Sei sulla pagina 1di 21

HEMOSTATIC TEST

Rahajuningsih D. Setiabudy

The Clinical Distinction between


Disorders of Vascular and Platelets and
Disorders of Coagulation
Vascular/Platelets
disorders
Petechiae
Bleeding from
superficial cuts
Positive family history:
rare
Relatively more
common in female

Coagulation disorders
Hemarthrosis,
hematoma
Delayed bleeding
Positive family history:
common
Hereditary forms occur
in male (80-90%)

Conditions that need hemostatic test


Bleeding

symptoms

Bleeding

history

Prior

to surgery

Monitoring
Conditions

of anticoagulant therapy

with abnormal hemostasis:


liver disease, sepsis, DIC

Hemostatic screening tests


Bleeding

time
Tourniquet test
Platelet count
Prothrombin time (PT)
Activated partial thromboplastin time
(APTT)
Thrombin time (TT)
Screening for F XIII

Bleeding time
To evaluate

vascular and platelet (number


and function)

Sphygmomanometer

at 40 mm Hg

Make

an incision using lancet at volar

Every

30 seconds blot the blood by filter

paper

Tourniquet test
To evaluate

integrity of vascular wall


Sphygmomanometer at pressure
between systolic and diastolic for 10 min.
Release the pressure and observe the
appearance of petechiae
Positive : > 10 petechiae

Platelet count
Manual

method: EDTA blood, Rees Ecker or


ammonium oxalate

Indirect

method: blood smear, compared with


RBC count

Automatic

cell counter: should be rechecked


on blood smear if there is abnormal result

Platelet

is fragile, tend to aggregate and to


adhere to glass surface

Pseudothrombocytopenia

EDTA-Blood (25 x 109/l)

Heparin blood (160 x 109/l)

Pseudothrombocytopenia

Platelet-Statelitism

Prothrombin time
To evaluate extrinsic and common pathway
(VII, X, V, II, I)
To monitor oral anticoagulant therapy, reported in
INR (international normalized ratio) with target
value 2-3
Normal range: around 11-14 seconds Prolonged
PT : deficiency or inhibitor in the extrinsic or
common pathway (VII, X, V, II, I)

FXII
PK HMWK
F VII

F XI
F IX
F VIII
FX
FV
F II
FI

clot

PT

Activated partial thromboplastin


time
To evaluate

intrinsic and common pathway (XII,


PK, HMWK, XI, IX, VIII, X, V, II, I)

To monitor

heparin therapy, the result shoud be


1,5 2,5 x control

Normal

range : around 27 37 seconds

Prolonged

APTT : deficiency or inhibitor in the


intrinsic or common pathway (XII, PK, HMWK,
XI, IX, VIII, X, V, II, I)

FXII
PK HMWK
F VII

F XI
F IX
APTT

F VIII
FX
FV
F II
FI

clot

Thrombin time
To evaluate

the changes of fibrinogen to

fibrin
To monitor heparin therapy
Normal range : 16 20 seconds
Prolonged TT:
Hypofibrinogenemia
Dysfibrinogenemia
Inhibitor

of thrombin (FDP, heparin)

FXII
PK HMWK
F VII

F XI
F IX
APTT

F VIII

PT

FX
FV
F II
FI

clot

TT

Screening for F XIII


Deficiency

of F XIII cannot be detected by PT,

APTT, TT
F

XIII deficiency : clot is not stable in urea

5M

Tests for fibrinolytic system


Whole

blood clot lysis


Euglobulin clot lysis time
Serial thrombin time
FDP, D dimer
Plasminogen activity
Antiplasmin
PAI
Plasmin-antiplasmin complex

Hemostatic special test


Platelet

aggregation
FDP, D dimer
Coagulation factor
Von Willebrands
factor
TGT
Prothrombin
consumption test
Lupus anticoagulant
Thrombotest

Anti

Xa
Antithrombin
Protein C
Protein S
Fibrinopeptide A
Prothrombin fragment F
1.2.
Fibrin monomer
complex
Thrombin-antithrombin
complex

Pre analytical factors


Patient

preparation:
Fasting/non fasting
Medicine: aspirin, NSAID, oral anticoagulant
Exercise ( t-PA release)
Sampling:
Method of blood collection (two syringes method)
Anticoagulant: sodium citrate 0.109 M
( 1: 9)
Plastic syringe and needle (no 20)
Container: plastic or siliconized glass