Suspected deficiency of multiple coagulation factors caused by liver cirrhosis is actually...

case after

case after

One day, during routine work, it was found that APTT was prolonged alone in four coagulation items in the outpatient department of rheumatology and immunology, and the endogenous coagulation factors ordered by the doctor on the same day were decreased , respectively, FVIII: C11%, FIX: C 1%, FXI: C 2% , FXII: C 8%, lupus anticoagulant (LA) (SCT-NR: 2.
45, DRVVT-NR: 2.
01)
.

It was speculated that the decrease in endogenous coagulation factor was caused by LA positive, so a series of dilutions were made, and finally the maximum dilution factor was 80 times and reported: FVIII: C39%, FIX: C 11%, FXI: C 7%, FXII: C20%, and in It should be noted on the report: the detection of endogenous coagulation factors is easily inhibited by LA positive, which will affect the results

During routine work, it was found that APTT was prolonged in four coagulation items in one case of rheumatology and immunology clinic, and the endogenous coagulation factors ordered by the doctor on the same day were decreased .

Consultation opinion of the department of hematology: For abnormal coagulation function, it is not ruled out that it is related to liver cirrhosis.
In terms of treatment, patients can be given intramuscular injection of vitamin K for 3 days, and if there is bleeding tendency, intermittent plasma infusion
.

The Department of Rheumatology and Immunology considered that the patient had no bleeding tendency and was not transfused with plasma

For abnormal coagulation function, it is not ruled out that it is related to liver cirrhosis.

case analysis

The patient's endogenous coagulation factor was decreased and LA was strongly positive.
It was suspected that the decrease in endogenous coagulation factor was caused by the strong LA positive
.

The patient's liver function was AST 52U/L, PA 12.

1.
On the STAGO-R-Evolution instrument, the patient's plasma (PP) and normal pooled plasma (NPP) were tested for endogenous coagulation factors at the same time (based on the APTT one-stage method), and then the PP was diluted 80 times (the maximum value of the instrument was dilution factor), and record the data separately
.

2.
The Silica Coagulation Time Confirmation (SCT-C) Reagent of Wofen IL Co.
, Ltd.
was used instead of the STAGO supporting reagent PTTA for calibration, and then the coagulation factors were detected
.

The results are shown in Table 1

Table 1 Comparison of the activities of different reagents for calibration of endogenous coagulation factors

Table 1 Comparison of activities of endogenous coagulation factors in different reagents

Most coagulation factors are produced in the liver, and a few are produced in endothelial cells.
Liver injury affects the synthesis of coagulation factors, resulting in their reduction, thereby affecting the coagulation function
.

Lupus anticoagulant (LA) is an immunoglobulin that can bind to negatively charged phospholipids or phospholipid protein complexes

At present, the detection of FVIII, IX, XI, and XII in most clinical laboratories is based on the first-stage APTT method.
Due to the limitations of the detection method, the presence of LA competes with the phospholipids in the APTT reagent to prolong APTT, which in turn leads to FVIII, IX, and XI.
, XII reduced
.

Although dilution can reduce the interference ability of LA, excessive dilution also reduces the factor content, so the final detection result may also be reduced

SCT has the same principle as APTT and contains sufficient phospholipids, which can completely neutralize LA in plasma and eliminate interference
.

By comparing the activities of different reagents to calibrate the coagulation factor, it was verified that the decrease in multi-factor activity in this case was caused by LA rather than liver cirrhosis

Summarize

Summarize

In recent years, with the rapid development of science and technology, the techniques and methods of clinical testing have been greatly improved, and the testing items are complicated.
Clinicians may not fully understand the testing methods and limitations of new or sub-new items
.
Based on this premise, inspection workers must first understand the limitations of instrument performance, detection principles and methods, communicate with the clinic in a timely manner when misunderstood results occur, explain possible interference, and assist clinicians in choosing appropriate treatment options
.

Based on this premise, inspection workers must first understand the performance of the instrument, the limitations of detection principles and methods, communicate with the clinic in a timely manner when misunderstood results occur, explain possible interference, and assist clinicians in choosing the appropriate treatment plan .
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