Professional Documents
Culture Documents
Legend
PPT
Recording
2012 trans
Hemostasis
Hemostasis
o Intricate system maintaining blood in
fluid state
reacts to vascular injury to stop
blood loss and seal vessel wall
o Tightly Regulated System
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Coagulation Cascade
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PRE-ANALYTICAL VARIABLES ON
HEMOSTATIC TESTS
A coagulation test result is only good as
the sample received.
- you would want to a have a result
that is accurate, precise and
reproducible
- type of sample must be strictly
monitored in order to get the real
actual result
Pre-analytical variables
1 1. Sample specimen
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volume 9:1 ratio of blood sample
to anticoagulant-assuming with normal Hct
USES:
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TEST OF HEMOSTASIS
Short Screening tests:
Bleeding.T - to test Platelet
& BV function, test for
primary hemostasis
Prothrombin.T Extrinsic,
common pathway
APTT Intrinsic , common
pathway
Thrombin.T common
pathway
D-dimer test
Specialized (Extended)
diagnostic tests:
Factor assays
Tests of thrombosis TT,
FDP, DDA,
Platelet function studies:
Adhesion,
Aggregation,
Release & PG
pathway tests
Bone Marrow study
SHORT SCREENING TESTS/PANEL
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BLEEDING TIME
Measures interaction between
platelets and (injured) vascular
endothelium.
Test for adequacy of primary
hemostasis or platelet function and
capillary integrity
Need adequate number of platelets
for a normal bleeding time
3 methods:
o Duke crude way
o Meilke has a standard depth
and length of puncture
o Ivy - uses BP cuff and lancet
Recommended criteria prior to testing
1. platelet count: >75,000/mm3
2. only 1 bleeding time/24hrs unless
patient has
received therapy ex. platelet infusion
3. discontinue heparin 6 hrs prior to
testing
Limitations:
If thrombocytopenia is present
( <75,000/mm3) BT may be
prolonged.
Aspirin & aspirin containing drugs
may prolong BT
Interpretation:
Reference range: 1-5 min. (Dukes)
2-10 min. (Mielke)
Prolonged in conditions like
thrombocytopenia, platelet function
PLATELET COUNT
USES ( for evaluation, diagnosis & followup):
bleeding disorders
Purpura/ petechiae lesions
Drug-induced thrombocytopenia
Idiopathic thrombocytopenic
purpura
DIC
Leukemia
chemotherapeutic mgt of malignant
diseases
PLATELETS
bone marrow megakaryocytes
Life span 7-10 days
Normal.count 150-450x109/l
36 hours in spleen - 1/3 of platelets
are destroyed in spleen
Functions:
hemostatic plug formation
Coagulation factors - release,
synthesis
Methods of Platelet Count
Direct (Rees and Ecker
method)
Indirect (Slide method)
Automated platelet count
Reference range : 150,000
450,000/mm3
specimen used is anticoagulant
blood (EDTA)
Platelet count estimation on PBS is
performed under OIF
7-20 platelets/OIF is adequate.
PROTHROMBIN TIME (Protime, PT)
USES:
to detect abnormalities in the
extrinsic and common
pathway of coagulation.
monitor the effect of warfarin
anticoagulant therapy
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Limitations:
o Lipemic samples may
interfere with photo-electric
measurements of clot
formation
o Specimens should not be
obtained after a meal
o Patients receiving
intermittent heparin
injections
APTT test should be
obtained one hour
before the next dose of
heparin is scheduled.
The specimen should
not be drawn from an
arm with a heparinized
catheter or heparin
lock
Ref.range : 25-35 sec.
THROMBIN TIME
assay to determine the time for clot
formation.
Measures the common
pathway
direct measure of fibrinogen
function and is used to ascertain if
there is a defect in fibrinogen
function.
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