血栓和止血障碍实验诊疗上交.ppt

Regulatory Protein Assays Antithrombin Protein C Protein S 主要参考文献 1］陈文彬、王友赤主编. 诊断学. 第五版. 北京: 人民卫生出版社. 2001 2］胡翊群、王鸿利、熊树民等主编. 现代血液学与临床实践. 上海:上海科技文献出版社. 1999 ［3］Colman RW,Hirsh J,Marder VJ, et al (eds). Hemostasis and thrombosis: Basic principles and clinical practice. 3rd ed. Philadelphia: J.B. Lippincitt Company. 1994 三、病例分析 女性，23岁，高热伴咽痛7天，近2天来有皮下瘀斑和牙龈出血。体检：T39.2℃,P116次/分,R25次/分,BP92/60mmHg,贫血貌。咽部明显红肿，扁桃腺II度肿大，有白色分泌物，颈部淋巴结可及，两肺呼吸音粗糙，心尖区II级收缩期杂音。腹平坦，肝肋下1.5cm，剑下3cm，脾侧卧可及。牙龈少许血迹，小腿、上肢、臀部等多处见瘀斑。 实验室检查：RBC3.96×1012/L，Hb88g/L，WBC12.5×109/L；白细胞分类：不名细胞45%，这些细胞体积较大，形态奇特，核染色质较细，核仁1~3个，胞质中充满刍搭客里、充满粗大颗粒；Plt25×109/L；PT18s/13s，Fg172g/L，3P（-）。 思考：（1）为了明确诊断，本例尚需做哪些实验室检查？ （2）根据临床资料和实验室检查，本例的诊断依据是什么？ * * fibrin degradation products * DIC在临床可表现为急性全身性，也可为亚急性、慢性，主要发生在脏器局部。对机体造成严重危害的是急性全身性DIC。DIC发病率约0.2‰~0.5‰，因其早期不易诊断，且治疗复杂，急性全身性DIC死亡率高达50%~60%，是一种严重威胁患者生命的临床综合征。 * thromboplastin: 促凝血酶原激酶，tissue factor Synonyms APTT; aPTT; Partial Thromboplastin Time; PTT Applies to Argatroban; Common Pathway; Extrinsic Pathway; Heparin; Heparin Resistance; High Molecular Weight Kininogen; Hirudin; Intrinsic Pathway; Prekallikrein Abstract The activated partial thromboplastin time (PTT) measures the clotting time from the activation of factor XII, through the formation of fibrin clot (see figure). This measures the integrity of the intrinsic and common pathways of coagulation, whereas the prothrombin time (PT) measures the integrity of the extrinsic and common pathways of coagulation. PTT prolongations are caused by either factor deficiencies (especially of factors VIII, IX, XI, and/or XII), or inhibitors (most commonly, lupus anticoagulants, or therapeutic anticoagulants such as heparin, hirudin, or argatroban). Specimen PlasmaContainer One blue top (citrate) tube; 3.2% citrate tubes are now recommended instead of 3.8% citrate tubes.1Sampling Time See Additional Information for sampling times with the various anticoagulant therapies.Collection Routine veni