hemostatic test
TRANSCRIPT
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HEMOSTATIC TESTHEMOSTATIC TEST
Rahajuningsih D. SetiabudyRahajuningsih D. Setiabudy
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Conditions that need hemostatic testConditions that need hemostatic test
Bleeding symptomsBleeding symptoms
Bleeding historyBleeding history
Prior to surgeryPrior to surgery
Monitoring of anticoagulant therapyMonitoring of anticoagulant therapy
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Hemostatic screening testsHemostatic screening tests
Bleeding timeBleeding timeTourniquet testTourniquet test
Platelet countPlatelet countProthromin time !PT"Prothromin time !PT"Acti#ated partial thromoplastin timeActi#ated partial thromoplastin time
!APTT"!APTT"Thromin time !TT"Thromin time !TT"Screening for $ %IIIScreening for $ %III
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Bleeding timeBleeding time
To e#aluate #ascular and platelet !numerTo e#aluate #ascular and platelet !numer
and function"and function"
Sphygmomanometer at &' mm HgSphygmomanometer at &' mm HgMa(e an incision using lancet at #olarMa(e an incision using lancet at #olar
E#ery )' seconds lot the lood y filterE#ery )' seconds lot the lood y filter
paperpaper
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Tourniquet testTourniquet test
To e#aluate integrity of #ascular *allTo e#aluate integrity of #ascular *all
Sphygmomanometer at pressureSphygmomanometer at pressure
et*een systolic and diastolic for +' min,et*een systolic and diastolic for +' min,-elease the pressure and oser#e the-elease the pressure and oser#e the
appearance of petechiaeappearance of petechiae
Positi#e . / +' petechiaePositi#e . / +' petechiae
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Platelet countPlatelet count
Manual method: EDTA blood, Rees Ecker orManual method: EDTA blood, Rees Ecker or
ammonium oalateammonium oalate
!ndirect method: blood smear, com"ared #ith!ndirect method: blood smear, com"ared #ith
RBC countRBC count
Automatic cell counter: should be recheckedAutomatic cell counter: should be rechecked
on blood smearon blood smear
Platelet is $ragile, tend to aggregate and toPlatelet is $ragile, tend to aggregate and to
adhere to glass sur$aceadhere to glass sur$ace
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Prothrombin timeProthrombin time
To e%aluate etrinsic and common "ath#a&To e%aluate etrinsic and common "ath#a&
'(!!, ), (, !!, !*'(!!, ), (, !!, !*
To monitor oral anticoagulant thera"&,To monitor oral anticoagulant thera"&,
re"orted in !+R 'international normaliedre"orted in !+R 'international normalied
ratio*ratio*
Prolonged PT : de$icienc& or inhibitor in theProlonged PT : de$icienc& or inhibitor in the
etrinsic or common "ath#a& '(!!, ), (, !!, !*etrinsic or common "ath#a& '(!!, ), (, !!, !*
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F VII
FXII
PK
HMWK
F XI
F IX
F VIII
F X
F V
F II
F I
PT
clot
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Acti%ated "artial thrombo"lastinActi%ated "artial thrombo"lastin
timetime
To e#aluate intrinsic and common path*ay !%II0To e#aluate intrinsic and common path*ay !%II0
P10 HM210 %I0 I%0 3III0 %0 30 II0 I"P10 HM210 %I0 I%0 3III0 %0 30 II0 I"
To monitor heparin therapy0 the result shoud eTo monitor heparin therapy0 the result shoud e
+04 5 604 7 control+04 5 604 7 control
Prolonged APTT . deficiency or inhiitor in theProlonged APTT . deficiency or inhiitor in the
intrinsic or common path*ay !%II0 P10 HM210intrinsic or common path*ay !%II0 P10 HM210
%I0 I%0 3III0 %0 30 II0 I"%I0 I%0 3III0 %0 30 II0 I"
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F VII
FXII
PK
HMWK
F XI
F IX
F VIII
F X
F V
F II
F I
APTT
clot
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Thrombin timeThrombin time
To e#aluate the changes of firinogen toTo e#aluate the changes of firinogen to
firinfirin
To monitor heparin therapyTo monitor heparin therapy
Prolongation of TT.Prolongation of TT.HypofirinogenemiaHypofirinogenemia
8ysfirinogenemia8ysfirinogenemia Inhiitor of thromin !$8P0 heparin"Inhiitor of thromin !$8P0 heparin"
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F VII
FXII
PK
HMWK
F XI
F IX
F VIII
F X
F V
F II
F I
PTAPTT
TT
clot
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-creening $or . )!!!-creening $or . )!!!
8eficiency of $ %III cannot e detected y PT08eficiency of $ %III cannot e detected y PT0
APTT0 TTAPTT0 TT
$ %III deficiency . clot is not stale in urea$ %III deficiency . clot is not stale in urea4 M4 M
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Test $or $ibrinol&tic s&stemTest $or $ibrinol&tic s&stem
2hole lood clot lysis2hole lood clot lysis
Eugloulin clot lysis timeEugloulin clot lysis time
Serial thromin timeSerial thromin time
$8P0 8 dimer$8P0 8 dimer
Plasminogen acti#ityPlasminogen acti#ity
AntiplasminAntiplasmin
PAIPAI
Plasmin9antiplasmin comple7Plasmin9antiplasmin comple7
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Hemostatic special testHemostatic special test
Platelet aggregationPlatelet aggregation $8P0 8 dimer$8P0 8 dimer
Coagulation factorCoagulation factor
3on 2illerand:s3on 2illerand:sfactorfactor
T;TT;T
ProthrominProthromin
consumption testconsumption test
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Pre analytical factorsPre analytical factors
Patient preparation.Patient preparation.$asting=non fasting$asting=non fastingMedicine. aspirin0 >SAI80 oral anticoagulantMedicine. aspirin0 >SAI80 oral anticoagulantE7ercise ! t9PA release"E7ercise ! t9PA release"
Sampling.Sampling.Method of lood collection !t*o syringes method"Method of lood collection !t*o syringes method"Anticoagulant. sodium citrate ',+'? MAnticoagulant. sodium citrate ',+'? M
! +. ?"! +. ?"Plastic syringe and needle !no 6'"Plastic syringe and needle !no 6'"Container. plastic or siliconi@ed glassContainer. plastic or siliconi@ed glass
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