Task 1. Blood fibrinolytic activity determining.
8,5 ml of distillate water + 0,15 ml of 1% solution of acetic acid and 0,5 ml of investigated plasma, mix and put in a fridge for 30 min. After this test tube is centrifugated at 1500 rotations per minute in course of 5 min. Then liquid is poured, test tube is turned over onto filter paper for several minutes to be dry. Investigator must add 0,5 ml of boric acid to sediment and to dissolve the sediment with glass stick, then it’s necessary to add 0,1 ml of fibrinolysin solution and 0,1 ml of 0,277% of CaCl2, content is mixed and is putted into bath at 37°C switching on the stop-watch. Norma: 120-240 min.
If the index is more than 240 min than it testifies to fibrinolytic activity inhibiting. If it is less than 130 min – it fibrinolysis activation sign.
Task 2. Fibrinolytic bleeding laboratory diagnostics principles.
Blood fibrinolytic activity increasing as a rule is observed in a case of blood coagulation activating. That’s why fibrinolysis as hemorrhagias primary reason is a very seldom phenomenon. But in a case of fibrinolysis expressed activation one can see complete degradation not only of fibrinogen but also other coagulational factors. Under these conditions real bleeding is developed which is only may be situated among fibrinolytic bleedings. Unfortunately, doctor in clinical practice without sufficient bases (without this process laboratory diagnostics) makes the diagnosis “fibrinolytic bleeding”. Such a situation may be with dentist too at alveolar bleedings after tooth extraction or other operations in oral cavity. To deny any suspicion (or to prove it, on the contrary) about possible fibrinolytic bleeding one must send to the laboratory following tests sets:
Norm:
1. Natural clot lysis 10-20%
2. Probe on accelerated fibrinolysis 10 min
3. Euglobulins lysis time 120-240 min
4. Fibrinogen derivative products 7,3± 3,9mg%
5. Ethanol test negative
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6. Prothamine-sulphate test negative
7. Fibrinogen “B” negative
If natural clot lysis index is decreased but probe to accelerated fibrinolysis is increased with simultaneous fibrinogen derivative products reducing that it testifies to blood lytic features decreasing. In course of contrary change and positive paracoagulation probes existence – it is concluded about fibrinolytic system activation.
Task 3. Getting acquaintance with some tests characterizing hemostasis anticoagulant link
1) Protein C. Normal value is near 1 mg/l or 70-130%.
2) Protein S. Normal value is 60-140%.
3) Antithrombin III (by Byshevsky) – 84-116% or 210-300 mg/l. Antithrombin III level is reduced at: DIC-syndrome (hypercoagulation phase), thromboses and thromboembolism.
4) Antiphospholipid antibodies – are absent under physiological conditions.
Antiphospholipid syndrome is observed at various diseases. Antiphospholipid antibodies recognize phospholipids complexes with plasma proteins participating in hemostasis process (prothrombin, proteins C and S, thrombomodulin, antithrombin III and others). Anticoagulants binding decreases organism antithrombotic potential and increases risk of thrombophilies. Autoantibodies belong to lg G, A, M.
Main antiphospholipid antibodies are:
· anticardiolipin (the mostly often) ;
· antiphosphatidylserin;
· antiphosphatidylinositol;
· antiphosphatidylethanolamin;
· antiphosphatidylcholine.
Autoimmune diseases such as systemic red lupus, rheumatism, dermatomyositis and some others as well as pregnancy (at varicous disease, accompanying thrombosis in woman) can be complicated by antiphospholipid syndrome development. Antiphospholipid syndrome can lead to miscarriages. Myocardial infarction also can carry this nature.
5. Literature recommended:
1. Lecture course.
2. Mistchenko V.P., Tkachenko E.V. Methodical instructions for dental students (short lecture course).-Poltava, 2005.-P.44-47.
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3. Mistchenko V.P., Tkachenko E.V. Methodical instructions for medical students (short lecture course).-Poltava, 2005.-P. 75-80.
4. Mistchenko V.P., Tkachenko E.V. Blood system Physiology //Methodical recommendations to practical classes for students of medical and dental departments.-Poltava, 2005.-20p.
5. Stuart Ira Fox. Human Physiology.-8th Ed.-McGrawHill, 2004.-P.375-377.
6. Seeley R.R., Stephens T.D., Tate P. Essentials of Anatomy and Physiology.-The 3rd Ed.-McGraw Hill, 1999.-P.295.
6. Materials for self-control:
Control questions
1. Fibrinolytic system factors.
2. Plasminogen external and internal activators.
3. Fibrinolysis scheme.
4. Fibrinolysis assessment methods.
5. Oral cavity role in fibrinolysis process.
LESSON 39
TOTAL BLOOD
1. The topic studied actuality. Blood analyze is non-specific, universal, still judiciousely used diagnostic method. It gives significant information at different physiological and pathological conditions.
2. Study aims:
To know: physiological limits of main blood indexes; major age peculiarities.
To be able to: interpret total blood (to see indexes abnorm, to say what conditions it can testify to).
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