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Coag Made Easy

The document provides an overview of the intrinsic and extrinsic coagulation pathways, referred to as the PTT and PT pathways, and provides mnemonic devices to help remember the factors in each pathway. Key factors that can cause clinically significant bleeding when deficient are factors XI, IX, VIII, VII, X, V, prothrombin, and fibrinogen. A mixing study can help differentiate between a coagulation factor deficiency and the presence of an inhibitor as the cause of a prolonged clotting time.

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Brian Roberts
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170 views

Coag Made Easy

The document provides an overview of the intrinsic and extrinsic coagulation pathways, referred to as the PTT and PT pathways, and provides mnemonic devices to help remember the factors in each pathway. Key factors that can cause clinically significant bleeding when deficient are factors XI, IX, VIII, VII, X, V, prothrombin, and fibrinogen. A mixing study can help differentiate between a coagulation factor deficiency and the presence of an inhibitor as the cause of a prolonged clotting time.

Uploaded by

Brian Roberts
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Coagulation Made Easy

Alice Ma, M.D.


University of North Carolina-Chapel Hill
Division of Hematology
Coagulation Made Easy

The PTT Pathway The PT Pathway

Rather than thinking about the intrinsic and the


extrinsic pathways, think about the PTT and the
PT pathways.
Coagulation Made Easy

The PTT Pathway The PT Pathway

X The PT and the PTT


pathway meet at
Factor X, because “X”
marks the spot.
Coagulation Made Easy

The PTT Pathway The PT Pathway

V
X Factor V is a cofactor for
Factor X, and you can
remember this because V
fits into the notch of the X.
Coagulation Made Easy

The PTT Pathway The PT Pathway

V
X
Prothrombin Thrombin
Factor Xa converts prothrombin (Factor II) into
thrombin, the most important enzyme on the planet.
Coagulation Made Easy

The PTT Pathway The PT Pathway

V Thrombin, among other


X things, converts the soluble
molecule fibrinogen into a
solid fibrin clot.

Prothrombin Thrombin

Fibrinogen Fibrin
The Common Pathway = Small Bills

V+X

II = prothrombin

I = fibrinogen

You can remember the factors in the common pathway by remembering the
bills in your wallet smaller than a $20. Don’t forget the $2 bill!
Coagulation Made Easy: The PT
The PT Pathway
PT has one less letter than PTT,
and PT values are shorter than
PTT values, because the
pathway is shorter. It means that 7
the PT pathway is also shorter.
This means that there’s fewer
V
steps to remember, and this is
lucky, so the lucky PT pathway
uses lucky Factor 7 to activate
X
Factor X.

Prothrombin Thrombin

Fibrinogen Fibrin
Coagulation Made Easy: The
The PTT Pathway
aPTT
The PTT pathway has all those
XII hideous roman numerals. . .

XI How are we going to remember

IX V
them? Hmmmmm. . .

VIII X
Prothrombin Thrombin

Fibrinogen Fibrin
Coagulation Made Easy: The aPTT
The PTT Pathway
Well, just remember that the
T PTT is a basic TENET of
E hematology.
N TENET stands for. . .
E V
T X
Prothrombin Thrombin

Fibrinogen Fibrin
Coagulation Made Easy: The aPTT
The PTT Pathway
Twelve
Eleven
Nine
Eight V
Ten X
Prothrombin Thrombin

Fibrinogen Fibrin
Coagulation Made Easy:
PT and PTT Both Prolonged

The PTT Pathway The PT Pathway

V These factors are in the


X common pathway.

Prothrombin (II)

Fibrinogen
Coagulation Made Easy:
Only PT Prolonged
7

Deficiency of Factor VII will prolong the PT but not the PTT.
Coagulation Made Easy:
Only PTT Prolonged

Deficiencies of Factors 12, 11,


Twelve 9, and 8 will prolong the PTT
Eleven and not the PT. Remember that
Factor 10 is in the common
Nine pathway, and affects BOTH the
Eight PT and the PTT.

Ten
XII What Matters Clinically
XI • Deficiencies of Factor XI,
IX, VIII, VII. X, V,
IX
prothrombin, and fibrinogen
VIII VII are clinically significant.
• Inhibitors of these factors
X
are clinically significant for
V bleeding.
• Deficiency of Factor XII,
Thrombin and the presence of the
Fibrinogen Fibrin lupus anticoagulant are not.
Coagulation Made Easy: The Mixing Study

• Useful to differentiate etiologies of prolonged clotting in a


coagulation assay.
• Patient’s plasma is mixed 50/50 with normal plasma. Coagulation
assay is repeated.
• If “ substantial” correction is noted after mix, suspect clotting
factor deficiency, because you replaced deficient factors in the
patient plasma with normal factors from the normal plasma.
• If no or not full correction is seen, suspect an inhibitor, because
you added the inhibitor (think of this as an anticoagulant) in the
patient plasma which inhibits clotting in the normal plasma.

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