Potpourri – CIN and elevated PTT

Today we had 2 fascinating cases in Resident Report.

1) A 51 yo F with HIV on HAART presenting originally for what was suspected to be gallstone pancreatitis. Pre-op evaluation for cholecystectomy was done, and a persistently elevated PTT was noted. How does one work up an elevated PTT?

Differential diagnosis includes – Lupus anti-coagulant, acquired factor inhibitor, von Willenbrand’s disease, cirrhosis, DIC, Vitamin K deficience.

Studies to order include: Lupus anti-coagulant (very commonly the cause), mixing study (mixes patient’s plasma with fresh plasma and if an inhibitor is present, will have abnormal mixing study), DIC panel, LFT’s (liver disease), factor activity assays (if other testing is negative).

Here is a lovely study which describes this exact patient scenario:

Singapore Med J 2005; 46(9) : 450

As this patient had a positive mixing study, it’s unclear which type of factor inhibitor she has. Factor VIII is the most common of all of them and its epidemiology, presentation and treatment is detailed in this review:

Blood July 15, 2008 vol. 112 no. 2 250-255

Contrast-Induced Nephropathy

Here is a good review of CIN:

Cleveland Clinic Journal of Medicine January 2006vol. 73 1 75-80