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The aPTT-based APC resistance test involves a modified aPTT test performed in the presence and absence of activated protein C (APC). [1] [5] The ratio of these aPTT values is calculated and is called the APC sensitivity ratio (APCsr) or simply APC ratio (APCr). [1] [5] This ratio is inversely related to the degree of APC resistance. [7]
The partial thromboplastin time (PTT), also known as the activated partial thromboplastin time (aPTT or APTT), is a blood test that characterizes coagulation of the blood. A historical name for this measure is the Kaolin-cephalin clotting time ( KCCT ), [ 1 ] reflecting kaolin and cephalin as materials historically used in the test.
A mixing test is generally in the initial workup of a prolonged aPTT. In a mixing test, patient plasma is mixed with normal pooled plasma and the clotting is reassessed. If a clotting inhibitor such as a lupus anticoagulant is present, the inhibitor will interact with the normal pooled plasma and the clotting time will generally remain abnormal.
Fresh normal plasma has all the blood coagulation factors with normal levels. If the problem is a simple factor deficiency, mixing the patient plasma 1:1 with plasma that contains 100% of the normal factor level results in a level ≥50% in the mixture (say the patient has an activity of 0%; the average of 100% + 0% = 50%). [3]
In pregnancy, ALT levels would rise during the second trimester. In one of the studies, measured ALT levels in pregnancy-related conditions such as hyperemesis gravidarum was 103.5 IU/L, pre-eclampsia was 115, HELLP syndrome was 149. ALT levels would reduce by greater than 50% in three days after child delivery.
Pregnancy after the age of 35 augments the risk of VTE, as does multigravidity of more than four pregnancies. [2] Pregnancy in itself causes approximately a five-fold increased risk of deep venous thrombosis. [6] Several pregnancy complications, such as pre-eclampsia, cause substantial hypercoagulability. [2]
Activated protein C resistance (APCR) is a hypercoagulability (an increased tendency of the blood to clot) characterized by a lack of a response to activated protein C (APC), which normally helps prevent blood from clotting excessively.
The reference range for prothrombin time depends on the analytical method used, but is usually around 12–13 seconds (results should always be interpreted using the reference range from the laboratory that performed the test), and the INR in absence of anticoagulation therapy is 0.8–1.2.
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