GDS2008
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Which clotting test is abnormal in chronic liver disease (and for that matter vitamin K deficiency, Warfarin therpay) and why??
A. PT
B. APTT
C. Bleeding time
D. Both PT and APTT
E. APTT and bleeding time
F. PT and bleeding time
Remember to explain why?
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| Sea_gull
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Chronic liver disease like cirrhosis
PT (in all )and bleeding time(40%) are increased
In vit K deficiency or Warfarin therapy
PT and aPTT shoud increase.
GL
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| tolito
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D.both PT and PTT are abn.
however, PT is more diagnostic for vit K def or warfarin treatment while PTT is more for heparin.
the basis is the clotting factors involved in the tests. the PTT tests for intrinsic pathway ( factorsXII,XI and common pathway) while PT tests for extrinsic (VII, and common pathway ).
i dont think you can diffeerentiate between vit k def and warfarin therapy from these 2 tests cos they act in similar ways. but you can differentiate them from heparin treatment.
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| GDS2008
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Sea_gull, so what U r saying is that APTT will be normal in CLD or cirrhosis..?
Also, increased bleeding time seen in CLD is not directly due to liver problems. It is because of 2 reasons: 1) Hypersplenism causing thrombocytopenia and 2) Functional platelet defect due to the accumulated toxins.
Please explain the answers....
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| robin082006
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D
it is given in Kaplan LN.
In warfarin therapy, only PT is used to follow its effect.
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| Sea_gull
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GDS2008 wrote:
Sea_gull, so what U r saying is that APTT will be normal in CLD or cirrhosis..?
Also, increased bleeding time seen in CLD is not directly due to liver problems. It is because of 2 reasons: 1) Hypersplenism causing thrombocytopenia and 2) Functional platelet defect due to the accumulated toxins.
Please explain the answers....
I do not mean to say that aPTT is not prolonged in CLD.I chose the option as per your question.
In fact PT,aPTT and TT all three parameters are prolonged in CLD.But in 40% cases bleeding time is prolonged due to various factors like
1:Thrombocytopenia
2 ecreased fibrinogen level
3:increased fibrinogen degradation products which in turn make platelets functionally defective.
GL .
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| frank100
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chronic liver disease: tipically is a prolongued PT.
but, PTT can either be normal or prolongued. all factors are low, except f.VIII. and there is no correction with vitamin K...
really, not sure, so do not kill me, but iŽd go for (A). Isolated prolongued PT plus stigmata of liver disease is diagnostic of liver disease.
VITAMIN k deficiency, there is a slight elevation of both, PT and PTT, PLUS: normal bleeding time, low levels of factors 2, 7, 9, and 10 protein C and S.
and WARFARIN is followed by PT.
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| study_ing
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anything affecting the common pathway wud likely to derange both PT AND APTT. the liver is the site of synthesis of all coagulation factors except one, which is made by the macrophages.
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| GDS2008
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Well, I guess the way I asked the question was not correct. The point that I was trying to convey was (asmany of you have already pointed out) is that in CLD (and for that matter warfain therapy and vitamin K def), both PT (Factor VII + common pathway) and APTT (XII, XI, IX + common pathway) will be prolonged. However, most text books usually talk about PT (for warfarin and CLD). The reason is that factor VII has the shortest t1/2 (Half life= 8 hours). Since the synthesis of these factors go down, factor VII is the first one to be depleted and therefore PT gets prolonged much before APTT and hence it is considered for monitoring. Nothing spectacualr about this but just wanted to share.........
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| frank100
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thanks
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| frank100
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what I think about this is that since on the test they will always give you a clinical scenario, which is the most important hint when it comes to bleeding, you adapt labs to the presentation or type of bleeding. then labs come to the party...
any way, thak you GDS2008
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| tolito
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point noted. thanks..
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