From Dr. Manohar Pravin:
I have a patient who presented with a history of painless gross hematuria with blood clots since 8 months. He had severe anemia and hepatosplenomegaly. His USG abdomen revealed only hepatosplenomegaly. CT abdomen and pelvis is normal. LFT, KFT, sickling test, CBC is normal. His PT and PTT are prolonged . How should I approach?
Hello, Dr. Pravin, and welcome to Fritsma Factor. Thank you for your question. Of course, we don’t attempt to diagnose patients’ conditions here, realizing that only the local physician possesses all the necessary facts.
From the hemostasis perspective, follow-up of the prolonged prothrombin time and partial thromboplastin time is the first step, this should be accomplished using mixing studies. The procedure for performing PTT mixing studies is described in my audio module 7,Lupus Anticoagulant Part 1; the procedure can be modified to perform PT mixing studies as well. Mixing studies will point you to a possible single or multiple factor deficiency, the result may be followed by individual factor assays. Once the factor deficiency is established, appropriate procoagulant therapy using single or multiple-factor preparations may be used. One additional laboratory assay that is useful when identifying factor deficiencies is the fibrinogen assay, this should be included in your workup.
As an aside, I am adding a new, expanded Mixing Studies audio module this week, please watch the audio modules section of our site. I hope this is helpful. Though I address only the hemostasis aspects of your question, there are additional factors to consider, and I hope your patient improves rapidly. Geo.