1.

/ Nhc li sinh l:
Qu trnh ng mu gm 3 giai on:
G 1: to protrombinase hot ng
C 2 con ng Ni sinh( intrinsic pathway) v Ngoi sinh (extrinsic pathway)
G 2 : to thrombin
G 3 : to fibrin
C tt c 13 yu t ng mu( theo kinh in, hin nay c 1 s yu t mi ):
+ cc yu t chung cho 2 con ng: I ; II; IV; V; X; XIII ;
+ Cc yu t ring ca con ng Ni sinh: VIII; IX; XI; XII
+ Cc yu t ring ca con ng Ngoi sinh : VII, III

Cc XN thm d ng mu thng dng trn LS:

PT (prothrombin time):
Cn gi l thi gian Quick, t gi prothrombin
Cch lm: mu chng ng bng natri oxalate hoc citrate , nay cho tha
thrombopastin (yu t III t chc) v thm Canxi
Gi tr bnh thng: 12- 16 s
INR: 0.9-1.3
( hu dng nht v n l ch s bnh thng ha quc t, khng khc nhau gia cc
mu thromboplasin khc nhau)
ngha: Thm d con ng ng mu Ngoi sinh:
Gm cc yu t VII, V, X, I, II
Tng khi:
+ 1 trong 5 yu t trn b thiu ht v s lng hoc bt thng v mt chc nng,
hay gp thiu vtm K gy gim tng hp II, VII, X ti gan
+ c s tng ng ( dn n tng s dng cc yu t ng mu=> thiu ht tng
i)
+ c yu t c ch hot ng cc yu t trn
+ c hin tng tiu fibrin
LS ta hay gp cc nhm bnh v gan, dng chng ng, bnh v mu, t min

aPTT (activated partical thrombopastin time) hay PTT

Tn gi khc: thi gian cephalin, kaolin
Cch lm: Tnh thi gian ng ca mu mu chng ng bng Natri oxalate ,citrate
, em ly tm ( loi tiu cu), sau cho thm cc yu t ging yu t 3 tiu cu v
hot ha XII
Bnh thng: 30-45s
Bnh/ chng: 0.9-1,15
ngha: Thm d qu trnh ng mu ni sinh
Gm cc yu t I. II, V, VIII, IX, X, XI, XII
Tng khi: Nguyn nhn tng t PT ch khc cc yu t ng mu thi :
Thi gian Howell:
Cch lm: mu chng ng bng Natri oxalate hay citrate, gi cho tha ion canxi
ngha: thm d ton b qu trnh ng mu
LS thng dng XN ny theo di Bn dng chng ng
Thrombine time
Cch lm : mu chng ng bng natri oxalate, citrate c cho 1 lng tng
ng thrombin t 37 C
Bnh thng: 15-20s
ngha: thm d giai on 3
Tng khi:
- Gim fibrinogen do khng tng hp c hoc do tng s dng qu mc
- C s tng thoi ha fibrin
- C cht chng ng loi khng thrombin ( v d in hnh nht chnh l heparingii c heparin bng protamin sulfat)
Gim khi: c hin tng tng ng
D-Dimer:
Cch lm: l 1 phn ng min dch hc nhm pht hin cc sn phm ging ha
ca fibrin
ngha : tm s tng ln ca cc sn phm ging ha fibrin
Bnh thng: < 0,5 mcg/ml
Tng khi:
- C hin tng Tng ng
- C s tiu fibrin
S lng tiu cu:
2

 ngha: thm d s lng tiu cu

Bnh thng: 150-450 G/l
Gim: chng t s thiu ht. nhiu nguyn nhn:
- Khng tng hp c
- Tng s dng hoc B ph hy
- Lch tng bt gi tiu cu
Nu :
- Tiu cu < 50 G/l m
o khng c triu chng LS xut huyt th khng cn truyn tiu cu
o C triu chng xut huyt hoc chun b phu thut, th thut xm ln th nn
truyn tiu cu
- Tiu cu < 10 G/l th truyn tiu cu d khng xut huyt

