Page 556 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

540 PART 7 ■ Principles and Disorders of Hemostasis and Thrombosis

FIGURE 27.7 hro boe astogra hy Patterns.

hro boe astogra hy atterns associate with Normal
hy ercoagu ab e con itions an anticoagu ant e - R; K; MA; Angle = Normal

ications. (Fro Berg SM, Bittner EA, Zhaoe KH.

Anesthesia Review: Blasting the Boards, Phi a e hia,

PA, Li incott, Wi ia s & Wi kins, 2016.) Anticoagulants /hemophilia

Factor deficiency

R; K = Prolonged

MA; Angle = Decreased

Platelet blockers

Thrombocytopenia/

Thrombocytopathy

R ~ Normal; K = Prolonged

MA = Decreased

Fibrinolysis (UK, SK, or tPA)

Presence of tPA
R ~ Normal;

MA = Continuous decrease
LY30 >7.5%; WBCLI30 <97.5%

LY60 >15.0%; WBCLI60 <85%

Hypercoagulation

R; K = Decreased;

MA; Angle = Increased

DIC

Stage 1

Hypercoagulable state with

secondary fibrinolysis

Stage 2

Hypocoagulable state

A though the thro boe astogra hy is ab e to etect By using a “s ow” f uorogenic thro bin substrate an

hy ercoagu ab e situations, it is not requent y use to re- continuous co arison to a si u taneous y run ca ibrator,

ict thro bosis but it is use to onitor antithro botic thro bin generation can be onitore auto atica y using

thera y. T is ight be ue to the act that thro boe astog- ate et- oor as a an ate et-rich as a. An auto ate

ra hy oes not ref ect the e ects o LMWHs an the new as a-base ca ibrate auto ate thro bogra (CA ) is

oral anticoagulants co ete y. In a ition, ate et ys unc- anu acture by Diagnostica Stago (Parsi any, NJ).

tion either inherite or rug in uce wi not be etecte . A thro bogra using ate et- oor as a easures

Another shortco ing is the insensitivity to etect the e ects hy ocoagu abi ity (he o hi ias, ora anticoagu ants, he arins

o von Wi ebran ’s actor, which is invo ve in the initia- (− ikes), irect inhibitors) an hy ercoagu abi ities (antithro -

tion o c ot or ing. Factor XIII, which is ain y res onsib e bin (A ) e ciency, rothro bin hy erex ression, roteins C

or stabi ization o the brinogen c ot, is a so not a equate y an S e ciency, actor V Lei en, ora contrace tives).

is aye . In ate et-rich as a, thro bin is i inishe in thro -

An investigation o qua ity contro an qua ity assurance bo athies, such as von Wi ebran ’s isease, by antibo ies

showe a wi e variation o EM resu ts. b ocking GPIIb-IIIa or GPIb, or by anti ate et rugs such as

as irin an c o i ogre . Lu us anticoagu ant both ecreases

an increases thro bin generation.
Calibrated Autom ated Throm bogram

A ca ibrate auto ate thro bogra thus a ears to be a

broa unction test o the he ostatic-thro botic echa- NOTE: This is a good time to complete Review Questions

nis o the b oo . related to the preceding content.