• PT: extrinsic pathway (VII)
• aPTT: intrinsic pathway (VIII, IX, XI, XII)
• TT: fibrinogen to fibrin
• Mixing study: differentiates factor deficiency from inhibitor
• X-linked recessive
• A: Factor VIII deficiency; B: Factor IX deficiency
• Haemarthroses, deep bleeding
• Prolonged aPTT, normal PT
• Rx: factor replacement
• Most common inherited bleeding disorder
• ↓ vWF → ↓ platelet adhesion & ↓ factor VIII
• Mucocutaneous bleeding, menorrhagia
• Rx: desmopressin (mild), vWF concentrate (severe)
• Trigger: sepsis, trauma, malignancy, obstetric catastrophe
• Labs: ↓ fibrinogen, ↑ D-dimer, ↓ platelets, prolonged PT/aPTT
• Rx: treat cause, FFP/cryoprecipitate, platelets if bleeding
• Affects II, VII, IX, X (extrinsic/intrinsic)
• Causes: warfarin, liver disease, malabsorption
• Prolonged PT > aPTT
• Rx: vitamin K, FFP if active bleeding
• Causes: liver disease, uraemia, anticoagulants, DIC
• Always review medications (especially anticoagulants and antiplatelets)
• Correction = factor deficiency
• No correction = inhibitor (e.g. lupus anticoagulant, acquired haemophilia)
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
