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Evaluation of a child with bleeding or

Coagulation Disorders P. de Alarcon M.J. Manco-Johnson abnormal coagulation screening tests

Evaluation of a child with bleeding or


abnormal coagulation screening tests
52

History and physical examination

Platelet count
Normal Decreased

Normal Coagulation screen Abormal (see Evaluation of a child with


PT, PTT, TT thrombocytopenia, p 54)

Acute illness Corrects 1:1 mix of patient: normal plasma Does not correct

Yes No Bleeding history Abnormal PTT Abnormal PT Abnormal TT TT PTT

No Yes Bleeding history

FVIII:C, VWF:RCo, +
VWFAg

FVIII:C, VWF:RCo, FVIII:C, VWF:RCo,


Reptilase
Normal Abnormal VWFAg VWFAg, FIX, FXI
time

Normal
Abnormal PT + PTT
Oral anticoagulants
FIX, XI, XII Liver disease
Vitamin K deficiency
Mild DIC
FII, V, or X deficiency
Meningococcus ? Platelet dysfunction VWD FXI or XII deficiency VWD Only PT abnormal 1:1 mix corrects Lupus-like
Purpura fulminans Child Variant VWD Mild hemophilia A Mild hemophilia B Hemophilia A or B Early in oral anticogulant 7 fibrinogen anticoagulant
Varicella abuse Mild hemophilia or or carrier or carrier Severe FXI deficiency therapy Dysfibrinogenemia Heparin
Pneumococcus carrier of hemophilia Prekallikrein or FVII deficiency Does not correct (confirm with
Mild DIC FXIII or mild FXI high-molecular weight Abnormal PT, PTT, TT and Reptilase normal: & TT + normal
Protein C, S or deficiency kininogen deficiency thrombocytopenia Heparin reptilase time)
ATIII deficiency DIC Reptilase time &:
(see Plalelet dysfunction, p 60) Severe liver disease Fibrin split products