1. C51 Coagulation

2. “Bleeding” VS “Coagulation” Vessels –Bleeding Time Blood cells: –Platelet(c60.ppt ) Number, function Coagulation –S(+)LAB(+) –S(-)LAB( +): F XII deficiency –S(+)LAB(-): Fibrinolysis –Euglobulin clot lysis test : If <90 mins  positive

3. 工作平台 Plt Aptt PT 範 圍 Out of range

6. Plt check Abnormal Plt count Function ??? O type : low VWF Overlaping is severe VWF: to sti and protect F VIII Function Clinical variation is large Most common cause is plt dys function, like chinese herb, NSAID

7. acquiredinherited Urea [5M] solubility test Usually acquired disease Trauma Hx( bone fracture) Also Consider mild deficiency of F VIII,IX,XI ( around sen 30-40%) and dysfibinogenemia Pts with mild bleeding disorder and normal aPTT; cause aPTT did not dected the mild deficiecy of F VIII,IX,XI 一定有 answer Drugs: Cpz, fortum,

8. Symptom(+)Lab (+) and Sym(-) Screen Lab: APTT, PT and PLt Confirmatory test mixted aPTT; mixed PT 0 and 2 hour If corrected (N+P < buffer+normal)  Factor deficiency  Or weak antibody If not  antibody 1. Anti phospholipid Ab ( no clincal importance) on 0 hr 2. Factor antibody ex: VIII ab ( delay titier: 2 hr more long) (-) (+) See You Clinical significant??? Factor F XII deficiency Prekallikrein deficiency High-molecular-weight kinogen deficiency Mild to moderate factor VII deficiency lpus anticoagulants Excess citrate anticoagulant (e with HCT>60%) vWD Plt function In release; Scott syndrome Factor FXIII Heterozygous carriere of inherited coagulation diorder: FIX deficiency Mild inherited coagulation disorder: FXI deficiency Dysfibrinogenemia Fibrinolysis Plasmin inhibitor deficiency Elegated of plasminogen activator Hereditary hemorrhagic telangiectasis Allergic and other vascular purpura

10. Stypven time ( RVVT) Add VIIa DDx of F 7 and 10 TT Add thrombin Reptilase time Add reptilase

11. Approach after Screen Test Re-check –blood sample and retest APTT PT if only mild prolonged: is appropriate: poor from veni puncture, cath History –Drugs: contracept, coumadin, –Medical Hx: liver and renal disease disorder, bed-ridden Trauma history –Tooth; operation previous Race( Asia not like other race) –Family hisotory –Personal hx:in pre-menopause women, if menorrhage  15- 20% with risk of inherited coagulation disorder

12. Physical Examination –2 classification Purpuric disorder(vessel and Plt) Non-purpuric disorder(coagulation) –Hematoma: hemarthrosis –Traumatic bleeding: tooth extraction

15. Confirmatory test