A 58 year old male is admitted with haematemesis. His coagulation profile is shown below. List 2 likely causes of his coagulation abnormalities?

Test

Value

Normal range

PT

*25.9 sec

(12-14)

APTT

*39 sec

(34-38)

INR

*2.4

(0.8-1.2)

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College Answer

1) Liver dysfunction due to alcoholic or viral liver disease.
2) Vit K deficiency
3) Patient on warfarin therapy.

Discussion

The question really asks, "What differen reasons could here be for an isolated PT elevation".

In a guy who is vomiting blood, alcoholism and liver disease are high up on the list.

An isolated PT elevation could be caused by:

  • Vitamin K deficiency
    • Malabsorption (leading to vitamin K deficiency)
  • Vitamin K antagonists e.g. warfarin, phenindione, rodenticides
  • Liver disease
  • Isolated Factor VII deficiency

The whole spectrum of abnormal coagulation studies is discussed in greater detail elsewhere.

References

References

Prothrombin Time, from the wonderful Practical-Haemostasis.com

Mariani, Guglielmo, and Francesco Bernardi. "Factor VII deficiency." Seminars in thrombosis and hemostasis. Vol. 35. No. 4. 2009.