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HEMOSTATIC TESTHEMOSTATIC TEST

Rahajuningsih D. SetiabudyRahajuningsih D. Setiabudy

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Conditions that need hemostatic testConditions that need hemostatic test

Bleeding symptomsBleeding symptoms

Bleeding historyBleeding history

Prior to surgeryPrior to surgery

Monitoring of anticoagulant therapyMonitoring of anticoagulant therapy

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Hemostatic screening testsHemostatic screening tests

Bleeding timeBleeding timeTourniquet testTourniquet test

Platelet countPlatelet countProthromin time !PT"Prothromin time !PT"Acti#ated partial thromoplastin timeActi#ated partial thromoplastin time

!APTT"!APTT"Thromin time !TT"Thromin time !TT"Screening for $ %IIIScreening for $ %III

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Bleeding timeBleeding time

To e#aluate #ascular and platelet !numerTo e#aluate #ascular and platelet !numer

and function"and function"

Sphygmomanometer at &' mm HgSphygmomanometer at &' mm HgMa(e an incision using lancet at #olarMa(e an incision using lancet at #olar

E#ery )' seconds lot the lood y filterE#ery )' seconds lot the lood y filter

paperpaper

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Tourniquet testTourniquet test

To e#aluate integrity of #ascular *allTo e#aluate integrity of #ascular *all

Sphygmomanometer at pressureSphygmomanometer at pressure

et*een systolic and diastolic for +' min,et*een systolic and diastolic for +' min,-elease the pressure and oser#e the-elease the pressure and oser#e the

appearance of petechiaeappearance of petechiae

Positi#e . / +' petechiaePositi#e . / +' petechiae

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Platelet countPlatelet count

Manual method: EDTA blood, Rees Ecker orManual method: EDTA blood, Rees Ecker or

ammonium oalateammonium oalate

!ndirect method: blood smear, com"ared #ith!ndirect method: blood smear, com"ared #ith

RBC countRBC count

Automatic cell counter: should be recheckedAutomatic cell counter: should be rechecked

on blood smearon blood smear

Platelet is $ragile, tend to aggregate and toPlatelet is $ragile, tend to aggregate and to

adhere to glass sur$aceadhere to glass sur$ace

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Prothrombin timeProthrombin time

To e%aluate etrinsic and common "ath#a&To e%aluate etrinsic and common "ath#a&

'(!!, ), (, !!, !*'(!!, ), (, !!, !*

To monitor oral anticoagulant thera"&,To monitor oral anticoagulant thera"&,

re"orted in !+R 'international normaliedre"orted in !+R 'international normalied

ratio*ratio*

Prolonged PT : de$icienc& or inhibitor in theProlonged PT : de$icienc& or inhibitor in the

etrinsic or common "ath#a& '(!!, ), (, !!, !*etrinsic or common "ath#a& '(!!, ), (, !!, !*

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F VII

FXII

PK

HMWK

F XI

F IX

F VIII

F X

F V

F II

F I

PT

clot

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Acti%ated "artial thrombo"lastinActi%ated "artial thrombo"lastin

timetime

To e#aluate intrinsic and common path*ay !%II0To e#aluate intrinsic and common path*ay !%II0

P10 HM210 %I0 I%0 3III0 %0 30 II0 I"P10 HM210 %I0 I%0 3III0 %0 30 II0 I"

To monitor heparin therapy0 the result shoud eTo monitor heparin therapy0 the result shoud e

+04 5 604 7 control+04 5 604 7 control

Prolonged APTT . deficiency or inhiitor in theProlonged APTT . deficiency or inhiitor in the

intrinsic or common path*ay !%II0 P10 HM210intrinsic or common path*ay !%II0 P10 HM210

%I0 I%0 3III0 %0 30 II0 I"%I0 I%0 3III0 %0 30 II0 I"

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F VII

FXII

PK

HMWK

F XI

F IX

F VIII

F X

F V

F II

F I

APTT

clot

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Thrombin timeThrombin time

To e#aluate the changes of firinogen toTo e#aluate the changes of firinogen to

firinfirin

To monitor heparin therapyTo monitor heparin therapy

Prolongation of TT.Prolongation of TT.HypofirinogenemiaHypofirinogenemia

8ysfirinogenemia8ysfirinogenemia Inhiitor of thromin !$8P0 heparin"Inhiitor of thromin !$8P0 heparin"

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F VII

FXII

PK

HMWK

F XI

F IX

F VIII

F X

F V

F II

F I

PTAPTT

TT

clot

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-creening $or . )!!!-creening $or . )!!!

8eficiency of $ %III cannot e detected y PT08eficiency of $ %III cannot e detected y PT0

APTT0 TTAPTT0 TT

$ %III deficiency . clot is not stale in urea$ %III deficiency . clot is not stale in urea4 M4 M

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Test $or $ibrinol&tic s&stemTest $or $ibrinol&tic s&stem

2hole lood clot lysis2hole lood clot lysis

Eugloulin clot lysis timeEugloulin clot lysis time

Serial thromin timeSerial thromin time

$8P0 8 dimer$8P0 8 dimer

Plasminogen acti#ityPlasminogen acti#ity

AntiplasminAntiplasmin

PAIPAI

Plasmin9antiplasmin comple7Plasmin9antiplasmin comple7

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Hemostatic special testHemostatic special test

Platelet aggregationPlatelet aggregation $8P0 8 dimer$8P0 8 dimer

Coagulation factorCoagulation factor

3on 2illerand:s3on 2illerand:sfactorfactor

T;TT;T

ProthrominProthromin

consumption testconsumption test

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Pre analytical factorsPre analytical factors

Patient preparation.Patient preparation.$asting=non fasting$asting=non fastingMedicine. aspirin0 >SAI80 oral anticoagulantMedicine. aspirin0 >SAI80 oral anticoagulantE7ercise ! t9PA release"E7ercise ! t9PA release"

Sampling.Sampling.Method of lood collection !t*o syringes method"Method of lood collection !t*o syringes method"Anticoagulant. sodium citrate ',+'? MAnticoagulant. sodium citrate ',+'? M

! +. ?"! +. ?"Plastic syringe and needle !no 6'"Plastic syringe and needle !no 6'"Container. plastic or siliconi@ed glassContainer. plastic or siliconi@ed glass

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