APTT(1) (activated cephalin time)
Mixing test (2)
PT (prothrombin time)
TT (thrombin time)
BT (bleeding time)
(1) APTT is increased in isolated cases; the degree of lengthening depends on the severity of factor IX deficiency and on the sensitivity of the reagent to factor IX deficiency.
(2) Lengthening of APTT may be corrected by mixing the patient's plasma in equal parts with a pool of normal plasma.
Differential diagnosis involves ruling out other causes for lengthening of APTT associated with decreased activity of factor IX.
Acquired hemophilia B is associated with the presence in non-hemophiliac subjects of antibodies directed against factor IX. This is a rare disease that can occur in particular in women during or at the end of pregnancy, in patients with autoimmune disease, and in elderly subjects.
The most common clinical sign is the presence of marked hematomas. Since the disease may be life-threatening, appropriate therapy must be given quickly.
Diagnosis involves screening for a specific inhibitor directed against factor IX using the Bethesda method or the Nijmegen method. These inhibitors are also seen more frequently (10 to 15% of patients) in hemophiliac subjects receiving replacement therapy containing factor IX, against which they are immunized due to the development of antibodies directed against factor IX.
Since the synthesis of factor IX is dependent upon vitamin K, levels of factor IX are low in the event of vitamin K deficiency or treatment with vitamin K antagonists.
In this event, the levels of other vitamin K-dependent coagulation factors (II, VII, X) are also low, as are proteins S and C.