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 ( ISSN: 2814-2098 )                                                                                                                Chinedu-Madu Jane U 
1
*  

https://ijojournals.com/                                                                                             Volume 08 || Issue 04 || April, 2025 || 

“STUDIES ON ACTIVATED PARTIAL THROMBOPLASTIN TIME, RED AND WHITE BLOOD CELL COUNTS IN CORONARY ARTERY DISEASE IN OWERRI, NIGERIA.." 

 
 

 

STUDIES ON ACTIVATED PARTIAL THROMBOPLASTIN TIME, RED AND WHITE 

BLOOD CELL COUNTS IN CORONARY ARTERY DISEASE IN OWERRI, NIGERIA. 

Chinedu-Madu Jane U1,  Onyejiawa Favour C.2,  and  Aloy-Amadi Oluchi C3. 

1Department of Haematology, Federal University Otueke, Bayelsa State, Nigeria. 

2, 3 Department of Medical Laboratory Science, Imo State University, Owerri, Nigeria. 

Corresponding Author: Chinedu-Madu Jane U.  

ABSTRACT 

Background: Coronary artery disease (CAD) is a multifactorial condition influenced by 

cardiovascular,  hematological and haemostatic factors. The knowledge of these parameters in 

CAD patients, including gender-based differences, is essential for personalized diagnosis and 

treatment. 

Objective: To investigate red cell indices and aspartate aminotransferase in CAD patients  

Federal Teaching Hospital, Owerri, Nigeria, and assess gender-based variations. 

Methods: A cross-sectional study was conducted involving 30 CAD patients (19 males and 11 

females) and 30 age-matched healthy controls. A total of 5 mL of venous blood was collected 

from each participant, with 3 mL placed in EDTA tubes for hematological analysis and 2 mls 

into sodium citrate containers for APTT determination..Haematological parameters were 

assessed using an automated hematology analyzer, while APTT was determined using a standard 

coagulometer and commercial reagents according to the manufacturer’s instructions. 

. Statistical analysis was conducted using independent t-tests to compare group differences and 

Pearson correlation for association studies, with p < 0.05 considered statistically significant. 

Results: CAD patients showed significantly higher mean activated partial thromboplastin time 

(APTT: 41.23 ± 4.09 )secsand white blood cell (WBC) count (15.23 ± 2.1) × 10 /L compared to 

controls (APTT: 28.30 ± 2.17)secs; WBC: (7.00 ± 1.68) × 10 /L with p-values of 0.002 and 

<0.001, respectively. Red blood cell (RBC) count was significantly lower in CAD patients (2.07 

± 0.35 )× 10¹²/L) compared to controls (4.01 ± 0.27 )× 10¹²/L. Among CAD patients, males had 

significantly higher APTT values (65.30 ± 14.48) secs than females (48.60 ± 8.95) secs(p = 

0.035). No significant gender differences were observed in RBC and WBC counts. Correlation 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                                                Chinedu-Madu Jane U 
1
*  

https://ijojournals.com/                                                                                             Volume 08 || Issue 04 || April, 2025 || 

“STUDIES ON ACTIVATED PARTIAL THROMBOPLASTIN TIME, RED AND WHITE BLOOD CELL COUNTS IN CORONARY ARTERY DISEASE IN OWERRI, NIGERIA.." 

 
 

 

analysis revealed insignificant negative correlations of APTT with RBC (r = -0.025, p = 0.897), 

and WBC(r = -0.038, p = 0.843).  

Conclusion: CAD patients in Owerri exhibit significant hematological abnormalities, including 

elevated APTT and WBC levels and reduced RBC counts. Although gender-related variations 

were observed in APTT, no significant correlations among APTT, RBC, and WBC suggest 

independent pathological mechanisms. Comprehensive hematological assessments should be 

incorporated into CAD management protocols. Further studies arewarranted to explore the 

underlying mechanisms of these hematological changes. 

Key words: Activted Partial Thromboplastin Time, Red Blood Cell, White Blood Cell, 

Coronary Artery Disease. 

