Prolonged APTT in Children: What Parents Should Know

Blood disorders / Prolonged APTT (Activated Partial Thromboplastin Time)

Hello Doctor, my son is 7 years old.
In October 2019, he had a fever due to influenza, and later developed some red spots on his hands.
The clinic doctor suggested that it would be best to check his coagulation function, so we immediately went to the hospital's emergency department for a blood test.
His platelet count and PT time were normal, but his APTT was prolonged (normal: 0-31, test result: 38.7).
The emergency doctor said that a slight prolongation due to fever is normal.
Later, in March 2020, we went to a laboratory for testing, and both the platelet count and coagulation function were normal (APTT normal: 23.9-35.5, test result: 32.5).
Last week, because my son occasionally had small red spots on his face and frequently had bruises on his knees, we visited the pediatric hematology department to follow up on his coagulation function (complete blood count, APTT, PT, platelet function, and ANA).
Today, the doctor reported that everything was normal, but the APTT time was slightly prolonged (normal: 24-31, test result: 36.5).
He believes it should be fine and suggested a follow-up in three months, along with testing for von Willebrand factor (VWF) and lupus anticoagulant (LA) to rule out conditions similar to hemophilia.
He thinks that the platelet function is normal, so there should not be any issues with VWF.
Additionally, the ANA was negative, making autoimmune diseases less likely to interfere.

Could you please explain why the doctor believes there is no significant issue with the prolonged APTT time? Is there a possibility that my child has hemophilia or a condition similar to hemophilia? Are there any other conditions we should be aware of? Thank you, Doctor!

Xiao Wu, 40~49 year old female. Ask Date: 2021/03/18

Dr. Xiao Kaiwen reply Pediatrics

Hemophilia is a congenital disorder, so issues with coagulation function should be evident after birth, such as skin petechiae, easy bruising, frequent nosebleeds, and joint bleeding leading to swelling and deformity.
Additionally, activated partial thromboplastin time (APTT) is typically significantly prolonged.
Therefore, your child is unlikely to have hemophilia.
As for acquired coagulation issues related to autoimmune diseases or conditions resembling hemophilia, these tend to worsen over time.
However, your child's coagulation function has not been deteriorating, and the APTT has not significantly worsened or prolonged.
Disorders associated with coagulation issues are generally quite rare, and the likelihood is indeed low.
It would be advisable to continue monitoring your child in the pediatric hematology outpatient clinic.

Reply Date: 2021/03/18

More Info

Understanding prolonged activated partial thromboplastin time (APTT) in children can be a source of concern for parents, especially when it comes to the implications for their child's health. In your case, your 7-year-old son has shown a pattern of prolonged APTT readings, which can be indicative of various underlying conditions. However, it is essential to interpret these results in the context of his overall health and any accompanying symptoms.

APTT is a blood test that measures the time it takes for blood to clot. It is particularly sensitive to deficiencies in certain clotting factors, which can be caused by various conditions, including genetic disorders, liver disease, and the presence of inhibitors. APTT can be prolonged due to several factors, including:
1. Infection or Inflammation: As noted by the emergency physician, a transient increase in APTT can occur during acute illnesses, such as infections. This is often temporary and resolves as the child recovers.

2. Genetic Conditions: Conditions such as von Willebrand disease (VWD) or hemophilia can lead to prolonged APTT. However, your child's normal platelet count and the absence of significant bleeding symptoms make these conditions less likely.

3. Autoimmune Disorders: Conditions that affect the immune system can also impact clotting factors. The negative ANA (antinuclear antibody) test is reassuring, as it suggests that an autoimmune process is less likely.

4. Vitamin Deficiencies: Deficiencies in vitamin K can lead to prolonged APTT, as vitamin K is essential for the synthesis of certain clotting factors. However, this is less common in children with a balanced diet.

Given that your child's APTT has been slightly prolonged but has normalized in some tests, it is crucial to consider the following:
- Monitoring: The recommendation to follow up in three months is standard practice. It allows for monitoring any changes in APTT and assessing whether the prolongation persists or resolves.

- Symptoms: Pay attention to any symptoms such as unusual bruising, prolonged bleeding from cuts, or other signs of bleeding disorders. If these symptoms occur, it is essential to seek medical attention promptly.

- Family History: If there is a family history of bleeding disorders, this may warrant further investigation.

- Consultation with Specialists: If concerns persist, a consultation with a pediatric hematologist may provide additional insights and reassurance. They can conduct more specialized tests if necessary.

In conclusion, while prolonged APTT can be concerning, it is essential to interpret these results in the context of your child's overall health and symptoms. The fact that other tests have returned normal and that your child is not exhibiting significant bleeding issues is reassuring. Regular follow-up and monitoring will help ensure that any potential issues are addressed promptly. Always feel free to discuss any concerns with your healthcare provider, as they can provide personalized advice based on your child's specific situation.

Similar Q&A

Understanding OCD in Teens: Symptoms, Treatment, and Parental Guidance

Dear Doctor: My 13-year-old child has Tourette syndrome and has been taking half a tablet of Aripiprazole. She has been experiencing health anxiety, and recently her obsessive thoughts have intensified. She believes she has a certain illness and is very paranoid, even though test...

Dr. Liang Sunyuan reply Psychiatry
Hello Fifi: Medication treatment typically takes six to eight weeks to achieve optimal effects. The current medication is not harmful with long-term use. In addition to medication, cognitive behavioral therapy can also be beneficial. It is advisable to discuss related resources w...

Understanding Chronic ITP and Prolonged Lymphadenopathy in Children

Hello, doctor. My three-year-old family member has been diagnosed with chronic ITP. They used a medication called Eltrombopag at the end of last year, and have just stopped taking steroids. They are currently taking 12 mg of Eltrombopag daily. About two months ago, we noticed bil...

Dr. Pei Rensheng reply Pediatrics
Hello: 1. Chronic ITP is defined as lasting more than one year, and a bone marrow biopsy may be considered. 2. The causes of lymphadenopathy include infections, tumors, and congenital developmental remnants, which may persist for several months and could still be due to an infect...

Managing Epilepsy in Autistic Children: Medication Concerns and Solutions

Dear Dr. Tsai, I have a child with autism who suffers from epilepsy. He has been taking Apo-Divalproex (250mg & 500mg) for two years and seven months without any recurrence of seizures. However, since starting this medication, he has changed significantly; he stays indoors a...

Dr. Cai Zongzhang reply Neurology
Hello Mr. Yeh: It is recommended to discuss medication with the prescribing physician and not to discontinue the medication on your own.

Understanding OTC Deficiency: Causes of Seizures in Infants and When to Seek Help

Hello Doctor, my young son is nearly five months old (born on November 4, 2004) and is a patient with OTC deficiency. He has experienced seizures both at birth and recently. I would like to ask whether these phenomena are caused by the following factors or if there are other reas...

Dr. Jian Yingxiu reply Rare Disease
Patients with OTC deficiency are prone to elevated blood ammonia levels during colds or when receiving vaccinations, which can lead to symptoms such as increased crying, vomiting, and even lethargy. Your baby's condition may be related to the cold medication, but the possibi...