Unbelievable but true: Partial thromboplastin time, kaolin 120 s and yet no surgical bleed!

Abstract

Partial thromboplastin time, kaolin (PTTK) is a global test sensitive to low levels of all the coagulation factors, except Factor VII and Factor XIII. Patients with extensive cancer have a propensity to develop a shortened PTTK. Our breast cancer patient had a prolonged PTTK result roughly 4 times the normal values. A detailed description of the preoperative workup including the special investigations is required to ascertain the cause of the prolongation and precautions taken, leading to successful breast cancer surgery and postoperative period in this patient follows. Allowing the surgeon to operate a patient with a PTTK >120 s and simultaneously at risk of thrombosis due to lupus anticoagulant is possible with a calculated risk and thorough preoperative evaluation. Prophylactic fresh frozen plasma and deep venous thrombosis prophylaxis have an important role.

Keywords

• Breast cancer surgery
• decreased Factor XI
• lupus anticoagulant
• raised partial thromboplastin time kaolin
• thromboelastography