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The missing slope: paradoxical shortening of activated partial thromboplastin time in a patient on unfractionated heparin therapy

This case report describes false shortening of activated partial thromboplastin time (aPTT) due to erroneous optical reading of the clotting point in the presence of unfractionated heparin (UFH), and a biphasic waveform. Activated partial thromboplastin time performed on a coagulometer with photo-op...

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Permalink: http://skupni.nsk.hr/Record/nsk.NSK01001163317/Details
Matična publikacija: Biochemia medica (Online)
31 (2021), 2 ; str. 372-376
Glavni autori: Lapić, Ivana (Author), Lončar Vrančić, Ana, Coen Herak, Désirée, Rogić, Dunja
Vrsta građe: e-članak
Jezik: eng
Online pristup: https://doi.org/10.11613/BM.2021.021003
Elektronička verzija članka
Elektronička verzija članka
Elektronička verzija članka
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024 7 |2 doi  |a 10.11613/BM.2021.021003 
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080 1 |2 2011 
100 1 |a Lapić, Ivana  |4 aut  |9 HR-ZaNSK 
245 1 0 |a The missing slope: paradoxical shortening of activated partial thromboplastin time in a patient on unfractionated heparin therapy  |h [Elektronička građa]  |c Ivana Lapić, Ana Lončar Vrančić, Désirée Coen Herak, Dunja Rogić. 
300 |b Ilustr. 
504 |a Bibliografija: 
504 |a Summary. 
520 |a This case report describes false shortening of activated partial thromboplastin time (aPTT) due to erroneous optical reading of the clotting point in the presence of unfractionated heparin (UFH), and a biphasic waveform. Activated partial thromboplastin time performed on a coagulometer with photo-optical detection yielded an ambiguous clotting curve characterized by an early and steady decrease in light transmittance throughout the whole measuring range, with the clotting point read at 65 seconds. Further investigations included measurement of aPTT by means of a mechanical clot detection method as well as determination of another heparin-sensitive coagulation assay, that is thrombin time (TT), both being unmeasurably prolonged (>150 seconds). Communication with clinicians revealed that the patient was on continuous UFH therapy and had an underlying sepsis, with highly elevated C-reactive protein (289 mg/L). The aPTT measurements requested at three timepoints later during the same day revealed gradual aPTT shortening and unveiled a peculiar biphasic waveform pattern. In this case, unmeasurably prolonged aPTT due to UFH therapy was masked by a biphasic aPTT curve pattern making only the first slope of the biphasic waveform visible within the measuring range. The early decrease in plasma light transmittance mimicked optical changes related to clot formation, thus causing erroneous optical reading and yielding a falsely shortened aPTT. This case emphasizes that such a pattern should be carefully inspected, especially when a combination of a critically ill condition and UFH therapy is present, in order to prevent erroneous reporting of aPTT and potential adverse effects on patient care. 
700 1 |a Lončar Vrančić, Ana  |4 aut  |9 HR-ZaNSK 
700 1 |a Coen Herak, Désirée  |4 aut  |9 HR-ZaNSK 
700 1 |a Rogić, Dunja  |4 aut  |9 HR-ZaNSK 
773 0 |t Biochemia medica (Online)  |x 1846-7482  |g 31 (2021), 2 ; str. 372-376  |w nsk.(HR-ZaNSK)000655372 
981 |b Be2021 
856 4 0 |u https://doi.org/10.11613/BM.2021.021003 
856 4 0 |u https://www.biochemia-medica.com/en/journal/31/2/10.11613/BM.2021.021003  |y Elektronička verzija članka 
856 4 0 |u https://www.biochemia-medica.com/en/journal/31/2/10.11613/BM.2021.021003/fullArticle  |y Elektronička verzija članka 
856 4 1 |y Digitalna.nsk.hr 
856 4 0 |u https://hrcak.srce.hr/258905  |y Elektronička verzija članka 

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