 

1. INTRODUCTION 

 

Coronary artery disease (CAD) is one of the foremost causes of morbidity and mortality 

globally, particularly in low- and middle-income countries where risk factor control is 

often suboptimal [1]. Although the classical risk factors such as hypertension, diabetes 

mellitus, dyslipidemia, smoking, and sedentary lifestyle are well established, growing 

evidence suggests that hematological and haemostatic parameters significantly influence 

the pathogenesis and prognosis of CAD [2]. 

Activated Partial Thromboplastin Time (APTT) assesses the intrinsic and common 

coagulation pathways and can reflect hypercoagulable or hypocoagulable states 

depending on the context [3]. In CAD, alterations in coagulation markers may signal 

endothelial dysfunction or thrombosis risk. Additionally, elevated white blood cell 

(WBC) count is a known marker of systemic inflammation and has been associated with 

plaque instability and adverse cardiac events [4]. Conversely, reduced red blood cell 

(RBC) count may impair oxygen delivery to ischemic myocardial tissue, exacerbating 

tissue damage [5] 

 

Gender-based differences in hematological and coagulation profiles in CAD patients have 

also been reported. Females may exhibit elevated coagulation markers and inflammatory 

indices compared to males, potentially influencing disease progression and therapeutic 

outcomes [6]. These gender-based disparities warrant investigation in specific 

populations, including Nigerians, where there is a paucity of localized data. This study 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                                                Chinedu-Madu Jane U 
1
*  

https://ijojournals.com/                                                                                             Volume 08 || Issue 04 || April, 2025 || 

“STUDIES ON ACTIVATED PARTIAL THROMBOPLASTIN TIME, RED AND WHITE BLOOD CELL COUNTS IN CORONARY ARTERY DISEASE IN OWERRI, NIGERIA.." 

 
 

 

aims to evaluate the levels of APTT, RBC, and WBC in CAD patients in Owerri, Nigeria, 

and to assess gender-based differences in these parameters 

 

 

.2. MATERIALS AND METHODS 

2.1 Study Area 

The study was conducted at  Federal University Teaching Hospital, Owerri, Nigeria.  

2.2 Study Design 

This study employed a cross-sectional analytical design to investigate selected hematological and 

haemostatic parameters—namely Activated Partial Thromboplastin Time (APTT), Red Blood 

Cell (RBC) count, and White Blood Cell (WBC) count—in patients diagnosed with coronary 

artery disease (CAD) compared to healthy age-matched controls. 

2.3Method of Recruitment 

A total of 60 participants were recruited for the study. Thirty (30) patients diagnosed with 

coronary artery disease (19 males and 11 females) were selected from the Cardiology Unit of a 

tertiary hospital in Owerri, Nigeria. Thirty (30) age- and sex-matched apparently healthy 

individuals without a history of cardiovascular disease served as the control group. Participants 

were recruited using purposive sampling based on inclusion and exclusion criteria. Inclusion 

criteria for CAD patients included clinical diagnosis of CAD confirmed by a cardiologist. 

Individuals with other comorbid conditions such as diabetes, malignancies, or hematological 

disorders were excluded. 

2.4 Ethical Approval 

Ethical approval for the study was obtained from the Ethics and Research Committee of the 

[Name of Hospital or Institution] (approval number: [insert number]). Informed consent was 

obtained from all participants prior to sample collection. Confidentiality and anonymity were 

maintained throughout the study. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                                                Chinedu-Madu Jane U 
1
*  

https://ijojournals.com/                                                                                             Volume 08 || Issue 04 || April, 2025 || 

“STUDIES ON ACTIVATED PARTIAL THROMBOPLASTIN TIME, RED AND WHITE BLOOD CELL COUNTS IN CORONARY ARTERY DISEASE IN OWERRI, NIGERIA.." 

 
 

 

2.5 Laboratory Analysis 

Venous blood samples (5 mL) were collected aseptically from each participant. Three milliliters 

(3 mL) of the blood were dispensed into ethylenediaminetetraacetic acid (EDTA) tubes for 

hematological analysis. The remaining 2 mL was used for haemostatic analysis. Hematological 

parameters, including RBC and WBC counts, were measured using a fully automated 

hematology analyzer. APTT was determined using a standard coagulometer and commercial 

reagents according to the manufacturer’s instructions. 

