A practical approach to pediatric patients referred with an abnormal coagulation profile

Arch Pathol Lab Med. 2005 Aug;129(8):1011-6. doi: 10.5858/2005-129-1011-APATPP.


Context: Workup for prolonged prothrombin time (PT) and activated partial thromboplastin time (PTT) is a frequent referral to a Hematology and Coagulation Laboratory. Although the workup should be performed in a timely and cost-effective manner, the complete laboratory assessment of the coagulation state has not been standardized.

Objective: To determine which clinical and laboratory data are most predictive of a coagulopathy and to formulate the most efficient strategy to reach a diagnosis in patients referred for abnormal coagulation profiles.

Design: Retrospective case review. Medical records of 251 patients referred for prolonged PT and/or PTT to our Hematology Service between June 1995 and December 2002 were reviewed.

Results: The study included 135 males and 116 females with a mean age of 7.0 years. A personal history of bleeding was reported in 137 patients, and a family history of bleeding was reported in 116 patients. Fifty-one patients (20%) had a coagulopathy (ie, a bleeding risk). Factors predictive of a bleeding risk were a positive family history of bleeding (P < .001) and a positive personal history of bleeding (P = .001). Of 170 patients with findings of normal PT and PTT values on repeat testing, 14 were subsequently diagnosed with a coagulopathy. Two of these patients reported no positive personal or family history of bleeding.

Conclusions: Coagulopathy was identified in 20% of the children referred for abnormal PT and/or PTT. In the absence of a personal or family history of bleeding, a normal PT and/or PTT on repeat testing has a negative predictive value of more than 95%.

MeSH terms

  • Blood Coagulation Disorders / blood
  • Blood Coagulation Disorders / diagnosis*
  • Blood Coagulation*
  • Child
  • Female
  • Humans
  • Male
  • Partial Thromboplastin Time
  • Pediatrics / methods*
  • Predictive Value of Tests*
  • Prothrombin Time
  • Referral and Consultation*
  • Retrospective Studies
  • Risk Factors