出血、血栓与止血检测3课件

Vocabulary1clot(thrombus)fibrinolyticsystemdisseminatedintravascularcoagulationHenoch-SchönleinpurpuraVocabulary1clot(thrombus)1血栓与止血检测

(LaboratoryDiagnosticsinThrombosisandHemostasis)温州医学院检验医学院胡昕血栓与止血检测

(LaboratoryDiagnostic2ContentsandObjectivesBasictheoryofthebloodcoagulationsystemHowtocollectspecimens,storethem,andtransportthemtothelaboratoryDiscussScreeningandDiagnosticTestsContentsandObjectivesBasict3止血和凝血系统抗凝和纤溶系统导言止血和凝血系统抗凝和纤溶系统导言4apathologicalactivationofcoagulationmechanismsthathappensinresponsetoavarietyofdiseasesthemassive,ongoingactivationofcoagulationmayresultindepletionofplateletsandcoagulationfactors,whichmaycausebleeding.atimelyandreliablediagnosisDisseminatedIntravascularCoagulation(DIC)apathologicalactivationofc5Case1Case16thrombinfibrin-fibrinogenplasmin-plasminogenfibrindegradationproductextrinsicandintrinsicpathwaysantithrombinheparinVocabulary2thrombinVocabulary27一.止血机制：机体的正常止血，主要依赖于完整的血管壁结构和功能，有效的血小板质量和数量，正常的血浆凝血因子活性及健全的神经体液调节。第一节基础理论（止血、凝血和纤溶机制）一.止血机制：第一节基础理论（止血、凝血和纤溶机制）81.Hemorrhage(Bleeding)2.Hemostasis(WhiteThrombus)3.Coagulation(RedThrombus)BleedingandClotting-11.Hemorrhage(Bleeding)2.He94.Restoration5.Hemostasis(WhiteThrombus)6.RestorationBleedingandClotting-24.Restoration5.Hemostasis(10二.凝血机制血液由液体状态变为凝胶状态称为血液凝固，这一过程分为三条途径两个系统。二.凝血机制血液由液体状态变为凝胶状11ThecoagulationcascadeThecoagulationcascade12Thecoagulationcascade

(依K因子：因子Ⅱ、Ⅶ、Ⅸ、Ⅹ）编号同义名Ⅰ纤维蛋白原（fibrinogen）Ⅱ凝血酶原(prothrombin)Ⅲ组织凝血激素(tissuethromboplastin)ⅣCa2+Ⅴ前加速素(proaccelerin)Ⅶ前转变素(proconvertin)Ⅷ抗血友病因子(antihemophilicfactor,AHF)Ⅸ血浆凝血激酶(plasmathromboplastincomponent,PTC)ⅩStuart-Prower因子Ⅺ血浆凝血激酶前质(plasmathromboplastinantecedent,PTA)Ⅻ接触因子(contactfactor)ⅩⅢ纤维蛋白稳定因子(fibrin-stabilizingfactor)Thecoagulationcascade(依K因子：13三.抗凝系统：细胞抗凝作用体液抗凝作用AT-Ⅲ：最主要的生理抗凝活性物质。蛋白C和蛋白S系统。四.纤溶系统三.抗凝系统：四.纤溶系统14出血、血栓与止血检测3课件15Vocabulary3anticoagulantvonWillebranddiseasemyocardialinfarctionhemophiliawarfarinhyperfibrinolysisVocabulary3anticoagulant16contains3.2%(0.109M)sodiumcitratecalciumionsplasmaisusedfortestingplateletrichplasma(PRP)isusedanticoagulanttherapysuchasheparinorwarfarinnotedonthetestrequestformSampleCollection第二节血栓与止血检测contains3.2%(0.109M)sodium17一.血管壁检测1.毛细血管脆性试验(毛细血管抵抗力试验、束臂试验，CRT，Tourniquettest

)

主要反映毛细血管结构和功能，也与血小板质和量有关。一.血管壁检测1.毛细血管脆性试验(毛细血管抵抗力试验、18TheWHOdefinitionofdenguehaemorrhagicfeverhasbeeninusesince1975;allfourcriteriamustbefulfilled:2.Hemorrhagictendency(positivetourniquettest,spontaneousbruising,bleedingfrommucosa,gingiva,injectionsites,etc.;vomitingblood,orbloodydiarrhea)DenguefeverTheWHOdefinitionofdengueh192

