1. Interpretasi hasil pemeriksaan skrining hemostasis
Departemen Patologi Klinik
UNTAD

2. LABORATORY RESULTS INTERPRETATION OF BLEEDING DISORDERS.
Types of tests
Screening tests for vascular & platelet disorders:
Formation of initial platelet plugs
1. Platelet count
2. Bleeding Time
3. Examination of peripheral blood film
4. Tourniquet test

3. b. Screening test for coagulation disorders :
Formation of fibrin
1. Prothrombin Time
2. Partial Activated Thromboplastin Time
3. Thrombin Time
c. Special Test → after :
* the patient’s history
* physical examination
* screening tests (a and b)

4. Include
1. Specific coagulation factor assays
2. Platelet function tests
3. Assay for von Willebrand’s Factor
4. tests for circulating inhibitor
5. tests for Disseminated Intravascular Coagulation (DIC)
6. tests for pathological fibrinolysis

5. Clot retraction time Platelet aggregation
TEST RESULT
1. a.Prolonged Bleeding time
Normal Platelet count
Normal PPT & APTT
b.Prolonged Bleeding Time
Normal Platelet Count
Prolonged APTT
Clot retraction
time
Vascular defect
Platelet Functional
defect
Platelet aggregation
Von Willebrand’s disease
- Von willebrand’s factor antigen
- Platelet Aggregation test with
Ristocetin

6. Platelet count, BT prolonged, PPT & APTT normal
A. Hipoproliferative / Failure of marrow production
Peripheral blood examination / CBC:
Pancytopenia
- Anemia ( Hb, RBC count, Hct)
WBC count
Blood smear :
Erythr : macrooval (oval macrocyt) &
hypersegmentation neutrophil
BMP : - megaloblast (specific
morphological changes)
- Giant metamyelocyt
Ineffective
Thrombopoiesis

7. Low % reticulocyte → < 0,5 %
CBC :
Pancytopenia
Low % reticulocyte → < 0,5 %
Blood Smear :
Eryth : normocytic normochr (macrocytic)
Diff.count : - relative lymphocytosis
- netropenia/granulositopenia
Aplasia / Hypoplasia of bone marrow
BMP :
megakaryocyt mass
Hypocelluler granulopoiesis
Erythropoiesis
Marrow : Lymphocytosis

8. Peripheral Blood Cell measurement:
- Anemia - WBC >
Peripheral Blood Smear morphology:
normocytic normochromic anemia
- Leucoerythroblastic blood picture
→ myelofibrosis & infiltr by other
neoplasm/metastatic
Leukemia / Lymphoma/Myeloma cell
BMP examination :
Hipercelluler
Wide spectrum of BM morph abnormalities
Bone Marrow Replacement disorder

9. A. Immune Thrombocytopenia Purpura
B. Increased Platelet Destruction
A. Immune Thrombocytopenia Purpura
Periph Blood Cell measurement / CBC
Anemia
WBC : depends on the causal
Blood smear morphology :
↓ platelet count (< 3 / HPF)
Abnormality of morph & size → Giant platelet (> 10 µm)
viral : atypical lymphocyte
Bacterial : left shifted of myeloid cells & features of
neutrophil toxicity (granulation, vacuolization)
Immune
Thrombocy
topenia

10. Sitoplasma basofilik
LIMFOSIT PLASMA
BIRU
Sitoplasma basofilik

11. Limfosit Plasma Biru

12. White blood cell (blood smear)
Qualitative abnormality
White blood cell (blood smear)
vacuolisation
vacuolisation
Toxic granulation
Leucocytosis : netrophilia absolute with toxic granulation & vacuolisation
Bacterial infection

14. BMP :
Normal or increased immature megakaryocytes characterized by :
Non budding / intact cytoplasm
More basophilic cytoplasm & decreased granularity
Hypoploidy of nuclei
marrow normoblast : compensation of bleeding
B. Non immun thrombocytopenia: DIC, HUS, TTP
Screening test: detection of consumptive coagulation
Confirmative test: detection of secondary fibrinolysis
Peripheral blood examination:
Erythrocyt fragmentation (helmet, trianguler, schistocyt)

15. Thrombocytopenia: Distribution abnormality
Peripheral blood examination:
Pancytopenia
splenic pooling/
Reticulocytosis hypersplenism
BMP: normal/ hipercelluler

16. III. Platelet Count : Normal
Coagulation tests (PPT & APTT) : Abnormal/Prolonged
(a) PPT>, APTT N
- Early oral Anticoagulant therapy: warfarin, coumarin
Congenital & acquired deficiency of F II, VII, V, X
Early cirrhosis / chronic liver disease : PPT is more
sensitive due to the shortest half life of F VII
- Vit K deficiency
Circulating Inhibitor of extrinsic coagulation/clotting factor

18. Acquired Hemophilia III. Platelet Count : Normal (b) PPT N, APTT >
Deficiency / defect of intrinsic coagulation factor
- Hemophilia: F VIII, F IX, F XI, F XII (herediter)
von Willebrand’s disease
Heparin anticoagulant therapy
spesific circulating Inhibitor of F VIII, Lupus anticoagulant /
Lupus inhibitor
Acquired
Hemophilia

20. c. PPT >, APTT>
* Def iciency of multiple coagulation factors → acquired
* Liver disease : cholestasis
* Vit K def (Factor II, VII, IX, X)
* Primary fibrinolysis → [fibrinogen] ↓↓
* Rapid stored blood transfusion

21. Rapid stored blood transfusion
IV. Platelet Count , prolonged coagulation test
(PPT & APTT)
Severe liver disease : liver cirrhosis with portal hypertension →
↓ platelet count due to excessive splenic pooling / hipersplenisme.
Thrombin Time: the most sensitive test for dysfibrinogenemia
detection
Disseminated Intravascular Coagulation/DIC (Secondary
Fibrinolysis)
Rapid stored blood transfusion

22. THROMBOTIC RISK FACTORS
Genetic
Deficiency of protein C, protein S, and AT III
Activated protein C resistency (APC-R)
Serine proteinase inhibitor deficiency
Hyperfibrinogenemia, dysfibrinogenemia
Hyperhomocysteinemia
Fibrinolysis pathway abnormalities
- Plasminogen
- tPA (Tissue Plasminogen Activator) deficiency PAI-1 excess
Lipoprotein a / Lp(a)

23. Acquired
Anti-phospholipid antibody and lupus anticoagulant
Hyperhomocysteinemia
Lipid imbalance / Dyslipidemia

25. What Test to Perform
APC resistance
Factor V Leiden mutation
Protein C, S antigen and activity, free protein S
Anti Thrombin III
Thrombin time
Serum homocystein
Current thrombosis markers
Test of fibrinolysis
Profile of serum lipid