凝血4项指标生物参考区间的实验室验证

目的该实验室使用sysmex CA-7000全自动血凝仪验证厂家推荐的凝血指标参考区间,并建立适用于该实验室的生物参考区间。方法运用日本sysmexCA-7000全自动血凝仪对120例健康体检者进行凝血4项的检测。结果经验证厂家提供的凝血4项参考值范围,凝血酶原时间(PT)、国际标准化比率(INR)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)的r值均大于0.95,表明厂家推荐的参考区间适用于该实验室,可以继续使用。FIB r0.95,需要重新制定本室的FIB参考区间。不同性别间凝血4项结果男性与女性差异无统计学意义(P0.05)。不同年龄间凝血4项结果差异无统计学意义(P0.05)。结论凝血4项的测定受特定条件影响较大,为了提高质量控制和规范管理。应该建立该实验室特定条件下测定的正常参考区间,为临床提供更精准的检验结果。     

ACL-TOP700血凝仪凝血4项正常参考区间的建立

目的：建立ACL‐TOP700全自动血凝分析仪本实验室凝血4项的正常参考区间。方法筛选1268住院患者及门诊体检者,均无肝病、血液病史及出凝血功能障碍,空腹采集其静脉抗凝血。采用美国IL公司生产的ACL‐TOP700全自动血凝分析仪进行凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）测定,建立本实验室 PT、APTT、TT、FIB的正常参考区间。结果该仪器精密度、正确度均良好,各参考区间与厂家提供的参考区间有一定的差异。结论各个实验室应建立自己的参考区间,不可盲目引用厂家试剂说明书上提供的正常参考区间。     

SYSMEX CS5100血凝分析仪性能评估及凝血六项参考区间的调整

目的评估本实验室SYSMEX CS5100全自动血凝分析仪(简称CS5100)的性能,验证厂家推荐的凝血指标参考范围,并建立适用于本实验室的参考区间。方法应用CS5100检测混合血浆、质控品和222名健康体检者血浆样本的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(DD)和纤维蛋白原降解产物(FDP)。结果按照国际血液学标准化委员会(ICSH)制定的技术方案,仪器的精密度、准确度、线性范围、携带污染等性能指标评价良好。厂家提供的TT、DD和FDP的参考区间经验证均适用于本实验室,重新建立的PT、APTT、FIB的参考区间分别为10.4~13.0 s、19.5~30.3 s、1.6~3.6 g/L。不同性别间凝血各指标的差异均无统计学意义(P0.05)。结论在保证仪器性能指标均为正常的基础上,验证和建立了适合本实验室的性能评价指标,符合本实验室的参考区间,为临床提供更精准的检验结果。     

GLP体系下全自动血凝分析仪的3Q验证

目的以Sysmex CA7000全自动血凝分析仪为例,探究良好实验室规范(GLP)体系下全自动血凝分析仪3Q验证过程。方法选择凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)4项检验指标,对仪器的批内精密度、日间精密度、准确性、线性、携带污染率进行性能验证。结果 PT、APTT、TT、FIB的批内精密度CV值分别为1.33%、1.57%、1.47%、1.90%;日间精密度CV值分别为1.73%、1.52%、1.55%、2.14%;在准确度方面,PT、APTT、TT、FIB的正常质控CV值分别为7.45%、3.88%、-4.98%、4.36%,PT、APTT的异常质控CV值分别为8.11%、8.77%;FIB的线性相关系数(r)值为0.999 3,a值为1.02;标本携带污染率最高CV值为2.15%;所测结果均符合行业通用标准和仪器厂家要求。结论通过GLP体系下的3Q验证,Sysmex CA7000血凝分析仪各方面性能优良,可以用于临床检验部的检验工作。     

