Coagulation Case Studies: Curious, Complex, and Compelling
Continuing Education Credits
Objectives
- Recall the major pathways in the coagulation system, inhibition of coagulation, and fibrinolysis.
- Contrast the role of Factor XII in its lab-based coagulation pathway with that of its role in the in vivo coagulation pathway.
- Compare different types of dysfibrinogenemia and their outcomes.
- Explain the role of the inhibitor Protein C and compare possible outcomes and symptoms.
- Evaluate the various roles of Factor XIII, the clot stabilizing factor.
- Describe the structure and function of von Willebrand factor, its role in coagulation testing, and possible conflicting outcomes.
Course Outline
- Introduction to Disorders of Coagulation
- Types of Coagulation Disorders
- Overview of Coagulation
- Overview of Inhibition of Coagulation
- Overview of Fibrinolysis
- Review of the Major Laboratory Tests for Coagulation
- True or False: The platelet plug and the fibrin clot are the same thing.
- Which of the following lab tests is prolonged if one of the intrinsic coagulation factors is deficient?
- The Many Faces of Factor XII
- Introduction to Factor XII
- Case 1A. An Accidental Discovery of Factor XII Deficiency in a Child
- Case 1A Discussion
- Case 1B. A Pregnant Patient with Factor XII Deficiency
- Case 1B Discussion
- Case 1C. A 23-year-old Accident Victim
- Case 1C Follow Up and Discussion
- Synopsis and Discussion of the Three Factor XII Deficiency Cases
- A Factor XII (FXII) deficiency causes which of the following test results? (Note: Normal equals within reference range.)
- Which of the following processes is FXII not involved in?
- Dysfibrinogenemia: Another Unpredictable Coagulation Disorder
- Introduction to Dysfibrinogenemia
- Introduction to Dysfibrinogenemia, continued
- Case 2A. A Child with Dysfibrinogenemia with Clinical Consequences
- Case 2A Discussion
- Case 2B. A Child with Dysfibrinogenemia and No Clinical Symptoms
- Case 2B Discussion
- Which protein cleaves fibrinogen?
- True or False: Congenital dysfibrinogenemia typically results in either bleeding or thrombosis, or both.
- Protein C Deficiency with Different Outcomes
- Introduction to Inhibitors of Coagulation
- Role of Protein C in Inhibiting Coagulation
- Case 3A. An Inherited Protein C Deficiency in a Young, Healthy Individual
- Case 3A Discussion
- Case 3B. An Inherited Protein C Deficiency in a Postpartum Mother
- Case 3B Discussion
- What is the direct target of Protein C and Protein S inhibition?
- True or False: Protein C (PROC) antigen levels and PROC activity typically correspond with one another.
- Factor XIII Deficiency: Difficult to Diagnose with Routine Testing
- Introduction to Factor XIII
- Case 4A. Congenital Factor XIII Deficiency Leading to Severe Bleeding
- Case 4A Discussion
- Case 4B. Acquired Factor XIII Deficiency
- Case 4B Discussion
- A patient with persistent bleeding problems has normal platelet, PT, and aPTT tests. Which one of the factors listed is most likely to be deficient?
- Which of the following tests is specific for detecting factor inhibitors?
- Von Willebrand Factor Deficiencies: Common but Complicated
- Introduction to von Willebrand Disease
- Von Willebrand Factor Structure
- Von Willebrand Factor Function
- Case 5A. A Toddler with a Bleeding Lip
- Case 5A Discussion
- Case 5B. A 48-year-old with Menorrhagia
- Case 5B Discussion
- Which clotting test can be abnormal in vWD?
- Which of the following classifications of von Willebrand disease (vWD) is most severe?
- Summary of Coagulation Disorders
- Summary of Cases
- Summary of Cases, continued
- Summary of Cases, continued
- References
- References
Additional Information
Level of Instruction: Intermediate
Intended Audience: Medical laboratory scientists, medical laboratory technicians, laboratory supervisors, and laboratory managers. This course is also appropriate for MLS and MLT students and pathology residents.
Author Information: Margaret Reinhart, MS, MLS(ASCP), is an adjunct medical laboratory science instructor at Pennsylvania Hospital in Philadelphia, PA. She is Senior Lecturer emerita of biological sciences at St. Joseph's University, formerly University of the Sciences in Philadelphia. She served as MLS program director and instructor at the University of the Sciences from 1990 to 2022, where she taught hematology, microbiology, parasitology, immunology, basic concepts of MLS, animal studies, and global sustainability courses.
The author has no conflict of interest to disclose.
Reviewer Information: Morgan Moss, MHA, MLS(ASCP)CM, is a Technical Training Specialist for Siemens Healthineers. She completed her Bachelor of Medical Technology at Old Dominion University. She then completed her graduate degree in Healthcare Administration at Grantham University. Prior to Siemens, Morgan worked as a generalist in the Department of Veterans Affairs. In her current position, she conducts classroom and onsite trainings throughout the continental U.S. Additionally, she edits and aligns training materials to represent real-world field/customer experiences, improve customer knowledge retention, and increase successful operation of instrumentation.
Course Description: This course uses several case studies to demonstrate the complexities of the coagulation system. It focuses on factors that can play multiple roles in coagulation, inhibition of coagulation, and fibrinolysis, as well as their interactions with inflammation and wound healing. It contrasts hereditary and inherited disorders and highlights individual variation in symptoms among patients. The course also focuses on factor deficiencies, which can cause symptoms that are counterintuitive given their obvious role in the lab-based coagulation pathway.