2.6 Statistical Analysis 

Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version [insert 

version, e.g., 25.0]. Results were expressed as mean ± standard deviation (SD). Independent 

sample t-tests were used to compare the mean values between CAD patients and controls, as well 

as between male and female subgroups. Pearson correlation was used to determine the 

relationship between APTT, RBC, and WBC. A p-value < 0.05 was considered statistically 

significant. 

3.RESULTS 

 

Table 1 Mean Values of APTT, Red Blood Cell and White Blood Cell Counts in Patients 

with Coronary Artery Disease and Healthy Subjects (Mean ± S.D) 

Table 1 shows the mean levels of APTT. Red Blood Cell and White Blood Cell Counts in 

Patients with Coronary Artery Disease and Healthy Subjects  

The mean values of APTT (41.23± 4.09)secs and WBC (15.23± 2.1) x 109 /L in patients with 

coronary heart disease were significantly raised when compared to that of the controls (28.30± 

2.17)secs and (7.00± 1.68) x 109 /L respectively (t= 20.01, p= 0.002 and t=59.58, p= < 0.001) 

On the other hand, the mean values of RBC (2.07± 0.35) x 1012 /L in patients with coronary heart 

disease were significantly reduced when compared to that of the controls (4.01± 0.27) x 1012 /L(t 

= 5.66, p =<0.001) 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                                                Chinedu-Madu Jane U 
1
*  

https://ijojournals.com/                                                                                             Volume 08 || Issue 04 || April, 2025 || 

“STUDIES ON ACTIVATED PARTIAL THROMBOPLASTIN TIME, RED AND WHITE BLOOD CELL COUNTS IN CORONARY ARTERY DISEASE IN OWERRI, NIGERIA.." 

 
 

 

 

Parameters No Test 

(n=30) 

Control  

(n=30) 

t-value P value 

      

APTT (Secs) 30 41.23± 4.09 28.3 ± 2.17 20.01 0.002*. 

RBC (1012 /L) 30 2.07±0.35 4.09 ±0.27 -5.66. < 0.001*, 

WBC (109/L) 30 15.33± 2.15 7.0 ± 1.68 59.58 0.001* 

 

Key: 

S.D- Standard Deviation 

*- Significant p value 

APTT- Activated Partial Thromboplastin Time 

RBC- Red Blood Cell 

WBC- White Blood Cell 

 

Table 2: Comparison of Levels of APTT, Red Blood Cell and White Blood Cell Counts in 

Male and Female Patients with Coronary Artery Disease  

Table .2 shows the mean values of APTT, Red Blood Cell and White Blood Cell Counts in Male 

and Female Patients with Coronary Artery Disease. 

The mean values of APTT (65.30± 14.48)secs in male patients with coronary heart disease was 

significantly increased when compared to female patients with coronary heart disease (48.60± 

8.95)secs (t= 3.880, p= 0.035) 

The mean values of RBC (2.36± 0.32) x 1012 /L in male patients with coronary heart disease was 

insignificantly increased when compared to female patients with coronary heart disease (1.92± 

0.22) x 1012 /L (t= 1.827, p= 0.076) 

The mean values of WBC (13.95± 2.20) x 109 /L in male patients with coronary heart disease 

was insignificantly reduced when compared to female patients with coronary heart disease 

(16.60± 5.68) x 1012 /L (t= -1.421, p= 0.167) 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                                                Chinedu-Madu Jane U 
1
*  

https://ijojournals.com/                                                                                             Volume 08 || Issue 04 || April, 2025 || 

“STUDIES ON ACTIVATED PARTIAL THROMBOPLASTIN TIME, RED AND WHITE BLOOD CELL COUNTS IN CORONARY ARTERY DISEASE IN OWERRI, NIGERIA.." 

 
 

 

Parameters No Male 

(n=19) 

Female 

(n=11) 

t-value P value 

      

APTT (Secs) 30 65.3± 14.48 48.6± 8.95 3.88 0.035*. 

