I can't understand the blood coagulation results, and the eight modes are easy to get!

The importance of coagulation results in clinical medicine is self-evident
.
However, in daily work and examinations, many examiners are often confused when they see the results of the five items of coagulation (PT, APTT, TT, FBG and DD
).
At the same time, many non-specialist clinicians, after getting abnormal coagulation reports, are also blind and will not analyze correctly, delaying the diagnosis and treatment
of patients.
Opening this part of the content, often starting with the "waterfall theory", followed by how factor A activates factor B, and how factor B activates factor C
.
This kind of text looks like a few lines, most beginners close the book and go directly to Zhou Gong to interpret the test sheet
.
In fact, for general examiners and clinicians, systematic mastery of these coagulation theories is not necessary
.
We can fully understand the general coagulation report
without knowing much about coagulation theory.
This is like that although we do not understand the working principle of the computer, we can still use it
smoothly on weekdays.
In addition, the five items of blood clotting in the book are separated, such as PT high, and a bunch of possible causes are listed; When APTT is elevated, it is another bunch of clinical significance
.
But in fact, the results of the five coagulation items, and the interpretation of other test reports is a truth, we cannot simply analyze why a certain item is abnormal, but to analyze
comprehensively.
For example, when we get the report of the hepatitis B system and see that the core antibody is positive
.
It is not to analyze why this one item is positive, but to combine the results of the other four items to interpret
it as a whole.
In the results of the three hepatitis B systems, there are fixed patterns
such as "big three yang" and "small three yang".
And in the results of the five items of coagulation, there are many similar fixed
routines.
Therefore, as long as we are familiar with the common coagulation result patterns, it is easy
to interpret.
Let's take a look at a very key schematic diagram: "Aren't you going back to talking about coagulation factors?" "Some students may have questions
.
Don't worry, this chart is just to show the clotting factors or processes
involved in each of the five tests for clotting.
You also don't need to memorize this diagram
at all.
Instead, just go back and look at the picture
when you encounter an unusual result.
Without further ado, we are starting to get started: mode 1: PT is significantly elevated, and the other four normal causes of this pattern are that the patient has just started taking the anticoagulant warfarin or has mild vitamin K deficiency
.
Because the half-life of VII involved in PT testing is short, patients only show elevated PT and usually do not exceed double
the reference limit.
Another possibility for this pattern is that patients are born with VII deficiency.

Of course, this is a very rare case
.
Mode 2: APTT is significantly elevated, and the remaining four are normal When APTT is significantly elevated, it can be divided into two categories according to the clinical manifestations of whether the patient has bleeding: (1) the patient has bleeding
.
That is most likely a congenital deficiency of factor VIII, IX, and XI, that is, congenital hemophilia
.
Or the presence of factor inhibitors, most commonly factor VIII inhibitors, is acquired hemophilia
.
To initially differentiate between the two types of disease, a plasma pooling test
can be used.
In addition, in patients with von Willebrand disease, APTT may also be simply elevated
.
(2) When the patient does not have bleeding manifestations, the elevation of APTT may be caused by
the presence of lupus anticoagulants (antiphospholipid antibodies) in the patient's body.
In addition, deficiency of factor XII, kallikrein (PK), and high molecular weight kininogen (HK) can also lead to elevated APTT, but these conditions are extremely rare
.
Mode 3: FBG is elevated, and the remaining four are normal because FBG is not only a coagulation factor, but also an acute phase reaction protein
.
Therefore, it may be elevated
in some conditions such as inflammation, trauma, and pregnancy.
Mode 4: PT and APTT are markedly elevated, and the most common reason for the normal occurrence of this pattern for the remaining three is vitamin K/oral anticoagulant (warfarin)/specific type of rat poisoning
.
And all three conditions are related
to vitamin K.
Because vitamin K is important
for the activation of coagulation factors II, VI, IX and X.
Therefore, bleeding and elevated
PT/APTT occur when patients kill the intestinal flora that can synthesize vitamin K due to insufficient intake or long-term use of antibiotics.
The anticoagulant warfarin and some rodenticides (such as bromideron and bromide) act as vitamin K antagonists, reducing the activity of the above four factors
.
When the amount of blood collected from coagulation specimens is significantly insufficient, or the patient's hematocrit is significantly increased, resulting in an imbalance between anticoagulant and plasma, PT and APTT pseudo-high will also occur, which should be distinguished
from pathological elevation.
In addition, if the nurse sister, "unknowingly" poured the blood (containing the complexing agent EDTAK) in the purple head tube into the blue head tube for testing, this result
will also occur.
At this time, measure the concentration of potassium ions in the plasma, and the truth will be revealed
.
In addition, when one of the congenital factors X, V, and II is lacking, the joint prolongation of PT and APTT will also occur (see the previous picture to help understand).

Of course, this is a very rare situation
.
Mode 5: APTT and TT are significantly elevated, and the other three are normal, which is generally caused by irregular collection of coagulation specimens and mixed with heparin in the
specimens.
Because the reagent of PT contains components that can neutralize heparin
.
The FBG test is generally measured after 10-fold dilution of plasma
.
Therefore, heparin generally does not interfere with
these two items.
Mode 6: PT, APTT and TT are significantly elevated, FBG is low, DD is normal or elevated This mode, the most common cause is liver disease (such as cirrhosis), resulting in insufficient synthesis of various coagulation factors in the liver
.
In addition, rarely, there is a congenital deficiency of fibrinogen or structural abnormalities
of fibrinogen.
Mode 7: PT, APTT, and TT are significantly elevated, FBG is low, and DD is significantly elevated when Mode 7 occurs, which means that the patient has less murder - disseminated intravascular coagulation (DIC)
has occurred.
DIC is common in patients
with obstetric accidents, sepsis, and malignancy.
To distinguish modes 6 and 7, DD results tend to be higher except when dicing
.
It can also be judged
based on the patient's basic condition and medical history.
Mode 8: The first four items can not be detected, DD can detect this situation, you need to open your eyes and re-examine this coagulation sample
.
In this case, most likely the specimen has solidified
.
Of course, when we encounter an abnormal coagulation result that does not match the patient's
clinical presentation, it is necessary to reconfirm that the specimen is OK.
Finally, we summarize the above result patterns into the following table
.
When you encounter abnormal coagulation results, you can
press the table.