Template

Bleeding

Time,TBT2TemplateBleedingTime,TBT20二.血小板检测二.血小板检测21ThePFA-100®Analyzer

血小板功能检测plateletfunctionscreen常见于一些高凝状态的疾病：心梗、脑梗、静脉血栓形成等。PLT粘附、聚集功能降低常见于PLT无力症、vWD、骨髓增生性疾病等ThePFA-100®Analyzer血小板功能检测22三.凝血功能检查32～43s11～13s三.凝血功能检查32～43s11～13s23Mostcommoncauses–Heparin(contaminationfromlinesortherapeutic)–LupusAnticoagulantOthercauses–Liverdisease(siteofproductionformost

coagulationfactors)–ConsumptionofcoagulationfactorsasseeninDisseminatedIntravascularCoagulation(DIC)–Deficienciesofcoagulationfactors•FVIII(HemophiliaAorVonWillebrandDisease),FIX,FXI,FXIICausesforProlongedaPTTMostcommoncausesCausesfo24CzarNicholasIIofRussiaandhisfamily(photographedc.1916)showinghiswifeAlexandra(whowasacarrierofhemophilia),hisfourdaughters,andhissonAlexis,perhapsthemostfamousEuropeanroyalwithhemophilia.QueenVictoriaCzarNicholasIIofRussiaand25出血、血栓与止血检测3课件2632～43s11～13sTFTissuethromboplastinⅦ32～43s11～13sTFⅦ27InternationalNormalizedRatio(INR)InternationalSensitivityIndex(ISI)PT:9sPT:14sISI为所用凝血活酶试剂利用标准品的凝血活酶进行校正而得出的，致使每个实验室及每批试剂所测的INR具有可比性InternationalNormalizedRatio28Example1MNP=12.0sISI=1.25PatientPlasma=20sINR=(20.0/12.0)1.25=1.9Example2MNP=12.0sISI=1.85PatientPlasma=17sINR=(17.0/12.0)1.85=1.9Example3MNP=12.0sISI=1.4PatientPlasma=20sINR=(20.0/12.0)1.4=2.0Example4MNP=12.0sISI=2.0PatientPlasma=20sINR=(20.0/12.0)2.0=2.8INRCalculationExample1Example3INRCalculat29CausesforProlongedPTDeficienciesorabnormalitiesin:–FVII(ExtrinsicPathway)–FV,FX,FII(prothrombin),andFI(fibrinogen)•BothPTandaPTTwillbeprolongedVitaminKantagonists–PTsensitivetoreductionsinthreeoffourvitaminK-dependentWarfarinmedicationmonitorLiverdisease–SiteforsynthesisofvitaminK-dependentproteins–Siteforclearanceofcoumarins(warfarin)andcoagulationproteinsCausesforProlongedPTDefi30四、抗凝系统检测AntithrombinIII——Inhibitstheformationofthrombin.增高：可导致出血，见于先天性凝血因子缺乏，如血友病；后天性凝血因子缺乏，如急性肝炎、肾移植、使用抗凝药物等。减低：可导致血栓形成，见于先天性缺乏和功能异常，如肺梗塞、深部静脉血栓等血栓性疾病；后天性减低，如DIC、慢性肝病、心肌梗塞等。四、抗凝系统检测AntithrombinIII——Inh31纤溶酶原纤溶酶凝血酶原凝血酶纤维蛋白原纤维蛋白纤维蛋白降解产物纤维蛋白原纤维蛋白降解产物原发性纤溶primaryfibrinolysis继发性纤溶secondaryfibrinolysis1.血浆硫酸鱼精蛋白副凝固试验plasma

protamine

paracogulation

test,3P2.D-二聚体3.FDPs五.纤溶功能检查纤溶酶原纤溶酶凝血酶原凝血酶纤维蛋白原纤维蛋白纤维蛋白降解产32卫生部卫医发[2000]412号文件一、停止使用出血时间测定项目的Duke法，但出血时间的检验项目不废除。若临床怀疑血管壁异常所致出血性疾病时（如血管性血友病、单纯性紫癜、过敏性紫癜等），可使用出血时间测定器法检测出血时间。二、停止使用凝血时间测定玻片法和毛细血管法，用活化部分凝血活酶时间（aPTT）或全血凝固时间（CT，试管法）测定进行替代。三、停止使用一般外科手术前的常规出血时间检测，用活化部分凝血活酶时间（aPTT）、血浆凝血酶原时间（PT）和血小板计数（PLT）联合检测取代，如临床有出血史时另加出血时间测定器法进行出血时间检测。

