BLOOD SPIN-OFFS FOR BLEEDING

LAB-INDICATORS-ACTION PLAN


Platelets must be counted in the blood if normal, we proceed to the tests that follow

3. TEST IN BLEEDING DISORDERS



3.1 BLEEDING TIME

This tests platelet and vessel wall interaction plus plug
formation.
This may be increased in thrombocytopenia, altered
Platelet function, Von Will brands disease factor V deficiency
and hypofibrinogenaemia .
It should not exceed 3-5 minutes.

3.2 PROTHROMBIN TIME

This test measures the efficiency of the extrinsic pathway.
Tissue source thromboplastin and calcium are added to citrated
plasma and the clotting time noted.

3.3 PARTIAL PROTHROMBIN TIME

This is a screening test for assessing the intrinsic pathway.
The range of normal varies and has to be compared with normal
control.

THROMBIN TIME (TT)

3.4 Tests Fibrinogen activity

The clotting time of patients’ plasma following addition of
standard controls are run.
Failure of clotting is evidence of low finbrinogen.
Excessive fibrinolysis can also prolong the thrombin time.




4 BLOOD COMPONENTS IN CLINICAL USE

4.1 PLATELET RICH PLASMA (PRP)

This is prepared by slow centrifugation of fresh whole blood.
Platelet concentrate is prepared by centrifuging PRP at 1500 rpm
for 20 minutes.
It can be stored and the platelet activity is preserved for seven days.

Platelets transfusions are indicated in cases of

* Thrombocytopenia
* Altered platelet functions

In general, platelets should not be given unless:

* There is micro vascular bleeding
* Patient of low count is for surgery
* Platelet count falls to below 10,000

After each unit, platelet count should rise by 5000/cmm at 1
hour.

4.2 Leukocyte concentrate

This is indicated in patients with granulocytopenia (<500/mm)
patient with infection (blood culture positive) with no response
to antibiotics.
Daily transfusions are required till counts exceed 1000/cmm.

4.3 Fresh Frozen Plasma (FFP)

This is normal plasma containing Citrate and is used in liver
disease and DIC.
This is indicated in a number of cases of coagulopathies with
proven deficiency of clotting factors.
This may be met with in:

* Liver dysfunction
* Congenital disorders
* Transfusion related deficiency

In cases of investigation documented factor deficienies.
Alternatives used are albumin, hetastarch.

4.4 Cryoprecipitate

If frozen plasma is brought to a temperature of 4oC white
Cryoprecipitate will seperate out.
This is rich in factor VIII and can be stored at -40oC.

The concentrate contains factor VII, fibrinogen, vWF.

This is indicated in Hemophilia, Von Wilhbrand's disease
Hypofibrinogenemia.
It may also help to treat uremia bleeding and DIC.

4.5 Packed RBC

A stable asymptomatic patient should not receive transfusion only
because haematocrit is below 30%.
Each unit of packed cell raises haematocrit by 2-3%

4.6 Washed RBC

Are indicated in patients who cannot tolerate plasma, leucocytes
and platelet debris.
These are patients with fever or renal failure

4.7 Deglycerised RBC

Deglycerised RBCs of rare blood groups can be stored for 3 years
at -65oC.
When they are required they are thawed, washed and transfused.
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