止血与血栓-七年制

ExaminationofHemostasis&InstituteofMedical钟宁 : Mechanismof小血管、微血管(smll 凝血系统(CoagulationProtein抗凝系统(AnticoagulationProtein纤溶系统(Fibrinolysis抗纤溶系统(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）血管壁的检测（二）血小板的检测（三）凝血因子的检测（四）抗凝物质的检测TT，AT-（五）纤溶系统的检测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：为国际敏感度指数（Intentonaltivtyx）（P）值，可用此值计算出R值。越接近于01.3、R：为国际标准化比率（entonalNomztPT比值计算出N，使不同的凝血活酶试剂测得INR计算：INR=PTRISI或 Sh（五）纤溶系统的【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血栓前状AT:A，FD