Diagnostic Performance of Prothrombin Time and Activated Partial Thromboplastin Time in Children: A Service Evaluation.

International journal of laboratory hematology Pub Date : 2025-09-09 DOI:10.1111/ijlh.14557

Gerard Gurumurthy, Mikias Lemma, Lianna Reynolds, John Grainger, Jecko Thachil

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Abstract

Background: Coagulation screening, consisting of prothrombin time (PT) and activated partial prothrombin time (aPTT), is routinely performed in paediatrics to identify bleeding disorders or guide peri-procedural management. We evaluated the trends in utilisation and diagnostic yield of PT and aPTT testing as part of coagulation screening in a tertiary paediatric centre.

Methods: All PT and aPTT samples received from June to September 2024 were analysed. Total requests, sample rejection rates, abnormal result patterns (isolated PT, isolated APTT, combined), and clinical correlations were recorded. Laboratory cutoffs were PT > 12.5 s and APTT > 30.0 s. Youden's Index determined cutoffs associated with inherited bleeding disorders.

Results: A total of 2808 coagulation profiles from 1207 patients were received, with 15.7% (442/2808) rejected in 268 patients. Of these, 31.7% (85/268) of patients were not re-tested. Among valid requests, 17.0% (402/2366) were abnormal (128 isolated APTT, 173 isolated PT, 101 combined). In a subgroup of 337 randomly selected patients, 28.8% (97/337) had deranged results, leading to 12 new haematological and 34 acute diagnoses. Youden's index determined isolated APTT > 31.4 s associated with inherited disorders (AUC > 0.8). The same was not identified with isolated PT (PT > 13.0 s, AUC < 0.6).

Conclusion: A substantial proportion of samples received are rejected, and some abnormal results remain unaddressed. Most abnormal findings are clinically significant, particularly when APTT > 33.1 s. There is scope to refine utilisation in paediatric practice.

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儿童凝血酶原时间和活化部分凝血活酶时间的诊断性能：服务评价。

背景：凝血筛查，包括凝血酶原时间（PT）和活化部分凝血酶原时间（aPTT），在儿科常规进行，以识别出血性疾病或指导围手术期管理。我们评估了PT和aPTT检测作为三级儿科中心凝血筛查的一部分的使用趋势和诊断率。方法：对2024年6 - 9月收集的所有PT和aPTT样品进行分析。记录总请求、样本拒绝率、异常结果模式（分离PT、分离APTT、联合）和临床相关性。实验室截止时间为PT bb0 12.5 s, APTT bb1 30.0 s。约登指数确定了与遗传性出血性疾病相关的临界值。结果：1207例患者共收到2808份凝血分析报告，268例患者有15.7%（442/2808）被拒绝。其中，31.7%（85/268）的患者没有重新检测。在有效请求中，异常请求占17.0%(402/2366)，其中APTT请求128个，PT请求173个，合并请求101个。在随机选择的337例患者的亚组中，28.8%（97/337）有精神错乱的结果，导致12例新的血液学诊断和34例急性诊断。约登指数确定与遗传性疾病相关的分离APTT > 31.4 s （AUC > 0.8）。分离的PT （PT > 13.0 s， AUC）也没有被鉴定出来。结论：收到的大量样品被拒绝，一些异常结果仍未得到解决。大多数异常表现具有临床意义，特别是当APTT bb0 33.1 s时。在儿科实践中有改进利用的余地。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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International journal of laboratory hematology

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