M u:
Cc xt nghim ng - cm mu ngy cng c s dng nhiu v cng ngy
ngi ta cng a thm cc xt nghim mi. Hu ht xt nghim ng mu l cn
c vo thi gian hnh thnh cc ng nh gi hot tnh cc yu t. Hin nay
nhiu xt nghim c thc hin trn my t ng. Tuy nhin, cn nm r nguyn
l xt nghim nh gi c ngha khi c s thay i kt qu xt nghim.
Phm vi bi ny trnh by nguyn l v ngha mt s xt nghim thng s dng
trong lm sng.
1. Xt nghim du hiu dy tht
1.1. Nguyn l: kim tra sc bn ca mch mu, c bit cc mch mu nh,
di da, ngi ta to ra mt p lc ca mu tc ng ln mch bng cch ngn cn
mu tr v tng khi lng mu cc b trong lng mch.
1.2. ngha: kt qu dng tnh th hin bng cc nt xut huyt di vng gar
ni ln mch mu d v, d b tn thng, qua phn nh cht lng mch mu
hay s lng v cht lng tiu cu.
2. Xt nghim thi gian mu chy
1.1. Nguyn l khi mch mu b tn thng, mu s thot ra ngoi, ng thi h
thng cm mu bt u hot ng. Hot ng cm mu gm vai tr ca thnh
3

mch v ca tiu cu. Cht lng ca hot ng ny khng tt s lm cho thi gian
cm c mu di hn.
Xt nghim thi gian mu chy l to ra tn thng mch mu v o thi gian n
lc cm c mu.
1.2. ngha:
Thi gian mu chy bnh thng di 5 pht. Thi gian mu chy ko di th hin
cc tn thng ca thnh mch mu v nht l cc thiu ht v s lng v cht
lng tiu cu. S lng tiu cu gim cng nng, bnh cht lng tiu cu cng
nng th thi gian mu chy cng ko di.
3. Thi gian mu ng
3.1. Nguyn l:
Mu ra khi mch mu s tip xc vi yu t khng ni mc, v qu trnh ng
mu c pht ng bng vic hot ho yu t tip xc (ni sinh). Thi gian t khi
mu ra khi mch mu (tip xc vi yu t khng ni mc) n khi hnh thnh cc
ng l thi gian mu ng.
3.2. Kt qu thi gian mu ng bnh thng 6-10 pht
Thi gian mu ng ko di l th hin ca ri lon ng mu, c th do gim yu
t hay c yu t c ch ng mu.
y l xt nghim n gin nhng khng nhy. Nhiu ri lon ca tiu cu v
thm ch thiu yu t (v d Hemophilia) vn c th b b qua. V vy, xt nghim
ny hin nay khng nn s dng.
4. Xt nghim co cc mu ng
4.1. Nguyn l:
Mu ra khi thnh mch s b ng, mu ng l mu chuyn thnh dng rn nh
hnh thnh cc si fibrin. Mng li si fibrin m ly cc thnh phn hu hnh ri
co rt li to nn cc mu ng tch ri khi phn huyt thanh. Cc mu ng co
c l nh vai tr ca tiu cu v ca fibrin.
4.2. ngha
Kt qu xt nghim th hin l:
- Cc mu co hon ton: phn nh tnh trng bnh thng ca fibrrinogen v tiu
cu (c s lng v cht lng).

- Cc mu khng co (khng to thnh cc mu tch ring r rng vi huyt thanh)

hay cc mu co khng hon ton (phn huyt thanh tch ra t di 30% mu) hoc
co cc mu nhng cn nhiu hng cu t do trong huyt thanh) l th hin bt
thng ca tiu cu (s lng hoc cht lng) v/hoc cc fibrrinogen.
Mc bt thng cng nng th cc mu cng khng co.
y l xt nghim n gin nhng kh c hiu.
5. Xt nghim thi gian Howell (cn gi l thi gian phc hi canxi)
5.1. Nguyn l:
Mu ra khi mch mu s b ng li. Qu trnh ng mu l mt lot cc phn
ng lin tip. u tin l hot ho yu t tip xc ri hot ho dy chuyn cc yu
t khc. Trong dng thc phn ng th n giai on hot ho yu t X (yu t
IX v VIIIa hot ho X) th cn ion Ca 2+ Nu khng c canxi th qu trnh phn
ng dng li v khng to nn fibrrin l sn phm cui cng c. Trn c s
ngi ta ly mu v dng citrat chng ng mu (ta cc ion Ca 2+ )Thi gian
Howell cn gi l thi gian phc hi canxi l thi gian t khi cho canxi (Ca 2+ ) vo
huyt tng chng ng bng citrat cho n khi cc ng c hnh thnh.
5.2. ngha
Thi gian Howell ko di c th do: Thiu ht yu t ng mu ng ni sinh
(thng nht l yu t VIII, yu t IX) hoc do cht c ch ng mu (c ch
ng ni sinh). Thi gian Howell cng ko di nu gim s lng hay cht lng
tiu cu. Bnh nhn c iu tr heparin cng lm thi gian Howell ko di.
Bnh nhn c ri lon cc yu t trn cng nng, tiu cu cng gim, dng cng
nhiu heparin thi gian Howell cng ko di. Do vy ngi ta c th dng xt
nghim thi gian Howell theo di iu tr heparin.
6. Xt nghim o thi gian prothrombin (thi gian Quick, PT)
6.1. Nguyn l
Mu ra khi mch, mu s b ng cng c th theo con ng ngoi sinh. Khi cho
tha thromboplastin v canxi vo mu chng ng bng citrat th con ng ng
mu ngoi sinh c thc hin t. o thi gian t khi b sung canxi v nhiu
thromboplastin n lc mu (huyt tng) ng li ( l thi gian prothrombin)
phn nh hot tnh cc yu t ng mu to nn Prothrombin (phc h
prothrombin) l yu t II, V, VII, X cn gi yu t ng mu theo ng ngoi
sinh.

