Phenotyping the clotting system

Abstract

The combined research efforts in our field over the last hundred years made that we now recognise dozens of plasma proteins with a function in the clotting system and a set of platelet components that is of the same order. Progress in molecular biology is such as to have identified some one hundred genes that may influence haemostasis and thrombosis and a new one comes about every month. Nevertheless the phenotype of the clotting system cannot be adequately established. There is no simple method that gives us a clear picture of the net result of the activity of all those genes, together with non-genetic influences (e.g. drugs), on the over-all clotting function of blood at a given moment. For over a century we make do with clotting times that we know to be marginally – if at all – sensitive to hypercoagulability and mild bleeding disorders. We are used to employing different variants for the control of oral anticoagulants and of heparin. Some anticoagulants do not significantly influence any type of clotting time and for convenienc