孕晚期妇女部分凝血功能检测的临床意义

目的：探讨孕晚期妇女血凝五项检测的临床意义,建立本实验室孕晚期常规凝血试验检测指标的正常参考区间。方法采用日本 SYSmex CA7000全自动血凝分析仪,对该院健康孕晚期妇女的凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（FIB）、凝血酶时间（TT）、D-二聚体进行检测。结果孕晚期妇女 PT、APTT、TT 凝固时间均缩短,FIB、D-二聚体水平增高。建立本实验室健康孕晚期血凝检测参考区间（x ±1．96s）,分别为 PT：（10．7±1．21）s,APTT：（26．4±5．5）s, TT：（18．1±2．92）s,FIB：（3．92±1．15）g／L,D-二聚体：（1．77±1．70）g／L。结论孕晚期妇女血凝指标发生改变,应密切关注该类人群凝血功能变化;凝血指标的动态监测对预防产后并发症及治疗有指导意义,建立的参考区间能满足临床需求。     

不同材质真空采血管对凝血指标检测的影响

目的 探讨玻璃材质和塑料材质的真空采血管对凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(FIB)结果的影响.方法 用Sysmex CA-7000全自动血凝仪检测64例用不同厂家生产的玻璃管和塑料管采血的患者(定为A组)及92例用相同厂家生产的玻璃管和塑料管采血患者(定为B组)的PT、APTT、TT、FIB结果.结果 A组的玻璃管和塑料管对PT、APTT、TT、FIB的结果经t检验差异有统计学意义(P<0.05).B组的玻璃管和塑料管对PT、APTT、FIB的结果经t检验差异有统计学意义(P<0.05),对TT结果差异无统计学意义(P>0.05).结论 不同材质的采血管对凝血指标的检测有一定的影响,建议更换不同材质的采血管时,都应确立自己实验室的参考范围.     

两台凝血分析仪检测结果的可比性研究

目的：探讨不同型号凝血分析仪检测凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（FIB）和凝血酶时间（TT）的结果是否具有可比性。方法随机选取40例患者新鲜血浆,分别在ACLTOP与ACLTOP700血凝分析仪上检测PT、APTT、FIB、TT,对结果进行比较分析。结果两凝血分析仪4个检测项目结果的相关系数（r）均大于0．975,各项结果的偏倚均在CLIA′88规定的允许误差范围内。结论ACLTOP与ACLTOP700血凝分析仪检测PT、APTT、FIB、TT的结果具有可比性,符合临床要求。     

CA-510全自动血凝仪的临床应用

目的：探讨CA-510全自动血凝仪应用于临床检验结果的准确性。方法：收集120例患者,抽取新鲜静脉血浆,分别应用日本Sysmex公司CA-510全自动血凝分析仪及美国IL公司ACL Advance全自动血凝分析仪进行检测。比较两仪器检测凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）和纤维蛋白原（Fbg）指标的结果。结果：两台血凝分析仪检测PT,APTT,TT和Fbg指标结果比较,差异无统计学意义。结论：应用CA-510全自动血凝仪检查患者凝血指标结果可靠,对临床诊断出血、血栓性疾病、正确给予治疗措施并观察其治疗效果具有重要的意义。     

2种全自动血凝分析仪检测结果的线性分析

目的探讨不同血凝分析仪之间检测结果是否具有可比性。方法收集82例新鲜血浆标本,采用ACL TOP700全自动血凝分析仪和Sysmex CA7000全自动凝血分析仪分别测定凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）和纤维蛋白原（FIB）,并比对结果,以医学决定水平的系统误差判断检测系统结果是否为临床接受,并计其检测结果的相关系数和直线回归方程。结果 ACL TOP700全自动血凝分析仪和Sysmex CA7000全自动凝血分析仪检测所得的PT、APTT、TT及FIB结果比较分析,差异均无统计学意义（P〉0.05）,相关系数分别为0.985、0.992、0.971及0.968;医学决定水平的系统误差均小于允许总误差的1/2。结论以ACL TOP700全自动血凝分析仪作为标准检测系统,Sysmex CA7000全自动凝血分析仪测定的结果具有临床可接受性,两台血凝仪检测的结果具有良好的相关性。     

