[Course entitled: Laboratory diagnostics of circulatory system diseases. Laboratory diagnostics of blood coagulation disorders].
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The lapse of coagulation disorders in polytraumatized patients is regarded as a substantial part of complications in the course of traumatic-hemorrhagic shock. In 71 polytraumatized patients blood-clotting tests were performed and showed that changes may already occur at a very early stage of the shock. The extent of these changes is closely related to the degree of the injury. It could be demonstrated that prompt shock-treatment and maintenance of adequate circulation as well as administration of low doses of heparin are important for spontaneous recompensation of the hemostatic defect.
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Coagulation physiologic tests were carried out and plasminogen activity and concentration were measured in the case of 6 patients (5 islet cell adenomas and 1 islet cell carcinoma). Except a reduced plasminogen activity in the postoperative phase no other unequivocally pathologic data were found. This phenomenon can probably by attributed to the enhanced plasmin inhibitors of the human plasma. The problem of so-called hypercoagulaemia of these patients can be clarified only after the investigation of the half-lives of the various coagulation factors.
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Bleeding symptoms require in many instances immediate professional care. In order to avoid unnecessary treatment, an exact diagnosis is mandatory. In most cases a differentiation between primary humoral and thrombocytogenic bleeding disorders and a secondary bleeding diathesis due to consumption coagulopathy is possible by means of anamnestic, clinical and laboratory parameters. As a single test, the bleeding time gives the best information, followed by the heparin-tolerance-time, the PTT and the platelet count. Withe Quick-test alone, only 5% of children with severe bleeding diathesis are detected. For preoperative laboratory evaluation we recommend a combination of PTT, Quick-test, platelet count and bleeding-time. For the diagnosis of disseminated intravascular coagulation, anamnestic criteria (procoagulant triggers) and clinical evaluation [thrombohemorrhagic syndrome of organ(s)] are as important als laboratory parameters (platelet count, plasminogenproactivator, splits, PTT, Quick-test).
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