Post on 23-Jul-2020
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Haemorrhagic Screening TestHaemorrhagic Screening Test
THE INTERPRETATION
PLATELET NUMBER (FBC) NPLATELET NUMBER (FBC)
BLEEDING TIME N
TORNIQUET TEST
P.T N
A.P.T.T N
NT.T N
BLOOD VESSEL FRAGILITYDISORDERS
EXAMPLE OF BLOOD VESSEL FRAGILITY IS:
PLATELET NUMBER (FBC) LOWPLATELET NUMBER (FBC)
BLEEDING TIME
TORNIQUET TEST
P.T N
A.P.T.T N
NT.T N
THROMBOCYTOPAENIATHROMBOCYTOPAENIA
IMMUNE THROMBOCYTOPAENIC PURPURAIMMUNE THROMBOCYTOPAENIC PURPURA
PLATELET NUMBER (FBC) NPLATELET NUMBER (FBC)
BLEEDING TIME
TORNIQUET TEST
P.T N
A.P.T.T N
NT.T N
PLATELET FUNCTION DISORDERS
Continue the investigationContinue the investigation• For possible bridging deficiency; vWF:AgFor possible bridging deficiency; vWF:Ag
Bernard Soulier Disease
Membrane Glanzman Thrombosathenia
Platelet factor-3 deficiency
• Platelet Hermansky-Pudlak
Storage Wiskot-Aldrich
Pool Chediak-Higashi
Intracellularα-granule Gray Platelet Syndrome
PLATELET FUNCTION DISORDERPLATELET FUNCTION DISORDER
Basic Principle ofpvon Willebrand’s Factor Test
• FUNCTIONAL TEST• Ristocetin co-factor assay dg Plt aggregometer
• ANTIGEN TEST (immunoassay)• Radioimmunoassay (RIA)• Enzyme-linked immunoassay (ELISA)
AGGREGATION OF PLATELETAGGREGATION OF PLATELET
IS MEASURED AFTER ADDING
THE PLATELET AGONISTS
SUH AS
ATPEPINEPHRINSEROTONINRISTOCETIN
Bernard Soulier DiseaseBernard Soulier Disease
• Inherited: autosomal recessiveInherited: autosomal recessive• Deficiency of the GPIb/IX
Bl di i t t d i th• Bleeding in severe case starts during the first weeks or moths of life
• In milder form in female when menarche starts
• Giant platelets
Diagnosis Bernard SoulierDiagnosis Bernard Soulier
• Can not be distinguished by clinicalCan not be distinguished by clinical grounds alone
• Confirmatory: platelet aggregometer• Confirmatory: platelet aggregometer ---defective aggregation by ristocetin can not be corrected with normal plasma butbe corrected with normal plasma, but normal with ADP
PLATELET NUMBER (FBC) NPLATELET NUMBER (FBC)
BLEEDING TIME N
TORNIQUET TEST N
P.T
A.P.T.T N
NT.T N
DISORDERS IN THE EXTRINSIC PATHWAYOFEXTRINSIC PATHWAYOF
COAGULATION
INHERITED FVII DEFICIENCY COAGULATION (UNCOMMON)COAGULATION (UNCOMMON) DISORDERS
CONTINUE THE INVESTIGATION
EFFECT OFDRUG TREATMENT WARFARIN
WARFARIN AS THE CAUSE OFWARFARIN AS THE CAUSE OF EXTRINSIC COAGULATION PATHWAY DISORDER
PLATELET NUMBER (FBC) NPLATELET NUMBER (FBC)
BLEEDING TIME N
TORNIQUET TEST N
P.T N
A.P.T.T
NT.T N
DISORDERS IN THE INTRINSIC PATHWAY OF COAGULATION
INHERITED FXII, FXI, CONTACT PHASE
COAGULATION DEFICIENCY (UNCOMMON)COAGULATION DEFICIENCY (UNCOMMON)
DISORDERS FVIII, FIX DEFICIENCY (MORE COMMON)
CONTINUE THE INVESTIGATION
EFFECT OFDRUG TREATMENT HEPARIN
HAEMARTHROSIS IN HAEMOPHILIAC
DO THE ASSAY FOR FACTOR VIII OR FACTOR IX OF THE COAGULATION
HEPARIN AS THE CAUSE OFTHE INTRINSIC COAGULATION PATHWAY DISORDER
PLATELET NUMBER (FBC) NPLATELET NUMBER (FBC)
BLEEDING TIME N
TORNIQUET TEST N
P.T N
A.P.T.T N
T.T
DISORDERS IN THE FINAL COMMON PATHWAY OFCOMMON PATHWAY OF
COAGULATION
COAGULATION HYPOFIBRINOGENEMIA DEFICIENCY (USUALLY ACQUIRED)DEFICIENCY (USUALLY ACQUIRED)
CONTINUE THE INVESTIGATION
EFFECT OFDRUG TREATMENT STREPTOKINASE
PLATELET NUMBER (FBC) LOW PLATELET NUMBER (FBC)
BLEEDING TIME
TORNIQUET TEST
P.T
A.P.T.T
T.T
DISORDER OF ALL SYSTEMDISORDER OF ALL SYSTEMCONSUMPTIVE
COAGULOPATHY
DISSEMINATED INTRAVASCULARINTRAVASCULAR COAGULATION
Sudden and Life-threateningDISSEMINATED INTRAVASCULAR COAGULATION
D-dimerD dimer
• To detect action of fibrinolysis (plasminTo detect action of fibrinolysis (plasmin digestion of X-linked fibrin)
• To show that X linked Fibrin has been• To show that X-linked Fibrin has been generated.Thi ll h id f D I C• This all shows evidence of D.I.C (Disseminated Intravasculkar Coagulation)
FXIII FXIIIa
THROMBIN
Fibrinogen Fibrin Fibrin X-linkedMonomer Polymer Fibriny
PLASMINOGEN PLASMIN
t-PA
D-dimer test by ICT technique (qualitative)
D-dimer by chomogenic assay (quantitative) in ng/ml
Diagnosis of D I CDiagnosis of D.I.C
• Clinical groundsClinical grounds• Laboratory: prolonged PT, APTT, TT,
C fi t t t i f D di• Confirmatory test: increase of D-dimer > 500 ng/ml or > 1.000 ng/ml in operative case
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