卫生部卫医发[2000]412号文件33一期止血缺陷二期止血缺陷特点血管壁-血小板型，皮肤紫癜和粘膜出血凝血-纤溶型出血，关节、肌肉出血筛选试验出血时间（BT）和血小板计数（PLT）活化部分凝血活酶时间（APTT）和血浆凝血酶原时间(PT)诊断试验血小板聚集试验（PagT）和流式细胞术（FCM）因子Ⅷ活性（FⅧ:C）和抗原（FⅧAg）基因诊断αⅡbβ3基因缺失、插入及点突变Ⅷ内含子第三节检测项目的合理选择和应用一期止血缺陷二期止血缺陷特点血管壁-血小板型，皮肤紫癜和粘膜34PrimaryhemostasisSecondaryhemostasissuperficialsitessuchastheskinandmucousmembranesdeepsubcutaneoustissues,muscles,joints,orbodycavitiesBleedingtimePlateletcountPlateletfunctionPTaPTTvWF?medication?FⅧ:C?vesselwallstatus?liverlupus?FVIIPrimaryhemostasisSecondaryhe35Reference/medlineplus/medlineplus.html/understanding/analytes/platelet_function/glance.html/projects/coagulation/coagulation.htmlPlatelets,SecondEditionbyAlanD.Michelson.tw/related/chapter26-01.htm//bookshelf/br.fcgi?book=cm&part=A4616Referencehttp://www.nlm.nih.g36Vocabulary1clot(thrombus)fibrinolyticsystemdisseminatedintravascularcoagulationHenoch-SchönleinpurpuraVocabulary1clot(thrombus)37血栓与止血检测

(LaboratoryDiagnosticsinThrombosisandHemostasis)温州医学院检验医学院胡昕血栓与止血检测

(LaboratoryDiagnostic38ContentsandObjectivesBasictheoryofthebloodcoagulationsystemHowtocollectspecimens,storethem,andtransportthemtothelaboratoryDiscussScreeningandDiagnosticTestsContentsandObjectivesBasict39止血和凝血系统抗凝和纤溶系统导言止血和凝血系统抗凝和纤溶系统导言40apathologicalactivationofcoagulationmechanismsthathappensinresponsetoavarietyofdiseasesthemassive,ongoingactivationofcoagulationmayresultindepletionofplateletsandcoagulationfactors,whichmaycausebleeding.atimelyandreliablediagnosisDisseminatedIntravascularCoagulation(DIC)apathologicalactivationofc41Case1Case142thrombinfibrin-fibrinogenplasmin-plasminogenfibrindegradationproductextrinsicandintrinsicpathwaysantithrombinheparinVocabulary2thrombinVocabulary243一.止血机制：机体的正常止血，主要依赖于完整的血管壁结构和功能，有效的血小板质量和数量，正常的血浆凝血因子活性及健全的神经体液调节。第一节基础理论（止血、凝血和纤溶机制）一.止血机制：第一节基础理论（止血、凝血和纤溶机制）441.Hemorrhage(Bleeding)2.Hemostasis(WhiteThrombus)3.Coagulation(RedThrombus)BleedingandClotting-11.Hemorrhage(Bleeding)2.He454.Restoration5.Hemostasis(WhiteThrombus)6.RestorationBleedingandClotting-24.Restoration5.Hemostasis(46二.凝血机制血液由液体状态变为凝胶状态称为血液凝固，这一过程分为三条途径两个系统。二.凝血机制血液由液体状态变为凝胶状47ThecoagulationcascadeThecoagulationcascade48Thecoagulationcascade

(依K因子：因子Ⅱ、Ⅶ、Ⅸ、Ⅹ）编号同义名Ⅰ纤维蛋白原（fibrinogen）Ⅱ凝血酶原(prothrombin)Ⅲ组织凝血激素(tissuethromboplastin)ⅣCa2+Ⅴ前加速素(proaccelerin)Ⅶ前转变素(proconvertin)Ⅷ抗血友病因子(antihemophilicfactor,AHF)Ⅸ血浆凝血激酶(plasmathromboplastincomponent,PTC)ⅩStuart-Prower因子Ⅺ血浆凝血激酶前质(plasmathromboplastinantecedent,PTA)Ⅻ接触因子(contactfactor)ⅩⅢ纤维蛋白稳定因子(fibrin-stabilizingfactor)Thecoagulationcascade(依K因子：49三.抗凝系统：细胞抗凝作用体液抗凝作用AT-Ⅲ：最主要的生理抗凝活性物质。蛋白C和蛋白S系统。四.纤溶系统三.抗凝系统：四.纤溶系统50出血、血栓与止血检测3课件51Vocabulary3anticoagulantvonWillebranddiseasemyocardialinfarctionhemophiliawarfarinhyperfibrinolysisVocabulary3anticoagulant52contains3.2%(0.109M)sodiumcitratecalciumionsplasmaisusedfortestingplateletrichplasma(PRP)isusedanticoagulanttherapysuchasheparinorwarfarinnotedonthetestrequestformSampleCollection第二节血栓与止血检测contains3.2%(0.109M)sodium53一.血管壁检测1.毛细血管脆性试验(毛细血管抵抗力试验、束臂试验，CRT，Tourniquettest

