Hemostasis and Thrombosis Testing

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Laboratory hemostasis and thrombosis testing is useful in many clinical settings, including the diagnosis of bleeding and clotting disorders, determination of the etiology of abnormal bleeding, and treatment decision-making. In conjunction with clinical examination, commonly used laboratory techniques include functional assays such as clotting time tests, immunoassays, activity assays, and genetic tests.

 

Impacts of Common
Anticoagulants on
Coagulation Testing

Anticoagulants have a prominent role in patient care. However, they may interfere with associated laboratory testing.



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Venous
Thromboembolism

D-dimer testing may be used in the initial evaluation for venous thromboembolisms, including deep vein thromboses and pulmonary embolisms.



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Heparin-Induced
Thrombocytopenia

Heparin-induced thrombocytopenia, an immune-mediated adverse effect of heparin treatment, is diagnosed based on clinical assessment and laboratory results.


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Prolonged Clotting
Time Evaluation

Prolonged clotting times of unclear etiology require evaluation to determine the cause and exclude clinically significant bleeding disorders.


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Thrombocytopenic
Disorders

Identifying the etiology of thrombocytopenia involves careful assessment of both clinical characteristics and the results of well-chosen laboratory tests.


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Disseminated
Intravascular
Coagulation - DIC

Diagnosis of DIC involves a combination of clinical evaluation and laboratory tests such as D-dimer and fibrinogen.


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Functional Platelet
Disorders

Laboratory testing for functional platelet disorders is appropriate in individuals with a platelet-type bleeding pattern.




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Hereditary
Thrombophilia -
Hypercoagulability

Thrombotic risk is multifactorial. The decision to test for hereditary thrombophilia can therefore be complicated.


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Hemophilia -
Factor VIII or
IX Deficiency

A workup for hemophilia typically involves tests such as prothrombin time, partial thromboplastin time, mixing studies, and factor assays to identify the factor deficiency.

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Uncommon Factor Deficiencies

Uncommon factor deficiencies that may lead to abnormal bleeding include deficiencies in fibrinogen (FI), factor II (FII), FV, FVII, combined FV plus FVIII, FX, FXI, and FXIII.

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Von Willebrand Disease - VWD

Although no single laboratory test can be used to diagnose VWD, an initial panel of tests typically includes tests for von Willebrand factor antigen and activity as well as FVIII activity.

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Fibrinolytic
Disorders

Testing for fibrinolytic disorders should be performed if there is high suspicion after exclusion of common disorders of coagulation.


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Thrombotic
Microangiopathies - TMA

Identification of thrombotic microangiopathy syndromes (such as thrombotic thrombocytopenic purpura) is necessary to ensure appropriate treatment.

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