不同血凝分析仪的凝血项目校正及比对试验

目的 对ACLTOP全自动血凝分析仪进行性能评价,建立适用于本实验室优化的血凝分析系统.并对另一台ACL Futura型全自动血凝分析仪进行校正及比对实验.方法 按照临床和实验室标准协会(CLSI,原名NCCLS)相关文件的要求,选择代表三种方法学的指标常规进行重复性、稳定性实验;对ACLTOP全自动血凝分析仪定期用配套校准物进行校准并绘制标准曲线,每天用定值全血质拉物做室内质控.并以此仪器作参考系统,每半年以ACLTOP对ACL Futura型全自动血凝分析仪进行校正及比对实验,以保证我院凝血分析结果的准确性和一致性.随机选取比对仪器已检测的凝血时间正常和异常的患者的新鲜血浆40份,在校正后的ACL Futura全自动血凝分析仪上检测凝血酶原时间(PT)、国际标准化比率(INR)、活化的部分凝血活酶时间(APTT)、纤维蛋白(FIB)项目的 检测.结果 ACL TOP全自动血凝分析仪PT、APTT、TY、Fbg(Clauss法)、D-二聚体(D-D)、抗凝血酶(AT)的批内及日间变异系数(CV%)均小于6%;40份正常和异常标本在ACLTOP全自动血凝分析仪与校正后的ACL Futura全自动血凝分析仪比对,PT、APIT、TT、FIB的比对结果的变异百分率(CV%)值均符合卫生部临床检验中心凝血实间质量评价标准.结论 ACL TOP血凝仪与ACL Fmum血凝仪常规凝血指标比对,具有良好的重复性、稳定性.利用比对仪器测定患者正常和异常标本来校正及比对其他仪器,可以提高不同血凝分析仪之间的PT、INR、FIB、APTT检测结果的可比性.     

Coagulation activity of platelets

Haemostasis is the concerted action of blood components aimed at prevention of blood loss after vessel injury. Thrombosis is the other side of the coin, a misled physiological process, i.e. a haemostatic reaction occurring at a diseased vessel wall. Haemodynamic forces enrich platelets in a fluid boundary layer adjacent to the vessel wall where they flow along the endothelium scanning it for defects. Once the platelets detect an injury they immediately adhere--a process beginning with initial deceleration and attachment via glykoprotein (GP) Ibalpha receptor-binding to immobilized von Willebrand factor (VWF). The GPIb receptor requires no stimulation. This is in contrast to subsequently interacting receptors such as integrin alphaIIbbeta3 (GPIIb/IIIa), integrin alpha2beta1, and GP VI, which are activated via outside-in and inside-out signalling. The latter receptors bind to their respective ligands: VWF, fibrinogen, collagen and other subendothelial proteins. Upon the first layer of adherent platelets additional accrual of platelets is transient when mediated by VWF, but is then stabilized by fibrinogen bridging integrin alphaIIbbeta3 receptors on neighboring platelets. Such aggregates present a large mass of procoagulant membranes, the surface of which serves for complexation and activation of clotting factors. Thereby fibrin polymerization is accelerated manyfold. In addition, platelets contain mRNA for fast production of tissue factor, the most effective trigger of extrinsic coagulation. The formed fibrin fibers stabilize the platelet aggregates against detachment by shear forces. A shortened clotting time probably due to activated membranes was also found with microparticles generated at high shear rates through GPIb-VWF-interaction. Thus, platelets and platelet derived microparticles seem to play an important role not only in focussing the haemostatic response to the region of injury but also in initiating and accelerating the subsequent clotting reaction.     

Coagulation and immunology

One of the most vital functions of the vertebrates is to maintain hemostasis through coagulation and fibrinolysis. This is achieved by the interaction of vascular walls with blood components such as cells and proteins (coagulation factors, immunoglobulins, and complement). Deficiency of coagulation factors results in bleeding disorders. The immune system, in response to foreign proteins or defective self proteins, produces antibodies triggering an Ag-Ab interaction with the related host of different reactions including abnormal coagulation leading to hemorrhagic diathesis.     