)

主要反映毛细血管结构和功能，也与血小板质和量有关。一.血管壁检测1.毛细血管脆性试验(毛细血管抵抗力试验、54TheWHOdefinitionofdenguehaemorrhagicfeverhasbeeninusesince1975;allfourcriteriamustbefulfilled:2.Hemorrhagictendency(positivetourniquettest,spontaneousbruising,bleedingfrommucosa,gingiva,injectionsites,etc.;vomitingblood,orbloodydiarrhea)DenguefeverTheWHOdefinitionofdengueh552

Template

Bleeding

Time,TBT2TemplateBleedingTime,TBT56二.血小板检测二.血小板检测57ThePFA-100®Analyzer

血小板功能检测plateletfunctionscreen常见于一些高凝状态的疾病：心梗、脑梗、静脉血栓形成等。PLT粘附、聚集功能降低常见于PLT无力症、vWD、骨髓增生性疾病等ThePFA-100®Analyzer血小板功能检测58三.凝血功能检查32～43s11～13s三.凝血功能检查32～43s11～13s59Mostcommoncauses–Heparin(contaminationfromlinesortherapeutic)–LupusAnticoagulantOthercauses–Liverdisease(siteofproductionformost

coagulationfactors)–ConsumptionofcoagulationfactorsasseeninDisseminatedIntravascularCoagulation(DIC)–Deficienciesofcoagulationfactors•FVIII(HemophiliaAorVonWillebrandDisease),FIX,FXI,FXIICausesforProlongedaPTTMostcommoncausesCausesfo60CzarNicholasIIofRussiaandhisfamily(photographedc.1916)showinghiswifeAlexandra(whowasacarrierofhemophilia),hisfourdaughters,andhissonAlexis,perhapsthemostfamousEuropeanroyalwithhemophilia.QueenVictoriaCzarNicholasIIofRussiaand61出血、血栓与止血检测3课件6232～43s11～13sTFTissuethromboplastinⅦ32～43s11～13sTFⅦ63InternationalNormalizedRatio(INR)InternationalSensitivityIndex(ISI)PT:9sPT:14sISI为所用凝血活酶试剂利用标准品的凝血活酶进行校正而得出的，致使每个实验室及每批试剂所测的INR具有可比性InternationalNormalizedRatio64Example1MNP=12.0sISI=1.25PatientPlasma=20sINR=(20.0/12.0)1.25=1.9Example2MNP=12.0sISI=1.85PatientPlasma=17sINR=(17.0/12.0)1.85=1.9Example3MNP=12.0sISI=1.4PatientPlasma=20sINR=(20.0/12.0)1.4=2.0Example4MNP=12.0sISI=2.0PatientPlasma=20sINR=(20.0/12.0)2.0=2.8INRCalculationExample1Example3INRCalculat65CausesforProlongedPTDeficienciesorabnormalitiesin:–FVII(ExtrinsicPathway)–FV,FX,FII(prothrombin),andFI(fibrinogen)•BothPTandaPTTwillbeprolongedVitaminKantagonists–PTsensitivetoreductionsinthreeoffourvitaminK-dependentWarfarinmedicationmonitorLiverdisease–SiteforsynthesisofvitaminK-dependentproteins–Siteforclearanceofcoumarins(warfarin)andcoagulationproteinsCausesforProlongedPTDefi66四、抗凝系统检测AntithrombinIII——Inhibitstheformationofthrombin.增高：可导致出血，见于先天性凝血因子缺乏，如血友病；后天性凝血因子缺乏，如急性肝炎、肾移植、使用抗凝药物等。减低：可导致血栓形成，见于先天性缺乏和功能异常，如肺梗塞、深部静脉血栓等血栓性疾病；后天性减低，如DIC、慢性肝病、心肌梗塞等。四、抗凝系统检测AntithrombinIII——Inh67纤溶酶原纤溶酶凝血酶原凝血酶纤维蛋白原纤维蛋白纤维蛋白降解产物