Thickening Profile Analysis: A Novel Approach to Understanding Hemostasis

Abstract

Background: Hemostasis is a sequence of enzymatic processes that result in the creation of a clot at the site of the injury. This is done with blood platelets and fibrin to regulate and stop additional bleeding. When the wound heals, the plug gradually remodels and dissolves as the injured area returns to its natural state. The protective mechanism against hemorrhage is controlled by the hemostatic cascade. Bleeding symptoms in the patient can often prompt laboratory evaluation for bleeding disorders. To screen for hemostatic disorders and distinguish between congenital and acquired disorders, physicians should obtain a detailed personal and family hemostatic history. They should also perform a thorough physical examination. Activated partial thromboplastin time (APTT) and prothrombin time (PT) are screening assays indicated for the initial assessment of hemostasis disorders. Although these assays have been described for several decades, recent improvements in coagulation automated analyzers now available in most clinical laboratories have led to their widespread use. Evaluation of hemostasis by evaluating and recording coagulation profile tests (PT & APTTs) of patients, including prolonged and shortened PT and/or APTTs according to age and sex.

Materials and Method: This study was carried out in the medical laboratory department - King Khaled Hospital and included 1884 patients whose ages ranged from 20 to over 60 years old. Different hospital clinics requested coagulation profile tests (PT and APTT) for all patients. Samples were tested during the first quarter of 2023 (January to March) recording the results of PT and APTT and distribution of results according to sex and age using the Stagogroupe - STA R Max®

Results: Prolongation and shortening of PT and/ or APTT were observed in 628 patients representing 33% of the total collected data in 1884. Of these patients, 284 were female (45.2%) and 344 were male (54.8%). According to age and sex, the majority of abnormalities were over 60 years of age for both genders, reaching 268 (42.7%). In both genders, there were 20 patients with high PT, representing 3.18 % of the overall abnormal results. According to age, the highest incidence was between 40-50 years for both genders and the total were 35% of total cases, (20%) females and (15%) males. Total patients with shortened PT were 120 (19.1%) of the total abnormal results (628) at an age over 60 years old. There were 42 patients (35%) with low PT, 15 female (12.5%) and 27 male (22.5%). Patients with prolonged PT according to age and gender were 357 (56.4%) out of the non-normal (628). At age over 60 there were 173 (48%) patients, 84 females (23.5%), and 89 males (25%). There were 35 patients out of 628 with short APTT representing 5.6%; at the age of 30-40 years, the total number was (37%), with 14.3% females and 22.9% males. Regarding prolongation of both PT and APTT, the total results were 84 (13.4%), at age over 60 the total cases were (48.8%); females were (23.8%) while males (25%). Results of the shortened PTT and APTT totaled (1.9%) out of 628. At age 50-60, the total was (25%), females were 8.33 percent, and males were 16.2%.  

Conclusions: According to the findings of this study, the results of prolongation and shortening of PT and/or APTT are age and risk-factor-related. These results increase the incidence of bleeding and thrombosis so laboratory testing should be pursued especially without an obvious explanation for the disturbances of the PT or APTT. The most susceptible age groups were over 50 years due to their greater exposure to coagulopathies and other risk factors.