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Laboratory Hemostatic Disorders

This document discusses various laboratory tests used to evaluate haemostatic disorders and bleeding tendencies. It describes global tests like full blood count, bleeding time, and coagulation tests including PT, APTT, TT, and D-dimer. Specific tests are used to identify platelet number and function issues or deficiencies in the intrinsic or extrinsic coagulation pathways. Monitoring of anticoagulant therapies like heparin and warfarin is also outlined. The tests provide information on the three aspects of Virchow's triad - blood vessels, platelets, and coagulation factors - to diagnose underlying haemostatic disorders.

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Yohanna Sinuhaji
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63 views

Laboratory Hemostatic Disorders

This document discusses various laboratory tests used to evaluate haemostatic disorders and bleeding tendencies. It describes global tests like full blood count, bleeding time, and coagulation tests including PT, APTT, TT, and D-dimer. Specific tests are used to identify platelet number and function issues or deficiencies in the intrinsic or extrinsic coagulation pathways. Monitoring of anticoagulant therapies like heparin and warfarin is also outlined. The tests provide information on the three aspects of Virchow's triad - blood vessels, platelets, and coagulation factors - to diagnose underlying haemostatic disorders.

Uploaded by

Yohanna Sinuhaji
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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LABORATORY TESTS IN

HAEMOSTATIC DISORDERS

Prof. Dr. Herman Hariman, SpPK (KH), Ph.D (U.K)


Prof. Dr. Adikoesoema Aman, SpPK (K)
Cardiovascular Unit
Division of Haematology
Department of Clinical Pathology
The University of Sumatra Utara
Essential factors to arrest bleeding
(Virchow’s triad)

• Blood vessels
• Platelets
• Coagulation and Fibrinolysis
Global test to cover the 3 aspects

• Full Blood Count (FBC); darah lengkap


• Bleeding Time
• Hess test; Rumpel Leede (X)
• P.T
• A.P.T.T
• T.T
• D-dimer
Full Blood Count (FBC)

• Complete Blood Count (CBC in USA)


• Darah lengkap (DL)
• Darah rutin (X) does not include
platelet
• Maybe used by automatic cell counter
such as Cell Dyne or Manual
CELL COUNTER
Full Blood Count, Complete
Blood Count (Darah Lengkap)
• Platelet number !!!
• Platelet morphology: normal size,
giant platelets (megathrombocytes) >
20% has the same size as RBCs
• P.D.W: platelet distribution width,
PDW high means variation of the
platelet size is high
Tourniquet Test
Capillary-fragility-test
• Hess test (commonly used): pressure is
put midway between systole and
diastole for 5 minutes. Reading is done
5 minutes after the release of the cuff
• Rumple Leed (X): the same pressure as
above but for 15 minutes and reading is
done straight away after the release of
the cuff
Pressure midway between systole and diastole
For 5 minutes (Hess test)
Interpretation

• (+): small red dots difficult to be seen


• (++): bigger dots and easily seen
• (+++): not only easily seen but also
quite prominent and sometimes
confluent
• (++++): true bruising
Of course you can not do tourniquet test with this man
In such a hairy man like this, dot will not be visible
Bleeding Time

• As a global test to measure roughly


• Platelet’s function
• Platelet’s number
Put blood pressure at 40 mmHg
First blood drop is wiped
Next, blood is tipped off by filter paper every 30 sec

Normal is less than 5 min


Triplet Automatic Bleeding Time Tester
So

• If platelet number is normal by FBC


and bleeding time is prolonged. This
shows platelet function disorders
• If the above case shows giant platelet >
20% and PDW high, possible Bernard
Soulier Disease
Intrinsic pathway Extrinsic pathway

Final Common pathway


X, V,
Prothrombin Thrombin

Fibrinogen Fibrin
The Use of Anticoagulant

• HEPARIN: intravenous or
subcutaneous
• WARFARIN: oral
• THROMBOLYTIC THERAPY:
continuous I.v infusion
WARFARIN
affects coagulation factors
in the extrinsic pathway
(II, VII, IX, X)

Monitor:
1. Prothrombin Time
2. Thrombotest
Intrinsic pathway Extrinsic pathway

Final Common pathway


X, V,
Prothrombin Thrombin

Fibrinogen Fibrin

Prothrombin Time (PT)


To standardise the result because
of different sensitivity in the
reagent (thromboplastin)

RESULT IS EXPRESSED IN
I.N.R
(International Normalized Ratio)
I.N.R

I.N.R = (P.T patient/P.T control)I.S.I

I.S.I (Internatioanl Sensitivity Index)


A sensitivity index of the reagent that
must be described by every producer
or factory
Interpretation

• INR: 1 is normal
• INR: 1-2 for prophylaxis of
thromboemblic disease
• INR: 2.0-2.5 for therapeutic
anticoagulation of DVT (deep vein
thrombosis)
• INR 2.5-3.0 for pulmonary emboli and
arterial thrombosis, AMI
• INR > 3.0: Risk of bleeding
P.T

• Other than to monitor warfarin


treatment
• P.T is used to detect defect or
deficiency in the extrinsic pathway of
coagulation, such as in the
measurement of the degree of
cholestasis in liver disorder
HEPARIN
affects coagulation factors
in the intrinsic pathway

Monitor
1. Activated Partial Thromboplastin
Time (APTT)
2. Partial Thromboplastin Time with
Kaolin (PTTK)
Intrinsic pathway Extrinsic pathway

Final Common pathway


X, V,
Prothrombin Thrombin

Fibrinogen Fibrin

Activated Partial Thromboplastin Time (APTT)


No standardisation for APTT

Use only the ratio of


APTT patient/APTT control as an
index
Therapeutic anticoagulation

• HEPARIN for 5-7 days


• WARFARIN: 3 days before stopping of
the heparin because the warfarin will
start to work 3 days after the
administration. How long warfarin is
given depends on the type of the
thrombotic process
A.P.T.T

• To monitor the use of Heparin


• To detect defect or deficiency in the
intrinsic pathway of coagulation such
as deficiency of FVIII:C Haemophilia
A, or deficiency of FIX:C such as
Haemophilia B
When APTT is prolonged

• Do the factor assay


• FVIII:C deficiency: Haemophilia A
• F IX:C deficiency: Haemophilia B etc
Thrombin Time (T.T)

• To detect defect or deficiency of


coagulation factors from the final
common pathway such in
hypofibrinogenaemia.
• It might be used also to monitor the use
of thrombolytic therapy
(Streptokinase, or t-PA Actylase)
Intrinsic pathway Extrinsic pathway

Final Common pathway


X, V,
Prothrombin Thrombin

Fibrinogen Fibrin

Thrombin Time (T.T)


D-dimer

• To detect action of fibrinolysis (plasmin


digestion of X-linked fibrin)
• To show that X-linked Fibrin has been
generated.
• This all shows evidence of D.I.C
(Disseminated Intravasculkar
Coagulation)
FXIII FXIIIa

THROMBIN

Fibrinogen Fibrin Fibrin X-linked


Monomer Polymer Fibrin

PLASMINOGEN PLASMIN

t-PA
D-dimer test by ICT technique (qualitative)
D-dimer by chomogenic assay (quantitative) in ng/ml
Diagnosis of D.I.C

• Clinical grounds
• Laboratory: prolonged PT, APTT, TT,
• Confirmatory test: increase of D-dimer
> 500 ng/ml or > 1.000 ng/ml in
operative case
Thank You for giving me your breast

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