血栓与止血检测临床应用进展

Sensitivity to Aspirin®
Col/Epi CT < 170 sec.
Col/Epi CT > 170 sec.
Col/ADP CT < 114 sec.
5
87
Col/ADP CT > 114 sec.
1
27
A total of 120 samples were tested in duplicate between2 and 30 hours after aspirin ingestion (325 mg) • Platelet dysfunction detected in 95% • Aspirin indicated in 72.5%
Epinephrine
ADP
10
Sensitivity in acquired vWD
Comparison of Bleeding Time (BT) and Closure Time (CT) in acquired vWD
BT
CT
(min)
(s)
250 20
200 15
150 10
5
100
0
50
PFA-100® Clinical Application
Comparison of Bleeding Time (BT) and Closure Time (CT) in Type 2 variants
BT
CT
(min)
(s)
20
250
15
200
10
150
5
100
0
50
Type 2A Type 2B Type 2N
Epinephrine
ADP
11
Sensitivity to Hereditary Platelet Defects
Closure Time for Col/ADP (sec)
Data scatter of all study groups :
300 250 200 150 100
50 0 0
50 100 150 200 250 300 Closure Time for Col/Epi (sec)
Abnormal
For further characterization other testing needed
Normal
Aspirin like Effect 7
Evaluate ASA-Induced Platelet Dysfunctions
PFA-100® Clinical Application
◆ 2A型,血浆中缺乏大中分子量VWF多聚物 ◆ 2B型,血浆中缺乏大分子量VWF多聚物，与血小板GPIb的
结合能力增强 ◆ 2M型,血浆中VWF多聚物分布正常，血小板黏附能力下降 ◆ 2N型,血浆中VWF多聚物分布正常，与因子VIII结合能力
14
VWF与生理性止血
Adherent platelet
Factor VIII VWF
Platelet
Platelet aggregation
Fibrin clot facillitated by FVIII on activated platelet
15
血管性血友病分型
1型, VWF 量部分缺乏 (75%) 90%以上漏诊 2型, VWF 质异常 (25%)
血栓与止血检测 的临床应用进展
上海交通大学医学院附属瑞金医院 王学锋
1
一、初期止血的特殊检测
2
凝血机制 Factor VIII and vWF
黏附
Fibrinogen
Fibrinogen PLT
聚集
PLT
PLT
PLT PLT
GPIb
GPIb
GPIb
GPIb
vWF vWF vWF vWF
VIII
VIII
Normals Glanzmann Bernard S. Giant Pl.S. Storage P.D.
12
Identify von-Willebrand-Disease
Data scatter of all study groups :
300
Closure Time for Col/ADP (sec)
capillary 200µm
6
Revolutionizing the Clinical Routine PFA-100® General Clinical Use
Clinical History
PFA Col/Epi
Normal
Normal Platelet Function
Abnormal PFA Col/ADP
VIII
VIII
Binding Site
Binding Site
Binding Site
Binding Site
皮下胶原（collagen）
PLT
Fibrinogen 血管内皮细胞
3
初期止血缺陷的诊断
出血时间延长
血小板计数减少
血小板减少
血小板计数正常
原发性
继发性
血小板功能缺陷
遗传性 获得性
某些凝血因子缺乏
250
200
150
100
50
0
0
50 100 150 200 250 300
Closure Time for Col/Epi (sec)
Normals vWD Type 1 vWD Type 2 vWD Type 3
13
特殊检测
51
血小板聚集功能检测 血小板膜特异糖蛋白检测 von Willebrand Factor 相关检测
血小板计数升高 血小板增多
原发性 继发性
筛选试验 特殊检测
血管性血友病
低（无）纤维 蛋白原血症
遗传性 获得性 遗传性 获得性
4
筛选试验
血小板计数 出血时间（测定器法） 一期止血功能初筛仪
5
PFA-100® Test Principle In Vivo Haemostasis
PFA100.avi
8
Sensitivity in vWD Type 1
Comparison of Bleeding Time (BT) and Closure Time (CT) in Type 1 vWD
BT
CT
源自文库
(min)
(s)
20 250
15
200
10
150
5
100
0
50
Epinephrine
ADP
9
Sensitivity in vWD Type 2
endothelial cell collagen fibrils
- 40 mbar
epinephrine or ADP
vWF fibrinogen
platelet
erythrocyte lumen
FLOW
aperture 150µm membrane collagen vWF
erythrocyte platelet