Abnormal activated partial thromboplastin time and malignancy

Our plain-English summary of Abnormal activated partial thromboplastin time and malignancy, by M. Delicata, H. Hambley (Scottish Medical Journal, 2011).

The study

• Authors: M. Delicata, H. Hambley
• Journal: Scottish Medical Journal
• Published: 2011;56(3):181
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Malignancy often results in clotting abnormalities. The aetiology of haemostasis problems in cancer is complex, and is still not completely understood. We describe a case of a patient with malignant mesothelioma, who was found to have elevated activated partial thromboplastin time, due to lupus anticoagulant. We suggest that patients with malignancy should have their coagulation checked prior to any invasive procedures.

In plain English

This was a case report about one patient. A 77-year-old man, a retired company director, had several months of increasing breathlessness, dry cough and hoarseness. He had been exposed to asbestos as a trainee working in power stations in the 1950s and had smoked pipes for 50 years. Scans showed a large left-sided effusion, enhancing pleural tissue and calcified pleural plaques. Cytology of pleural fluid confirmed mesothelioma. About a month later, an abscess on his back kept bleeding and he had nosebleeds. His activated partial thromboplastin time (APTT), a clotting test, was 79 seconds (normal range 25–37). It did not correct with fresh frozen plasma. Factors VII and VIII were low, and lupus anticoagulant was positive. He was not taking anticoagulant or antiplatelet drugs. The authors thought the bleeding had some other cause, not the raised APTT. Antiphospholipid syndrome was never conclusively diagnosed. He died a few weeks later. The authors concluded that patients with malignancy should have coagulation checked before procedures. The discussion calls the tumour peritoneal mesothelioma, although the case description points to the pleura.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: one 77-year-old male retired company director in the UK with mesothelioma
• Exposure: asbestos exposure as a trainee working in power stations in the 1950s (fiber type not stated); also smoked pipes for 50 years, quitting in 2006
• Main results:
  • CT showed calcified pleural plaques, which the authors took to suggest previous asbestos exposure
  • Pleural fluid cytology confirmed the working diagnosis of mesothelioma
  • In the patient, prothrombin time was 16 seconds (normal range 9–12 seconds)
  • In the patient, APTT was 79 seconds (normal range 25–37 seconds)
  • The patient's APTT did not correct after four units of fresh frozen plasma
  • In the patient, factor VII was 43 (normal range 67–153 IU/dL) and factor VIII was 10 (58–152 IU/dL); lupus anticoagulant was positive
  • The patient was not taking anticoagulant or antiplatelet medications
  • No signs of thrombosis were found in the patient, so antiphospholipid syndrome was never conclusively diagnosed
  • The authors postulated that the bleeding had some other cause and that the raised APTT was not directly linked to the patient's symptoms
• The authors' conclusion: The authors concluded that coagulation should be checked before any procedures in patients with malignancy
• Limitations the authors state:
  • Further investigation was not possible because the patient died a few weeks later
  • The reason for the low factor VII level was unknown

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma.

Related studies

• Inflammatory particles stimulate thromboplastin production by human monocytes — R.T. Dean, H. Prydz (1983)
• Abnormal lung function associated with asbestos disease of the pleura, the lung, and both: a comparative analysis — K.H. Kilburn, R.H. Warshaw (1991)
• Cardiorespiratory responses to incremental exercise in patients with asbestos-related pleural thickening and normal or slightly abnormal lung function — A. Miller, A. Bhuptani, et al. (1993)
• HLA-A and B antigen frequencies in an asbestos exposed population with normal and abnormal chest radiographs — C. Darke, M.M. Wagner, et al. (1979)
• Navy Asbestos Medical Surveillance Program 1990-1999: demographic features and trends in abnormal radiographic findings — D.M. Dell, B.K. Bohnker, et al. (2006)
• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)

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