Hemorrhagic disease Diagnosis
Diagnosis for hemorrhagic disease need to the patient's past history of bleeding in combination with the current bleeding situation and Laboratory Examination.
1) study the history of hemorrhagic diseases, such as a child that there is bleeding, minor injuries, trauma, or bleeding after minor surgery. Should be considered hereditary hemorrhagic disease; adult acquired bleeding should be considered for many, need to search the primary disease; skin and mucous membrane purpura with abdominal pain, joint pain with normal platelet and anaphylactoid purpura should be considered; mucocutaneous purpura, menstrual volume , a low platelet count should be considered idiopathic thrombocytopenic purpura, for many women.
B) The physical examination should pay attention to the characters and parts of hemorrhage. Allergic Purpura good hair in two lower extremities and buttocks, size, symmetrical distribution, and may be accompanied by skin rash and urticaria. Thrombocytopenic Purpura or platelet function disorders often needle-like bleeding points were scattered generalized distribution.
After careful and detailed history of inquiry after the physical examination, laboratory tests must be carried out before a clear diagnosis possible.
1. Screening test, including the capillary fragility test, platelet count bleeding time (BT) clotting time (CT), activated partial thromboplastin time (APTT), prothrombin time (PT), prothrombin consumption test (PCT ), thrombin time (TT) and so on. PT is the extrinsic coagulation pathway screening test but only in the clotting factor, or 30 percent lower than the level of fibrinogen less than 1.0 / L, when the health of english, PT will be extended. APTT coagulation pathway are endogenous screening tests fibrinogen, clotting factor, pre-kallikrein or high molecular weight kininogen in the absence of any factor can be APTT cause extension of the final three kinds of the lack of clotting factor can significantly prolonged APTT and bleeding, there is no clear clinical. APTT screening cycle can also be used anticoagulant, heparin has the time exist, APTT fibrinogen also extended content and features to reduce the time, TT can be extended. When the TT was significantly prolonged when there is usually prompted the existence of heparin-like substance.
2. Test for Confirm diagnosis. At the completion of the screening test, can determine the general condition of children from possible abnormal platelet, coagulation, or vascular abnormalities caused by abnormal. At this point we must further examine the specific target of a coagulation related to a clear diagnosis.
If the suspected coagulopathy, should be a special determination of coagulation factor activity: the first stage of coagulation: TF antigen and activity assay of thromboplastin generation test and correct; the second phase of blood coagulation: prothrombin antigen and activity of health search prothrombin fragment 1 +2 (F1 +2) Determination; the third phase of coagulation: fibrinogen fibrinogen abnormal blood (urine) fibrinopeptide A (FPA) measured factor antigen and activity measurements.
If the suspected abnormal anticoagulant system can check the following: activity or thrombin - antithrombin complex (TAT) measured; protein C and determination of related factors; determination, such as lupus anticoagulant. If the suspected abnormal fibrinolysis can check the following: protamine Vice condensate (3P) test; blood and urine fibrin degradation products (FDP) measured; D-dimer; Determination plasminogen; t - Determination PA.
If vascular abnormality suspected capillary microscopy can be measured, such as inspection and VWF. If suspected platelet dysfunction, and to check the platelet aggregation test, such as adhesion.
Hemorrhagic disease need to perform many test including: Determination of platelet adhesion function ; Determination of platelet aggregation ; prothrombin consumption test ; thromboplastin generation test ; Determination of thrombin time ; Determination of coagulation factor activity.