Prolonged Partial Thromboplastin Time Without Bleeding History; Fletcher Factor Deficiency

Area of Science:

• Hematology
• Coagulation Disorders

Background:

• A 67-year-old patient presented with a lower esophageal lesion suspicious for cancer.
• Preoperative laboratory tests revealed a prolonged activated partial thromboplastin time (aPTT) with a normal prothrombin time (PT).
• The patient had no personal or family history of bleeding or thrombosis.

Purpose of the Study:

• To investigate the cause of the prolonged aPTT in a patient undergoing esophagogastrectomy.
• To determine the safety of surgical intervention in patients with Fletcher factor deficiency.

Main Methods:

• Activated partial thromboplastin time (aPTT) and prothrombin time (PT) assays were performed.
• Plasma mixing studies with normal plasma were conducted.
• Incubation studies were performed to assess aPTT stability.
• Fletcher factor activity was measured.

Main Results:

• The patient's aPTT was prolonged (44 s), while PT was normal (11 s).
• Plasma mixing corrected the prolonged aPTT, and prolonged incubation shortened it.
• Fletcher factor activity was found to be 50%.
• The patient underwent esophagogastrectomy without bleeding complications.

Conclusions:

• Fletcher factor deficiency is a rare cause of isolated prolonged aPTT.
• This deficiency should be considered in patients with unexplained prolonged aPTT and no bleeding history.
• Surgical interventions, including esophagogastrectomy, are safe in patients with Fletcher factor deficiency.