RBC (1012 /L) 30 2.36±0.32 1.92±0.22 1.83 0.076 

WBC (109/L) 30 13.95± 2.2 16.6± 5.68 −1.421 0.167 

 

Key: 

S.D- Standard Deviation 

*- Significant p value 

APTT- Activated Partial Thromboplastin Time 

RBC- Red Blood Cell 

WBC- White Blood Cell 

Table 3: Correlation of APTT with Red Blood Cell and White Blood Cell Counts in Patients 

with Coronary Artery Disease 

 

Table 3 showed the Correlation ofAPTT with Red Blood Cell and White Blood Cell Counts in 

patients with Coronary Artery Disease 

There was a non- significant negative correlation of APTT with Red Blood Cell (r= -0.025, 

p=0.897) among Patients with Coronary Artery Disease, and a non- significant negative 

correlation with White Blood Cell (r= -0.038, p=0.843) among patients with Coronary Artery 

Disease 

 

 

 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                                                Chinedu-Madu Jane U 
1
*  

https://ijojournals.com/                                                                                             Volume 08 || Issue 04 || April, 2025 || 

“STUDIES ON ACTIVATED PARTIAL THROMBOPLASTIN TIME, RED AND WHITE BLOOD CELL COUNTS IN CORONARY ARTERY DISEASE IN OWERRI, NIGERIA.." 

 
 

 

Parameters  N R p-value 

    

Red Blood Cell 30 -0.025 0.897 

White blood cells 30 -0.038 0.843 

 

 

4. DISCUSSION 

This study observed that APTT and WBC counts were significantly elevated in CAD patients 

when compared to controls, while RBC counts were significantly reduced. These findings 

suggest a concurrent state of inflammation and potential coagulopathy in CAD, consistent with 

prior literature [3,4]. 

Elevated APTT in CAD patients may reflect an adaptive response to chronic endothelial damage 

or a prothrombotic state that is being compensated for by anticoagulant factors [7]. Similar 

findings were reported by Anvari et al., who observed a prolonged APTT in CAD patients and 

linked it to altered coagulation dynamics and increased cardiovascular risk [3]. Furthermore, the 

significantly higher APTT observed in male patients compared to females aligns with studies 

that suggest gender-based physiological differences in coagulation response and factor levels 

[6,8]. 

The elevated WBC count seen in CAD patients corroborates with earlier reports that 

leukocytosis serves as a biomarker for inflammation and is associated with the development and 

progression of atherosclerosis [4,9]. A study by Madjid et al. also established that higher 

leukocyte counts were linked to increased coronary heart disease risk and adverse outcomes 

[10].On the other hand, reduced RBC levels in CAD patients, although sometimes overlooked, 

can aggravate myocardial ischemia by impairing oxygen delivery [5]. Anemia has previously 

been associated with poor prognosis in CAD, particularly in elderly and female patients [11] 

Interestingly, while APTT was significantly higher in males, WBC was insignificantly lower, 

and RBC insignificantly higher compared to females. These gender variations are similar to 

those noted in a study by Pradhan et al., who reported sex differences in inflammatory and 

coagulation profiles among cardiovascular patients [6]. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                                                Chinedu-Madu Jane U 
1
*  

https://ijojournals.com/                                                                                             Volume 08 || Issue 04 || April, 2025 || 

“STUDIES ON ACTIVATED PARTIAL THROMBOPLASTIN TIME, RED AND WHITE BLOOD CELL COUNTS IN CORONARY ARTERY DISEASE IN OWERRI, NIGERIA.." 

 
 

 

Correlation analysis in this study did not show a significant relationship between APTT, RBC, 

and WBC, indicating that these parameters may contribute independently to CAD 

pathophysiology. This independence reflects the multifactorial nature of CAD, where 

inflammation, anemia, and coagulopathy may all simultaneously affect patient outcomes [12]. 

In summary, the findings support previous evidence of hematological disturbances in CAD and 

suggest the need for routine hematologic assessments in CAD management. Further large-scale 

studies are necessary to explore these associations and validate their prognostic significance. 

