LABORATORY RESULTS INTERPRETATION OF

BLEEDING DISORDERS.

Types of tests
a. Screening tests for vascular & platelet disorders:

Formation of initial platelet plugs

1. Platelet count
2. Bleeding Time
3. Examination of peripheral blood film
4. Tourniquet test
b. Screening test for coagulation disorders :
Formation of fibrin

1. Prothrombin Time
2. Partial Activated Thromboplastin Time
3. Thrombin Time

c. Special Test → after :

* the patient’s history
* physical examination
* screening tests
Include

1. Specific coagulation factor assays

2. Platelet function tests
3. Assay for von Willebrand’s Factor

4. tests for circulating inhibitor

5. tests for Disseminated Intravascular Coagulation (DIC)
6. tests for pathological fibrinolysis
TEST RESULT
1. a.Prolonged Bleeding Clot retraction
time Vascular defect time
Normal Platelet count Platelet Functional
defect
Normal PPT & APTT
Platelet aggregation

b.Prolonged Bleeding
Time - Von Willebrand’s disease
Normal Platelet Count
Prolonged APTT - Von willebrand’s factor antigen
- Platelet Aggregation test with
Ristocetin
 Platelet count, BT prolonged, PPT & APTT normal
A. Hipoproliferative / Failure of marrow production
Peripheral blood examination / CBC:
Pancytopenia
- Anemia ( Hb, RBC count, Hct)
- WBC count
Blood smear :
Ineffective
Erythr : macrooval (oval macrocyt) &
Thrombopoiesis
hypersegmentation neutrophil
BMP : - megaloblast (specific
morphological changes)
- Giant metamyelocyt
CBC :
Pancytopenia
Low % reticulocyte → < 0,5 %
Blood Smear :
Eryth : normocytic normochr (macrocytic)
Aplasia / Hypoplasia
Diff.count : - relative lymphocytosis
of bone marrow
- netropenia/granulositopenia
BMP :
megakaryocyt mass
Hypocelluler granulopoiesis
Erythropoiesis
Marrow : Lymphocytosis
Peripheral Blood Cell measurement:
- Anemia - WBC >
Peripheral Blood Smear morphology:
- normocytic normochromic anemia
- Leucoerythroblastic blood picture
→ myelofibrosis & infiltr by other Bone Marrow
Replacement
neoplasm/metastatic
disorder
- Leukemia / Lymphoma/Myeloma cell
- BMP examination :
- Hipercelluler
-Wide spectrum of BM morph abnormalities
B. Increased Platelet Destruction
A. Immune Thrombocytopenia Purpura
Periph Blood Cell measurement / CBC
- Anemia
- WBC : depends on the causal
Blood smear morphology : Immune
- ↓ platelet count (< 3 / HPF) Thrombocy
topenia
-Abnormality of morph & size → Giant platelet (> 10
µm)
- viral : atypical lymphocyte
- Bacterial : left shifted of myeloid cells & features of
neutrophil toxicity (granulation, vacuolization)
Sitoplasma basofilik

LIMFOSIT PLASMA
BIRU

Sitoplasma basofilik
Limfosit Plasma Biru
 Qualitative abnormality

White blood cell (blood smear)

vacuolisation

vacuolisation

Toxic granulation

Leucocytosis : netrophilia absolute with toxic granulation & vacuolisation

Bacterial infection
BMP :
Normal or increased immature megakaryocytes characterized
by :
-Non budding / intact cytoplasm
-More basophilic cytoplasm & decreased granularity
-Hypoploidy of nuclei
marrow normoblast : compensation of bleeding
B. Non immun thrombocytopenia: DIC, HUS, TTP
Screening test: detection of consumptive coagulation
Confirmative test: detection of secondary fibrinolysis
Peripheral blood examination:
Erythrocyt fragmentation (helmet, trianguler, schistocyt)
Thrombocytopenia:

Distribution abnormality
• Peripheral blood examination:
• Pancytopenia
• splenic pooling/
• Reticulocytosis hypersplenism

• BMP: normal/ hipercelluler

III. Platelet Count : Normal
Coagulation tests (PPT & APTT) : Abnormal/Prolonged
(a) PPT>, APTT N
- Early oral Anticoagulant therapy: warfarin, coumarin
- Congenital & acquired deficiency of F II, VII, V, X
- Early cirrhosis / chronic liver disease : PPT is more
sensitive due to the shortest half life of F VII
- Vit K deficiency
- Circulating Inhibitor of extrinsic coagulation/clotting factor
III. Platelet Count : Normal
(b) PPT N, APTT >
Acquired
- Deficiency / defect of intrinsic coagulation factor
- Hemophilia: F VIII, F IX, F XI, F XII (herediter) Hemophilia
- von Willebrand’s disease
- Heparin anticoagulant therapy
- spesific circulating Inhibitor of F VIII, Lupus anticoagulant /
Lupus inhibitor
c. PPT >, APTT>
* Def iciency of multiple coagulation factors → acquired
* Liver disease : cholestasis
* Vit K def (Factor II, VII, IX, X)
* Primary fibrinolysis → [fibrinogen] ↓↓
* Rapid stored blood transfusion
IV. Platelet Count , prolonged coagulation test
(PPT & APTT)
- Severe liver disease : liver cirrhosis with portal hypertension →
↓ platelet count due to excessive splenic pooling / hipersplenisme.
Thrombin Time: the most sensitive test for dysfibrinogenemia
detection
- Disseminated Intravascular Coagulation/DIC (Secondary
Fibrinolysis)
• Rapid stored blood transfusion
THROMBOTIC RISK FACTORS

Genetic
• Deficiency of protein C, protein S, and AT III
• Activated protein C resistency (APC-R)
• Serine proteinase inhibitor deficiency
• Hyperfibrinogenemia, dysfibrinogenemia
• Hyperhomocysteinemia
• Fibrinolysis pathway abnormalities
- Plasminogen
- tPA (Tissue Plasminogen Activator) deficiency-
- PAI-1 excess
• Lipoprotein a / Lp(a)
• Acquired
Anti-phospholipid antibody and lupus anticoagulant
Hyperhomocysteinemia
Lipid imbalance / Dyslipidemia
What Test to Perform

• APC resistance
• Factor V Leiden mutation
• Protein C, S antigen and activity, free protein S
• Anti Thrombin III
• Thrombin time
• Serum homocystein
• Current thrombosis markers
• Test of fibrinolysis
• Profile of serum lipid