{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:06:32Z","timestamp":1784117192186,"version":"3.55.0"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006537","name":"Vanderbilt University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006537","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prekallikrein (PK) deficiency is a rare contact factor deficiency that can markedly prolong the activated partial thromboplastin time (aPTT) without a bleeding phenotype. Because viscoelastic hemostatic assays also rely on contact activation, their behavior in severe PK deficiency is relevant to perioperative evaluation of isolated aPTT prolongation. We describe thromboelastography (TEG) 6s findings in a patient with severe PK deficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods<\/jats:title>\n                    <jats:p>A 59\u2010year\u2010old woman without a bleeding history was evaluated for an isolated prolonged aPTT identified during preoperative testing. Studies included prothrombin time (PT), thrombin time, an anti\u2010factor Xa assay, aPTT mixing studies including with PK\u2010deficient plasma, and factor VIII, IX, XI, and XII activities. PK antigen was assessed by western immunoblotting. Whole blood viscoelastic testing was performed on a TEG 6s analyzer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patient had a markedly prolonged aPTT (87.4\u2009s, reference range [RR]: 24.5\u201334.0\u2009s) with normal PT, thrombin time, and a negative anti\u2010factor Xa assay. The aPTT corrected on mixing with normal pooled plasma but not with PK\u2010deficient plasma. Factor VIII, IX, XI, and XII activities were normal or modestly elevated. Western immunoblotting showed absent PK antigen, establishing cross\u2010reactive material\u2010negative PK deficiency. Despite the prolonged aPTT, TEG 6s parameters were normal, including the citrated kaolin R time (4.6\u2009min, RR: 4.6\u20139.1\u2009min). The patient underwent surgery without hemostatic complications or transfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Severe PK deficiency may markedly prolong the plasma\u2010based aPTT without parallel abnormalities on TEG 6s, highlighting assay\u2010specific differences in sensitivity to PK deficiency.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.70327","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T11:05:56Z","timestamp":1784113556000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Normal thromboelastography with a markedly prolonged activated partial thromboplastin time in severe prekallikrein deficiency: Implications for perioperative hemostatic assessment"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5719-9685","authenticated-orcid":false,"given":"Jeremy W.","family":"Jacobs","sequence":"first","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Esoteric Coagulation Laboratory Vanderbilt Medical Laboratories  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Matafonov","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Esoteric Coagulation Laboratory Vanderbilt Medical Laboratories  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia G.","family":"Baxter","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Esoteric Coagulation Laboratory Vanderbilt Medical Laboratories  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiufang","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8422-9480","authenticated-orcid":false,"given":"Garrett S.","family":"Booth","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deva","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Division of Hematology\/Oncology, Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6282-9322","authenticated-orcid":false,"given":"Benjamin F.","family":"Tillman","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Esoteric Coagulation Laboratory Vanderbilt Medical Laboratories  Nashville Tennessee USA"},{"name":"Division of Hematology\/Oncology, Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8142-8014","authenticated-orcid":false,"given":"David","family":"Gailani","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Esoteric Coagulation Laboratory Vanderbilt Medical Laboratories  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.74.10.4636"},{"issue":"1","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1182\/blood.V70.1.1.1","article-title":"The coagulation\u2010kinin pathway of human plasma","volume":"70","author":"Kaplan AP","year":"1987","journal-title":"Blood"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13194"},{"issue":"10","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"3819","DOI":"10.1182\/blood.V90.10.3819","article-title":"Contact system: a vascular biology modulator with anticoagulant, profibrinolytic, antiadhesive, and proinflammatory attributes","volume":"90","author":"Colman 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