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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