1 / 53

Marilah kita membiasakan diri menjadi manusia yang jujur.

Marilah kita membiasakan diri menjadi manusia yang jujur. Laboratory Approach to Patient with Hemostasis (Bleeding) Disorders. Dr.Nadjwa ZD, SpPK-K 16 April 2012. Hemostasis.

charis
Download Presentation

Marilah kita membiasakan diri menjadi manusia yang jujur.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Marilah kita membiasakan diri menjadi manusia yang jujur.

  2. Laboratory Approach to Patient with Hemostasis (Bleeding) Disorders Dr.Nadjwa ZD, SpPK-K 16 April 2012

  3. Hemostasis Is the complex process by which the body spontaneously stop bleeding and maintains blood in the fluid state within the vascular compartment. Normal hemostasis: rapid & localized.

  4. The major role of the hemostasis system is to maintain a complete balance of the body’s tendency toward clotting and bleeding.

  5. Hemostasis can be divided into 2 stages :

  6. Primary Hemostasis (platelet plug) Secondary Hemostasis (Hemostatic Plug)

  7. Highly integrated & regulated Hemostasis

  8. Hemostasis Disorders

  9. Approach to Hemostasis Disorders • Clinical History Taking - Physical Examination - • Laboratory

  10. Physical Examination • Petechaie • Ecchimosis • Hematom • Epistaxis • Gingival bleeding

  11. Any Questions ???

  12. Hemostasis Test

  13. Hemostasis Tests Screening assays in hemostasis: • Patients without any signs/symptoms  preoperative • Monitoring of anticoagulant therapy • Disseminated Intravascular Coagulation • Thrombophilia • Inhibitor (Lupus Anticoagulant, Anti Phospholipid Antibody)

  14. Tourniquet Test Bleeding Time Clotting Time Clot Retraction Platelet Count* PT* APTT* TT* Fibrinogen* Euglobulin Clot Lysis Test D-Dimer Thrombelastography Hemostasis Screening Test

  15. Single, comprehensive hemostasis screening test Thrombelas- tography

  16. Tourniquete Test = Capillary Resistance Test. = Rumpel Leede Test = Hess’s Test Principle : This test measures the ability of the capillaries to resist pressure. In healthy individu, the capillaries in the arm will resist a pressure of 100 mmHg. If the capillaries can not resist, they will break or rupture, tiny spot will then appear. These spots are hemorrhages or petechiae.

  17. 5 cm 5 cm TOURNIQUET TEST SYSTOLIC DIASTOLIC 100 mmHg 5 min Leave for 5 min • Normal : < 10 petechiae • > 10 petechiae abnormal, due to: • Increased capillary resistance • Decreased platelet number petechiae

  18. BLEEDING TIME (Duke’s Method & Ivy’s Method) • Principle : The skin is incised, blood flowing out is aspirated with a filter paper, and then the time until hemostasis is measured. • Purpose : To evaluate platelet and vascular ability in performing platelet plug.

  19. Interpretation • Time in minutes equals number of blots divided by 2 • When the blood spot becomes 1 mm or smaller, stop the stop watch. • If the bleeding doesn’t stop in 10 min., discontinue testing. Indicate the result as 10 min or longer. • Cover the wound with a sterile gauze for a while, hemostasis should be confirmed, after which the patient may leave. • The size of the blood spot about 1 cm in diameter is desirable, but becomes larger in some cases. However bleeding usually stops for several minutes regardless of the size. • Don’t wipe off the blood. Gently touch. Note so as not to touch the wound.

  20. CLOT RETRACTION Principle • When whole blood is allowed to clot spontaneously, the initial coagulum is composed of all elements of the blood. • With time the coagulum reduces in mass, and fluid serum is expressed from the clot, and its volume stated in %. • This is due to an action of platelets on the fibrin network.

  21. Clotting Time

  22. BEDSIDE CLOTTING TIME Principle : • Record the time interval from the blood contact with glass surface, until fibrin network is performed at the room temperature. Sample : • Capillary blood

  23. !....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!....!.... Clotting Time : Lee & White blood 3 ml 1 cc 1 cc 1cc 37oC N : 5 – 11 min

  24. Coagulation Screening Tests: Related to the Coagulation Cascade

  25. Coagulometer

  26. Prothrombin Time (PT) • Screening test for the extrinsic and common pathways of coagulation (factors II, VII, V, X). • Limited sensitivity to fibrinogen. • Normal range : 11-13 sec

  27. INR (International Normalized Ratio) To overcome some of the difficulties with the variability of thromboplastin  normalizing the responses of thromboplastin reagents against an international standard. • INR = { -----------} PTpat ISI PTn

  28. ISI(International Sensitivity Index) • Needs to be developed for each thromboplastin reagent and instrument combination used in performing PT and calculation of INR. • Ideal reagent  ISI < 1.7

  29. Activated Partial Thromboplastin Time (aPTT) • Screening test for the intrinsic and common pathways of coagulation (factors XII, XI, IX, VIII, X, V and II). • Limited sensitivity to fibrinogen. • Maybe normal in some cases of vWD • Normal range : < 35 sec

  30. Thrombin Time (TT) • Identified stage 3 defects in the coagulation mechanism • Clinical significant  Prolonged TT : • Decreased fibrinogen concentration • Presence of dysfunctional fibrinogen • Presence of heparin • Presence of FDP

  31. Prothrombin Time Principle of the test : • Time required for the formation of a fibrin clot when plasma is added to a thromboplastin-calcium mixture. • Measure extrinsic and common pathway (FI,II,V,VII,X)

  32. Prothrombin Time Purpose : • Evaluation of coagulation disorders • Evaluation of liver function • Monitoring anticoagulan therapy Result  inform in : • Second • Percent • INR (International Normalized Ratio) PT prolonged if coagulation factors in extrinsic pathway decreased <30%

  33. APTT Activated Partial Thromboplastin Time (APTT) Principle of the test : • Time required for the formation of a fibrin clot without additional thromboplastin. • Measuredintrinsicand common pathway

  34. D-Dimer Test Principle : Is the time required for the formation of a fibrin clot if thrombin is added. Affected by : • Concentration and fibrinogen reaction • Inhibitor (also FDPand heparin).

  35. D-dimer

  36. Thromboelastography • Screening & control therapy • Easy to perform, no reagent needed, fast • Record clot formation and converse to graph • TEG ruler • Conversion table

  37. 1. TEG NORMAL PATTERN m. a 20 mm r k r = reaction time (start to amplitudo 1 mm) k = coagulation time (end of r to amplitudo 20 mm) m .a = maximum amplitudo (mm) m . e = maximum elasticity 100 x a m . e = ------------- 100 - a

  38. 2. THROMBOCYTOPENIA r = normal k = normal/prolonged m.a. = shortened m. a r k 3. HYPERFIBRINOLYSIS r = normal k = normal m.a. = previously normal, but suddenly become shortened m.a r k

More Related