止血與血栓-七年制

ExaminationofHemostasis&InstituteofMedical鐘寧 : Mechanismof小血管、微血管(smll 凝血系統(tǒng)(CoagulationProtein抗凝系統(tǒng)(AnticoagulationProtein纖溶系統(tǒng)(Fibrinolysis抗纖溶系統(tǒng)(Antifibrinolysis BV

1.

BloodBloodBlood

PrimaryhemostaticPlt-Plt-

StableHemostatic CapillaryPla et 5Intrinsic ExtrinsicXIIaHKa

TF

XCommon

ProteinC,Protein

（四）Anticoagulation、fromtissue：AT-IIIProtein、Protein II，IX，X，XI，XII etalPC,PS：Va,VIIIaetalTFPI(tissue ShAnti-fibrinolysis：PAI,a2- Sh Sh Sh Sh（一）血管壁的檢測(cè)（二）血小板的檢測(cè)（三）凝血因子的檢測(cè)（四）抗凝物質(zhì)的檢測(cè)TT，AT-（五）纖溶系統(tǒng)的檢測(cè)3PD- 1、Capillary )test,【Diseases】petechiaorblood、Abnormalstructureorfunctionofvesselwalle.g.allergicpurpura,hereditaryhemorrhagic 、Plaetdisease:、vonWillebrand’s Sh【Diseases】BTprolonged1）LowcountofPla et:e.g.ITPDysfunctionofPla et:e.g.Thromasthenia3）bloodvesseldiseases:e.g.HHT(hereditary 4）anticoagulationdrugs:aspirin Sh（二 ets【Referencevalue】1Thrombocytopenia：e.g.①generationreasonsAA；②destructionorconsumption: Thrombocytosis：e.g. IntrinsicExtrinsic-ScreeningTestsIntrinsicExtrinsic-Prothrombin→Prothrombin→CommonPathFX→Fibrinogen→ Sh（三）Examinationforcoagulation1、ActivatedClotting【Princple】Thewholebloodclottingtimeisaroughmeasureofallintrinsicclottingfactorsintheabsenceoftissue Sh2、ActivatedPartialThromboplastinTime,【RefRanger】32～43s，10sovercontrol【Interpretation】IIIVVIIIIX,XXI,&coagulationfactordeficiency(e.g.hemophiliaA,B,useofantiphospholipidantibody(especiallylupus Sh3、Prothrombintimetheextrinsicpathwayofcoagulation:V,VitaminKLiveruseof Sh：為國(guó)際敏感度指數(shù)（Intentonaltivtyx）（P）值，可用此值計(jì)算出R值。越接近于01.3、R：為國(guó)際標(biāo)準(zhǔn)化比率（entonalNomztPT比值計(jì)算出N，使不同的凝血活酶試劑測(cè)得INR計(jì)算：INR=PTRISI或 Sh（五）纖溶系統(tǒng)的【PriciplesFM+FDPs=SFMCSolubleFibrin【Refprimaryfibrinolysis:secondaryfibrinolysis:Positiveor ShOFCOAGULATIONDepletionof etsDepletionof etsanddepositionofThrombosisofsmallandmidsizeThrombosisofsmallandmidsizeOrganOrgan Tissuefactor*Clotting

Prot.Prot.FibrinolyticSh Sh2、laboratorytestforDIC1）PLT<100×109／L2)5)D-

Shplatcount<100,000orrapidlyProlongedclottingtimes(PT,PresenceofFibrindegradationproductsorpositiveLowlevelsofcoagulationLowlevelsofcoagulationFactorsFibrinogenlevelsnotusefulEarlydiagnostics Sh 一期：Blood二期DIC血栓前狀A(yù)T:A，F(xiàn)D