March 2019 — Special Coagulation

A 72-year-old man with a history of chronic atrial fibrillation on warfarin anticoagulation and a questionable history of immune-mediated heparin-induced thrombocytopenia was admitted for elective abdominal surgery. His warfarin anticoagulation was bridged with argatroban in the peri-operative period. Two days after the procedure, a DIC/ICF profile was ordered due to a fall in platelet count and hematocrit and operative site oozing. The results of the coagulation laboratory studies are shown below.

Test Result Units Reference Range
Prothrombin time (PT) 25.1 sec 10.3 – 12.8
PT 1:1 mix 14.5 sec 10.3 – 12.8
Activated partial thromboplastin time (APTT) 58 sec 26 - 36
APTT 1:1 mix 50 sec 26 - 36
Dilute Russell viper venom time (DRVVT) screen ratio 2.3 ratio 0.0 – 1.1
DRVVT mix ratio 2.0 ratio 0.0 – 1.1
DRVVT confirm ratio 0.9 ratio 0.0 – 1.1
Thrombin time (TT) 276 sec 15 - 23
Reptilase time (RT) 17 sec 14.0 – 23.9
Clauss fibrinogen 125 mg/dL 200 – 430
PT-derived fibrinogen 480 mg/dL 261 - 595
D-dimer 750 D-dimer units (DDU) 0 - 250
Soluble fibrin monomer complexes (SFMC) <8 mcg/mL 0.0 – 7.9

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Jansen Seheult, M.B., B.Ch., B.A.O.
Resident, Special Coagulation
Mayo Clinic
Nahla Heikal, M.D.
Senior Associate Consultant, Hematopathology
Mayo Clinic
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