C51 Coagulation

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C51 Coagulation
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Bleeding VS Coagulation

• Vessels
• Bleeding Time
• Blood cells
• Platelet(c60 .ppt )
• Number, function
• Coagulation
• S()LAB()
• S(-)LAB( ) F XII deficiency
• S()LAB(-)
• Fibrinolysis
• Euglobulin clot lysis test If lt90 mins?positive

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???? Plt
Out of range
Aptt PT ??
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Abnormal Plt count
Plt check
Function Clinical variation is large
Function ???
O type low VWF Overlaping is severe VWF to sti
and protect F VIII
Most common cause is plt dys function , like
chinese herb, NSAID
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acquired
inherited
???answer Drugs Cpz, fortum,
Usually acquired disease
Urea 5M solubility test
Trauma Hx( bone fracture) Also Consider mild
deficiency of F VIII,IX,XI ( around sen 30-40)
and dysfibinogenemia Pts with mild bleeding
disorder and normal aPTT cause aPTT did not
dected the mild deficiecy of F VIII,IX,XI
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See You
Clinical significant??? Factor F XII
deficiency Prekallikrein deficiency High-molecular
-weight kinogen deficiency Mild to moderate
factor VII deficiency lpus anticoagulants Excess
citrate anticoagulant (e with HCTgt60)
Symptom()
Lab () and Sym(-)
Screen Lab APTT, PT and PLt
(-)
vWD Plt function In release Scott
syndrome Factor FXIII Heterozygous carriere of
inherited coagulation diorder FIX deficiency
Mild inherited coagulation disorder FXI
deficiency Dysfibrinogenemia Fibrinolysis Plasmin
inhibitor deficiency Elegated of plasminogen
activator Hereditary hemorrhagic
telangiectasis Allergic and other vascular purpura
()

• Confirmatory test
• mixted aPTT mixed PT 0 and 2 hour
• If corrected (NP lt buffernormal)
• Factor deficiency
• Or weak antibody
• If not? antibody
• 1. Anti phospholipid Ab ( no clincal importance)
  on 0 hr
• 2. Factor antibody ex VIII ab ( delay titier 2
  hr more long)

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Stypven time ( RVVT) Add VIIa DDx of F 7 and
10 TT Add thrombin Reptilase time Add reptilase
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Approach after Screen Test

• Re-check
• blood sample and retest APTT PT if only mild
  prolonged is appropriate poor from veni
  puncture, cath
• History
• Drugs contracept, coumadin,
• Medical Hx
• liver and renal disease disorder, bed-ridden
• Trauma history
• Tooth operation previous
• Race( Asia not like other race)
• Family hisotory
• Personal hxin pre-menopause women, if
  menorrhage? 15-20 with risk of inherited
  coagulation disorder

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• Physical Examination
• 2 classification
• Purpuric disorder(vessel and Plt)
• Non-purpuric disorder(coagulation)
• Hematoma hemarthrosis
• Traumatic bleeding tooth extraction

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Confirmatory test