A prolonged PTT is corrected when mixed with normal plasma and tested immediately and after a 2-hour incubation. Which test (or tests) should be performed next?
a. Bethesda titer
b. High phospholipid PTT
c. Anti-Xa assay
d. Factor VIII and IX assays
ANS: D
This pattern suggests a factor deficiency, and factor VIII and IX assays should be performed. The Bethesda titer is performed when a specific factor inhibitor is present; no evidence exists for this because the PTT on the incubated 1:1 mix did not prolong. High phospholipid PTT testing is done to confirm the lupus anticoagulant; this is not present because the immediate 1:1 mix on this sample corrected. No reason exists to perform an anti-Xa assay, often used to monitor LMWH.
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