Causes of Abnormal PT and/or aPTT Prolonged Prothrombin Time (PT) 1. Acquired deficiency of FVII a. Early warfarin therapy b. Early vitamin K deficiency c. Early liver disease 2. Drugs a. Direct Xa inhibitors - Rivaroxaban, apixaban, edoxaban (typically prolong aPTT) 3. Congenital deficiency of FVII 4. Specific inhibitors to FVII (exceptionally rare) Prolonged Activated Partial Thromboplastin Time (aPTT) 1. Therapeutic unfractionated heparin - Other anticoagulants may prolong the aPTT alone but typically prolong PT too 2. Nonspecific inhibitors e.g. antiphospholipid antibodies 3. Congenital intrinsic coagulation factors deficiencies: Contact pathway factors (prekallikrein, kallikrein, HMWK), FXII, FXI, FIX, FVIII 4. Specific inhibitors to one factor e.g. FVIII antibody Prolonged PT and aPTT 1. Pre-analytical cause e.g. heparin contamination, under filling of tube 2. Drugs a. Direct or indirect inhibitory drugs e.g. direct thrombin inhibitors, heparin b. Supratherapeutic warfarin effect - FII, FVII, FIX, FX < 30% 3. Inhibitors a. Nonspecific inhibitor e.g. antiphospholipid antibodies b. Specific inhibitors to the common pathways (rare) 4. Decreased factor synthesis a. Congenital deficiency b. Reduced liver synthesis - Impaired production Fll, FV, FVII, FIX, FX, FXI, FXII, FXIII, dysfibrinogenemia c. Severe vitamin K deficiency ( decreased Fll, FVII, FIX, FX). 5. Factor consumption or binding a. Massive hemorrhage b. Disseminated intravascular coagulation (DIC) c. Factor X deficiency associated with systemic amyloidosis - Jorge Cortés @Jcortesizaguirr #Abnormal #PT #aPTT #Prolonged #Causes #diagnosis #differential #hematology #coagulation

Secondary causes of Hypertension • Medications, Drugs, Chemo: NSAIDS, Steroids, CNI, Alcohol, Cocaine, OCP, Licorice, MAOI, Anti VEGF agents, TKI, Pseudoephedrine • Primary Renal Disease • Pheochromocvtoma • Renovascular • Primary Hyperaldosternism (low renin HTN) • Pseudopheochromocytoma - respond to SSRIs • Coarctation of Aorta • Other Endocrine causes: Thyroid disease, Hyperparathyroidism, Acromegaly, Renin producing tumor • Other low renin HTN causes: Cushing's Syndrome, 11B hydroxylase def, 17alpha hydroxylase def, Deoxycorticosterone tumor, Chrouros syndrome, Geller syndrome, Gordon syndrome, Liddle syndrome, Apparent minerolocorticoid excess • Obstructive Sleep Apnea - Dr. Kenar Jhaveri @kdjhaveri #Secondary #causes #Hypertension #differential #diagnosis