Are shortened aPTT values always to be attributed only to preanalytical problems?
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Vanja Radišić Biljak
,
Matea Tomas
and
Andrea Saračević
Abstract
Objectives
It has been recognized that shortened activated partial thromboplastin time (aPTT) may be caused by various preanalytical conditions. As coagulation Factor VIII is included in the in vitro intrinsic coagulation cascade measured by aPTT, we hypothesized that the shortened aPTT could be a result of elevated FVIII activity. We aimed to inspect the connection of elevated FVIII with shortened aPTT, and the possible effect inflammation has on routine laboratory parameters.
Methods
40 patients from various hospital departments with aPTT measurement below the lower limit of the reference interval (<23.0 s) were included in the study. To compare the obtained results with aPTT measurements in the non-inflammatory state, samples from 25 volunteers (laboratory personnel) were collected. White blood cell count, C-reactive protein, aPTT, and FVIII values were measured in the control group.
Results
Only two samples among 40 patients with shortened aPTT (5 %) were clotted. Out of the remaining 38, 26 had FVIII activity above 150 % (upper limit of a reference interval), median value of 194 % (IQR: 143–243 %). Seven samples in the control group had shortened aPTT results (36 %). However, all coagulation samples were clot and hemolysis-free. Multiple regression identified only FVIII activity as an independent variable in predicting aPTT values (p=0.001).
Conclusions
Our results support the thesis that shortened aPTT is rarely a consequence of preanalytical problems. Elevated FVIII activity causes shortened aPTT, not only in the inflammatory state but also in individuals with concentration of inflammatory markers within reference intervals.
Acknowledgments
Each author contributed to the writing, reviewing, revision, and acceptance of the manuscript.
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Research ethics: Not applicable.
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Informed consent: Not applicable.
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Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: The raw data can be obtained on request from the corresponding author.
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Articles in the same Issue
- Frontmatter
- Editorial
- Should APTT become part of thrombophilia screening?
- Review
- n-3 fatty acids and the risk of atrial fibrillation, review
- Guidelines and Recommendations
- Root cause analysis of cases involving diagnosis
- Opinion Papers
- What is diagnostic safety? A review of safety science paradigms and rethinking paths to improving diagnosis
- Interprofessional clinical reasoning education
- Original Articles
- Quality of heart failure registration in primary care: observations from 1 million electronic health records in the Amsterdam Metropolitan Area
- Typology of solutions addressing diagnostic disparities: gaps and opportunities
- Diagnostic errors and characteristics of patients seen at a general internal medicine outpatient clinic with a referral for diagnosis
- Cost-benefit considerations of the biased diagnostician
- Delayed diagnosis of new onset pediatric diabetes leading to diabetic ketoacidosis: a retrospective cohort study
- Monocyte distribution width (MDW) kinetic for monitoring sepsis in intensive care unit
- Are shortened aPTT values always to be attributed only to preanalytical problems?
- External Quality Assessment (EQA) scheme for serological diagnostic test for SARS-CoV-2 detection in Sicily Region (Italy), in the period 2020–2022
- Recent mortality rates due to complications of medical and surgical care in the US
- Short Communication
- The potential, limitations, and future of diagnostics enhanced by generative artificial intelligence
- Case Report – Lessons in Clinical Reasoning
- Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of persistent dysphagia and patient partnership
- Letters to the Editor
- The ‘curse of knowledge’: when medical expertise can sometimes be a liability
- A new approach for identifying innate immune defects
