Ifeanyichukwu Ifechidere: When PT and APTT Are Normal but Bleeding Persists
Ifeanyichukwu Ifechidere, Specialist Biomedical Scientist at Sheffield Teaching Hospitals NHS Foundation Trust, shared a post on LinkedIn:
”Normal PT/APTT… but the patient is bleeding — what are we missing?
As biomedical scientists, we’re trained to trust our screening assays. A normal PT and APTT often reassure clinicians that the coagulation cascade is intact.
But here’s the critical reminder: normal screening tests do NOT exclude a bleeding disorder.
When the clinical picture and the lab results don’t align, it’s time to think beyond the basics.
So what could we be missing?
- Factor XIII deficiency
PT and APTT assess clot formation — but not clot stability.
Factor XIII acts after fibrin is formed, cross-linking and stabilising the clot.
Deficiency can present with:
Delayed bleeding (hours to days post-procedure)
Poor wound healing
Recurrent miscarriages
Key point: Routine coagulation screens will be completely normal. Specific FXIII assays are required.
- Platelet function disorders
Platelet count ≠ platelet function.
Even with a normal platelet count and coagulation screen, dysfunctional platelets can lead to significant bleeding.
Consider in patients with:
Mucocutaneous bleeding
Easy bruising
Post-surgical bleeding with normal labs
Think about:
Inherited disorders (e.g. Glanzmann, Bernard-Soulier)
Acquired causes (antiplatelet drugs, uraemia)
Specialist testing (e.g. platelet function analysis, aggregometry) is essential.
- von Willebrand Disease (VWD)
The most common inherited bleeding disorder — and frequently underdiagnosed.
VWF plays a dual role:
Mediates platelet adhesion
Carries and stabilises Factor VIII
Why PT/APTT may be normal:
Mild VWD may not significantly reduce FVIII
APTT may only prolong in more severe cases
Clues:
Personal or family history of bleeding
Menorrhagia, epistaxis, dental bleeding
Diagnosis requires a panel: VWF antigen, activity, and FVIII levels.
The takeaway
Normal PT and APTT do not rule out:
Defects in clot stabilisation
Platelet dysfunction
von Willebrand Disease
As laboratory professionals, our value lies not just in reporting numbers — but in recognising when the numbers don’t tell the full story.
- When bleeding is unexplained, expand the investigation.
- When results don’t fit the clinical picture, question them.
Because sometimes, what’s not abnormal is exactly where the answer lies.”
Other posts featuring Ifeanyichukwu Ifechidere on Hemostasis Today.
-
Apr 6, 2026, 14:59Michal Farkowski: Cardiooncology Also Deals with Arrhythmia
-
Apr 6, 2026, 14:08David McIntosh: What Truly Determines the Safety of Plasma Donation
-
Apr 6, 2026, 13:52Andrew Zapfel: Expanding Newborn Screening for Sickle Cell Disease in Africa
-
Apr 6, 2026, 13:51Frank Nocken: FDA Approves Caplacizumab Therapy for Pediatric Acquired TTP
-
Apr 6, 2026, 13:45Svenja Tatjana Barckhausen: From Plasma Dependence to Self-Sufficiency in Africa
-
Apr 6, 2026, 13:35Gregory Piazza: When Antibodies Trigger Thrombosis
-
Apr 6, 2026, 13:24Paritosh Garg: Importance of Ruling Out an Underlying Cause Before Treatment of AIHA
-
Apr 6, 2026, 10:49Chokri Ben Lamine: Routine VTE Prophylaxis Is Not Recommended for Chronically Bedridden Patients at Home
-
Apr 6, 2026, 10:03Mohamed Sikkander Abdul Razak: Clinical Steps for Evaluating and Managing Heavy Menstrual Bleeding