Disseminated Intravascular Coagulation

ObjectivesThis article describes the pathophysiology and causes of disseminated intravascular coagulation (DIC). Implications for nurses are also reviewed.Data SourcesPee-reviewed articles and up-to-date references were used to check accuracy of the information and provide information for current management of this syndrome.ConclusionDIC is an oncologic emergency in which bleeding and clotting occur simultaneously. In the cancer population, the syndrome is frequently associated with certain malignancies or sepsis. If not recognized and treated early, mortality can be high. This article describes the risk factors that contribute to DIC, clinical manifestations of DIC, and its treatment.Implications for Nursing PracticeNurses need to consider the presenting diagnosis of the patient and understand laboratory abnormalities that signify DIC. The nurse plays a key role in early recognition of this syndrome as prompt treatment can reduce fatality.     

Coagulation in sepsis

Coagulation abnormalities, ranging from a simple fall in platelet count to full-blown disseminated intravascular coagulation, are a common occurrence in critically ill patients and have been associated with increased mortality. In sepsis, activation of the extrinsic coagulation pathway by tissue factor induces increased coagulation, and simultaneous depression of the inhibitory mechanisms of coagulation, and suppression of the fibrinolytic system results in a procoagulant state that may lead to the formation of microvascular thrombi disturbing organ microcirculation and promoting the development of organ dysfunction. Many inflammatory mediators are involved in the activation of coagulation, but many coagulation proteins are themselves actively involved in the inflammatory process. In this article, we explore the complex relationship between inflammation and coagulation and how improved understanding of this interaction has led to the development of new therapeutic agents for patients with severe sepsis.     

Coagulation point-of-care testing

With PT point-of-care devices, further study is needed to fully evaluate the safety and efficacy regarding home self-monitoring of oral anticoagulant therapy. Point-of-care PTT testing is also undergoing evaluation. In contrast, the ACT is commonly in use, despite its limitations, at least partly because of the lack of a readily available, inexpensive alternative with sufficient turnaround time. Several platelet function point-of-care devices have also become available, but their role in clinical care is not yet well defined.     

不同功率时间组合下微波凝固范围、形态的演变规律

目的研究不同功率时间组合下,微波凝固范围、形态及演变规律。方法微波功率60W、90W和凝固时间5min、15min依次组合,水循环冷却式微波天线凝固活体猪肝,超声仪实时观察凝固形态和范围。实验结束,所有凝固标本沿天线插入针道剖开,观察凝固区,范围指标为纵径、横径,形态指标为纵横径比、前纵径后纵径比。结果60W5min~经有较满意的凝固形态,15min时,形态稍退化。90W5min、15min均有较满意的凝固形态。结论当凝固范围直径为2cm左右时,可选择60W5min;当凝固范围直径为3cm左右时,可选择90W15min。     

The Syndrome of Intravascular Coagulation

Nitroglycerin and long-acting nitrates are the pharmacologic mainstays of antianginal therapy, both for acute attacks and for prophylaxis. Propranolol is often effective for prophylaxis in patients incompletely helped by nitrates. A holistic approach is stressed. Appropriate drug use will effect marked improvement in most patients.     

