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coagulation_disorders.ppt
- 1. APPROACH TO COAGULATION DISORDERS Dr.K.Pavithran, MD, DM Assistant Professor,Dept of Hematology Medical College Hospital Trivandrum-695011, India
- 2. Clinical approach 1. Is the bleeding significant ? 2. Local Vs Systemic ? 3. Platelet Vs Coagulation disorder ? 4. Inherited Vs Acquired ?
- 3. 1. Demonstration of the defect 2. Identification of the defect(s) 3. Assessment of severity 4. Consequential studies eg. carrier detection 5. Monitoring of treatment Laboratory Approach
- 4. 1. Platelet count & morphology 2. Bleeding Time 3. Clotting Time 4. Prothrombin Time 5. Activated Partial Thromboplastin Time 6. Thrombin Time Screening Tests
- 5. Collection of blood sample 1. Minimum circulatory stasis 2. Clean venous puncture 3. Proper anticoagulant 4. Proportion of blood to anticoagulant 5. Separation of plasma and storage 6. Effect of stress, pregnancy, drugs 7. Effect of PCV on the proportion of plasma to anticoagulant
- 6. • Coagulation factor deficiency/inhibitor • Test plus control plasma - 1:1 • Repeat PT/APTT • > 50% correction – Yes - Factor deficiency – No - inhibitor Prolonged PT/APTT timed incubation abnormally increasing specific inhibitor no change Lupus Anticoagulant
- 7. PT TT APTT PT - APTT, TT, PLC - N HMWK XII PK XI IX VIII VII X V II I * Factor VII deficiency * Anticoagulant therapy
- 8. APTT - PT, TT, PLC - N * Factor deficiency * vWD * Inhibitors * Heparin therapy PT TT APTT HMWK XII PK XI IX VIII VII X V II I
- 9. Mixing tests with APTT APTT of test plasma + Aged plasma Adsorbed plasma Diagnosis No correction Corrected VIII Corrected No correction IX Corrected Corrected XI,XII
- 10. Prolonged APTT, BT von Willebrand’s disease Ristocetin Induced Platelet Agglutination VIII:C vWF:Ag vWF multimeric analysis Type 1 - Partial deficiency of vWF 2A - Absence of large and interm. multimers 2B - Absence of large multimers 2M- multimers normal, pl. function 2N - affinity for FVIII 3 - severe deficiency of vWF
- 11. PT TT APTT PT, APTT - TT, PLC - N HMWK XII PK XI IX VIII VII X V II I * Common Pathway Factor deficiency * Vitamin K deficiency * Oral anticoagulant therapy * Liver disease
- 12. Mixing tests with PT PT of test plasma + Aged plasma adsorbed plasma Diagnosis Corrected Not corrected X Not corrected Corrected V Not corrected Partial II
- 13. PT TT APTT PT, APTT, TT - PLC - N HMWK XII PK XI IX VIII VII X V II I * Hypo / dysfibrinogenemia * Heparin * Liver disease * Systemic hyperfibrinolysis
- 14. PT TT * DIC - FDP - D-dimer - Fibrin monomer APTT APTT, PT,TT all PLC - low HMWK XII PK XI IX VIII VII X V II I
- 15. PT TT APTT PT, APTT- TT - N PLC - HMWK XII PK XI IX VIII VII X V II I Massive transfusion with stored blood
- 16. Thrombocytopenia Pseudo vs True Bone marrow biopsy to differentiate production destruction PT APTT PT, APTT,TT-N PLC - HMWK XII PK XI IX VIII VII X V II I TT
- 17. • Factor XIII deficiency • Thrombasthenia – congenital – drug induced • Disorders of vascular hemostasis • Factor XIII - clot solubility PT, APTT, TT, PLC - Normal • Platelet function – BT – clot retraction – 1 minute platelet count – aggregation • Tourniquet test
- 18. Asymptomatic Patient Routine screening tests shows prolonged APTT – Inhibitor - lupus anticoagulant – Factor XII deficiency – Mild congenital factor deficiency
- 19. Antiphospholipid Antibody Syndrome Criteria by Branch and Silver 1996 • Clinical – Recurrent abortion – Recurrent venous thrombosis – Recurrent arterial thrombosis – Persistent thrombocytopenia – Livedo reticularis • Laboratory – IgG/IgM anticardiolipin Ab – Lupus anticoagulant • Diagnosis – 1 clinical + 1 lab criteria – Lab result must be positive on at least 2 occasions more than 3 months apart
- 20. • Kaolin clotting time • Dilute Russel’s viper venom time • Platelet neutralization test • Tissue thromboplastin inhibition test Lupus Anticoagulant