Feb, 2020 Quick Question: Chronic Bleeding

Our February, 2020 Quick Question, which drew 114 answers, asks, “For chronic bleeds, poor wound healing with normal PT, PTT, FG and platelets, what assay should be next?”

Answers:

1. Factor VIII: 18% (21)
2. Factor IX: 3% (3)
3. Factor XI: 4% (5)
4. Factor XIII: 75% (85)

The question was meant to draw us to factor XIII deficiency as it references poor wound healing. In defense of those who chose factor VIII deficiency as a possibility, a moderately low factor VIII level may not necessarily prolong the PTT in cases where the PTT is conservatively calibrated to prolong at levels below 30 U/dL. However, given the normal platelet parameters, factor XIII deficiency is the most likely situation.