5. CONCLUSION 

In conclusion, the study's findings highlight significant hematological and haemostatic 

alterations in CAD patients, with notable gender-based differences. These insights underscore 

the importance of incorporating hematological assessments into the clinical management of CAD 

and suggest avenues for personalized therapeutic strategies. Further research is warranted to 

elucidate the mechanisms underlying these alterations and their implications for CAD prognosis 

and treatment. 

REFERENCES 

1. Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk 

factors, 1990–2019: update from the GBD 2019 study. J Am CollCardiol. 2020;76(25):2982–

3021. 

2. Singh RB, Mengi SA, Xu YJ, Arneja AS, Dhalla NS. Pathogenesis of atherosclerosis: a 

multifactorial process. ExpClinCardiol. 2002;7(1):40–53. 

3. SotoudehAnvari M, Tavakoli M, Lotfi-Tokaldany M, et al. Coronary artery disease 

presentation and its association with shortened activated partial thromboplastin time. J Tehran 

Heart Cent. 2018;13(1):1–5. 

4. Cannon CP, McCabe CH, Wilcox RG, et al. Association of white blood cell count with 

increased mortality in acute myocardial infarction and unstable angina pectoris. Am J Cardiol. 

2001;87(5):636–639. 

5. Sabatine MS, Morrow DA, Giugliano RP, et al. Association of hemoglobin levels with clinical 

outcomes in acute coronary syndromes. Circulation. 2005;111(16):2042–2049. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                                                Chinedu-Madu Jane U 
1
*  

https://ijojournals.com/                                                                                             Volume 08 || Issue 04 || April, 2025 || 

“STUDIES ON ACTIVATED PARTIAL THROMBOPLASTIN TIME, RED AND WHITE BLOOD CELL COUNTS IN CORONARY ARTERY DISEASE IN OWERRI, NIGERIA.." 

 
 

 

6. Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, 

and risk of developing type 2 diabetes mellitus. JAMA. 2001;286(3):327–334. 

7. Sharma R, Goyal A, Sinha M, et al. Coagulation profile in patients of ischemic heart disease 

with reference to activated partial thromboplastin time. Int J Adv Med. 2018;5(3):612–615. 

8. Cushman M, Glynn RJ, Goldhaber SZ, et al. Hormone replacement therapy and risk of venous 

thromboembolism in postmenopausal women. JAMA. 2004;292(13):1573–158, 

9. Libby P. Inflammation in atherosclerosis.Nature. 2002;420(6917):868–874. 

10. Madjid M, Awan I, Willerson JT, Casscells SW. Leukocyte count and coronary heart 

disease: implications for risk assessment. J Am CollCardiol. 2004;44(10):1945–1956. 

11. Sharma R, Francis DP, Pitt B, Poole-Wilson PA, Coats AJ, Anker SD. Haemoglobin predicts 

survival in patients with chronic heart failure: a substudy of the ELITE II trial. EurHeart J. 

2004;25(12):1021–1028. 

12. Packard RR, Libby P. Inflammation in atherosclerosis: from vascular biology to biomarker 

discovery and risk prediction. Clin Chem. 2008;54(1):24–38. 

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	2.5 Laboratory Analysis
	Venous blood samples (5 mL) were collected aseptically from each participant. Three milliliters (3 mL) of the blood weredispensed into ethylenediaminetetraacetic acid (EDTA) tubes for hematological analysis. The remaining 2 mL was used for haemostatic analysis. Hematological parameters, including RBC and WBC counts, were measured using a fully automated hematology analyzer. APTT was determined using a standard coagulometer and commercial reagents according to the manufacturer’s instructions.
	2.6 Statistical Analysis
	Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version [insert version, e.g., 25.0]. Reults were expressed as mean ± standard deviation (SD). Independent sample t-tests were used to compare the mean values between CAD patients and controls, as well as between male and female subgroups. Pearson correlation was used to determine the relationship between APTT, RBC, and WBC. A p-value < 0.05 was considered statistically significant.
	3.RESULTS

