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Diagnostic Performance of Prothrombin Time and Activated Partial Thromboplastin Time in Children: A Service

Gerard Gurumurthy1, Mikias Lemma1, Lianna Reynolds2

  • 1The University of Manchester, Manchester, UK.

International Journal of Laboratory Hematology
|September 9, 2025
PubMed

Insights

Paediatric coagulation screening using prothrombin time (PT) and activated partial thromboplastin time (aPTT) shows high rates of abnormal results, with many requiring clinical attention. Refining test utilization is crucial for effective diagnosis of bleeding disorders.

Area of Science:

  • Paediatric Haematology
  • Clinical Pathology
  • Diagnostic Testing

Background:

  • Coagulation screening, including prothrombin time (PT) and activated partial thromboplastin time (aPTT), is standard in paediatrics for identifying bleeding disorders and guiding management.
  • Evaluation of current utilization and diagnostic yield of PT and aPTT testing in a tertiary pediatric center was performed.

Purpose of the Study:

  • To assess trends in the utilization of coagulation screening tests (PT and aPTT) in a pediatric setting.
  • To determine the diagnostic yield and clinical significance of abnormal PT and aPTT results.
  • To identify areas for refining the use of these tests in pediatric practice.

Main Methods:

  • Analysis of all PT and aPTT samples received over a four-month period in 2024.
  • Recorded total requests, sample rejection rates, patterns of abnormal results (isolated PT, isolated aPTT, combined), and clinical correlations.
  • Utilized Youden's Index to determine cutoffs associated with inherited bleeding disorders.

Main Results:

  • A total of 2808 coagulation profiles were analyzed, with a 15.7% rejection rate.
  • Among valid tests, 17.0% showed abnormal results, with 28.8% of selected patients having deranged results leading to new diagnoses.
  • Isolated aPTT > 31.4s was associated with inherited disorders (AUC > 0.8), unlike isolated PT.

Conclusions:

  • A significant number of coagulation screening samples are rejected, and some abnormal results are not followed up.
  • Most abnormal findings, especially aPTT > 33.1s, are clinically significant, impacting diagnoses and management.
  • There is a clear need to optimize the utilization of PT and aPTT testing in pediatric clinical practice.
Abstract

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