Coagulation Profiling of Random-Source Cats

The chemistry and hemostatic parameters of class B vendor cats (Felis catus) can show wide levels of variation, possibly because of initial health status. We compared prothrombin time, partial thromboplastin time, common pathway assay and thrombin time between Class B vendor cats (n = 30) and a control group of healthy cats (n = 16). The antiprotease activities of antiXa, antiIIa, heparin cofactor II, and antithrombin were measured also. Plasma samples from citrated blood were analyzed by using standard clotting assays and commercially available chromogenic substrate assays. Tests for homogeneity of variances and 1-way ANOVA were used to test for significant differences between groups. Results of ANOVA were highly significant between groups for heparin cofactor II and Heptest activity levels. Variances were significantly different between groups for prothrombin time; therefore, an ANOVA was not done. These studies suggest that the class B cats exhibited sufficiently wide variations in their coagulation parameters that they may not be optimal subjects for vascular or cardiovascular research.Abbreviations: aPTT, activated partial thromboplastin time; USDA, United States Department of AgricultureFor many years the domestic cat (Felis catus) has been used by research institutions for a variety of studies,¹² including cardiovascular research,⁵ leading to advancements in both human and feline healthcare.¹⁷ Cats that are available to research institutes are acquired through 1 of 2 groups approved by the US Department of Agriculture (USDA) and protected by a division of the USDA, the Animal and Plant Health Inspection Service.¹⁹ Class A dealers supply purpose-bred animals and provide information that describes the genetic and pathogen status of these animals and assures the investigator that any data obtained by using these animals will be similar in results.¹⁰ Alternatively, class B dealers supply random-source animals and are required to supply information regarding the name and address of the seller or donor, USDA license number of the dealer, vehicle license plate number, the animal''s birth date, and either the purchase price of the animal or whether the animal was donated. However, class B vendors are not required to provide a long-term history of an animal''s health.¹⁹ Of the 34 research universities that responded to a survey question in 2006 regarding the purchase of random-source animals, 10% indicated that they in fact did purchase animals from licensed class B vendors.⁹When cats are used for cardiovascular or hematologic studies, the investigator should know the health status of the animal, because various illnesses can alter the coagulation cascade and affect the final data. The coagulation system typically is evaluated by the use of clotting tests,⁴ which screen the different pathways of the coagulation cascade. In particular, prothrombin time is used to screen the extrinsic pathway which includes factors X, VII, V, prothrombin, and fibrinogen;¹⁵ activated partial thromboplastin time (aPTT) screens the intrinsic pathway comprising of factors XII, XI, X, IX, VIII, V, prothrombin, and fibrinogen;¹⁴ a proprietary commercial assay (Heptest, Hemochem, St Louis, MO) which measures clotting time relative to components of the common coagulation pathway, including factors X and V, prothrombin, and fibrinogen;²¹ and thrombin time measures the conversion of fibrinogen into fibrin.³Serine protease inhibitors target chymotrypsin-like serine proteases including thrombin¹ and play an important role in the regulation of coagulation.⁷ These inhibitors are evaluated by the use of chromogenic substrate assays and include antiXa,²⁰ antiIIa,⁸ antithrombin (which targets factors X, IX, XI, XII, and II of the intrinsic clotting pathway as well as factor VII of the extrinsic pathway),¹³ and heparin cofactor II which specifically inhibits thrombin¹⁸.Results from earlier clinical studies in cats demonstrated that 1 or more abnormalities in the coagulation profiles, including prolonged prothrombin time and prolonged aPTT, can be associated with hypertrophic cardiomyopathy, but the cats were asymptomatic.² Other diseases that can be associated with hemostatic abnormalities include neoplasia and diabetes mellitus.¹⁷ An individual cat''s health status can affect each step of the hemostatic process,¹² and underlying conditions may exist that could compromise the use of coagulation markers, even though the cat itself is asymptomatic.¹⁷ The health status of every cat should be known before data collection can begin. However, depending on the source of the cat, that information may or may not be readily available. We hypothesized that because underlying disease can affect various laboratory parameters, including hematologic and clinical chemistry values, and because random-source cats, depending on the quality of care prior to purchase, have unknown initial health status upon arrival at research facilities, the hemostatic system of random-source cats could be compromised unknowingly. The purpose of this study was to investigate whether the health of class B cats affects the range of variation in coagulation parameters and serine protease inhibitors compared with those of cats with a known health history. Our findings will help researchers determine what source of cat best suits their study requirements.