血栓与止血检测临床应用进展

Abnormal
For further characterization other testing needed
Normal
Aspirin like Effect 7
Evaluate ASA-Induced Platelet Dysfunctions
PFA-100® Clinical Application
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
(min)
(s)
20 250
15
200
10
150
5
100
0
50
Epinephrine
ADP
9
Sensitivity in vWD Type 2
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
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%
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)
VIII
VIII
Binding Site
Binding Site
Binding Site
Binding Site
皮下胶原（collagen）
ห้องสมุดไป่ตู้PLT
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
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
endothelial cell collagen fibrils
- 40 mbar
epinephrine or ADP
vWF fibrinogen
platelet
erythrocyte lumen
FLOW
aperture 150µm membrane collagen vWF
erythrocyte platelet
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
◆ 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
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)
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