenia 
 
 –
sometimes ordered to help rule out heparin contamination
 
 
Fibrinogen testing
 –
may be done to rule out hypofibrinogenemia as a cause of PTT
 
prolongation^ Back to top 
When is it ordered?
The PTT may be ordered along with other tests such as a PT when a person presents with unexplained bleeding or bruising, a thromboembolism,an acute condition such as disseminated intravascular coagulation (DIC) that may cause both bleeding and clotting as factors are used
 
up at a rapid rate, or with a chronic condition such as liver disease.When someone has had a thrombotic episode or recurrent miscarriages, the PTT may be ordered as part of an evaluationfolupus anticoagulant or  anticardiolipin antibodies. 
 
When a person is on intravenous (IV) or injection heparin therapy, the PTT is often ordered at
 
regular intervals to monitor the degree of anticoagulation. When someone is switched from
 
heparin therapy to longer-term warfarin (COUMADIN
®
) therapy, the two are overlapped andboth the PTT and PT are monitored until the person has stabilized. A PTT may be ordered as part of a pre-surgical evaluation for bleeding tendencies, especially if the surgery carries an increased risk of blood loss and/or if the person has a clinical history of bleeding, such as frequent or excessive nosebleeds and easy bruising, which may indicate thepresence of a clotting disorder.^ Back to top 
 
What does the test result mean?
PTT results that fall within the reference interval as established by each laboratory usuallyindicate normal clotting function; however, mild to moderate deficiencies of a single coagulationfactor may still exist. The PTT may not be prolonged until the factor levels have decreased to30% to 40% of normal. Also lupus anticoagulant may be present but may not prolong the PTT
 
result. If the lupus anticoagulant (LA) is suspected, an LA-sensitive PTT or a Dilute RussellViper Venom Time can be used to test for it. A prolonged PTT means that clotting is taking longer to occur than expected and may be due toa variety of causes. Often, this suggests that there may be a coagulation factor deficiency or aspecific or nonspecific inhibitor  affecting the body's clotting ability. Coagulation factor  deficiencies may be acquired or inherited.Prolonged PTT tests may be due to:
 
Inherited or acquired factor deficiencies 
. Prolonged PTTs due to a factor deficiency usually"correct" after being mixed with pooled normal plasma.The PTT may be prolonged in von
 
Willebrand disease, the most common, inheritedbleeding disorder ,which affects platelet
 
function due to decreased von Willebrand factor .Hemophilia A and Hemophilia B (Christmas disease) are two other inherited bleeding disorders resulting from a decrease infactors VIII and IX, respectively. Deficiencies of other coagulation factors are rare but mayalso adversely impact PTT results. An example of an acquired deficiency is one due to lack of vitamin K. Vitamin K, found invarious leafy green vegetables and produced by certain gastrointestinal bacteria, is a keycomponent to proper blood coagulation. Vitamin K deficiencies are rare but can occur due to an extremely poor diet, malabsorption disorders,or prolonged use of certain antibiotics.
 
Most coagulation factors, including the vitamin K-dependent ones, are manufactured by the

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