6.2. ngha
Thi gian Prothrombin ko di c th do thiu ht cc yu t ng mu hot ng
theo ng ngoi sinh (II, V, VII, X). Trong 4 yu t th 3 yu t l II, VII, X
c sn xut ti gan v ph thuc vitamin K, v vy khi gan b suy hay dng
thuc khng vitamin K th PT ko di. Mc ko di ph thuc vo mc gim
yu t v liu vitamin K dng. Do vy c th dng xt nghim ny theo di
iu tr khng vitamin K. Ch s iu tr c hiu qu l PT 25 - 30%. Kt qu
xt nghim c th c th hin theo ch s INR (International nornalised Ratio)
l (PT bnh/PT chng)[sup]SI[/sup]. SI l mt ch s lin quan n loi ho
cht s dng. T s INR v vy khng ph thuc vo ho cht s dng do khch
quan hn. Khi iu tr thuc khng vitamin K th c hiu qu m vn an ton
ngi ta khuyn dng liu xt nghim PT c INR 2,5 - 3.
7. Xt nghim APTT (activated partial thromhoplastin time) cn gi l thi gian
cephalin-kaolin.
7.1. Nguyn l: Thi gian phc hi canxi ( trnh by trn) cn ph thuc vo yu
t tip xc v phosphor lipid (yu t 3) tiu cu. Xt nghim APTT l xt nghim
o thi gian ng ca huyt tng t khi phc hi canxi sau khi cho huyt tng
vi Kaolin (hot ho yu t tip xc) v cephalin (c chc nng nh yu t 3 tiu
cu). Xt nghim ny loi c nh hng ca yu t tip xc v tiu cu cho nn
nh gi c chnh xc hn cc yu t ng mu ni sinh.
7.2. ngha
Gi tr bnh thng phi so vi chng (khong 30-35 giy).
- APTT ko di (Khi ko di hn chng trn 8 giy) l tnh trng ri lon ng
mu ni sinh (gim ng) do thiu ht yu t c th bm sinh (hemophilia) hay do
yu t ng mu b tiu th (hi chng ng mu ri rc) hoc do suy gan nng
khng tng hp c yu t; cng c th do trong mu c cht c ch ng mu
ni sinh; APTT ko di khi iu tr bng heparin (loi heparin - tiu chun).
8. Thi gian thrombin (TT = Thrombin time)
8.1. Nguyn l: ng mu huyt tng d ni sinh hay ngoi sinh u to ra
thromboplastin chuyn prothrombin thnh thrombin. Khi c thrombin th
fibrinogen s chuyn thnh fibrin to cc ng. Thi gian thrombin l thi gian
ng khi cho thrombin vo huyt tng . Mc ch xt nghim ny l nh gi
fibrinogen - yu t cui cng ca ng mu.

8.2. ngha: Kt qu phi so vi chng bnh thng, thng thng khong 14 - 16

giy. Khi TT bnh nhn ko di hn TT ca chng 5 giy c gi l TT ko di.
TT ko di l do thiu fibrinogen hoc phn t fibrinogen bt thng. TT cn ko
di do c mt heparin hay mt s cht trung gian nh PDF.
9. Xt nghim nh lng Fibrinogen
9.1. Nguyn l: Cho thrombin vo huyt tng, huyt tng s ng v thi gian
ng tu thuc vo lng fibrinogen. Da trn c s ngi ta pha dung dch
fibrinogen chun cc nng khc nhau ri cho thm thrombin. Kt qu ln xt
nghim ny s to c mt ng cong nng fibrinogen - thi gian.
Huyt tng bnh nhn c pha long v xt nghim thi gian ng vi thrombin
ri i chiu ng cong chun s bit nng fibrinogen.
9.2. ngha: Kt qu bnh thng t 2 - 5g/l
Fibrinogen tng trong vim nhim.
Fibrinogen gim c th do tiu th (ng mu ri rc), tiu fibrin (tiu si huyt),
hay mc bnh khng c fibrinogen.
10. Nghim php Von-Kaulla
10.1. Nguyn l
Fibrin c hnh thnh v s b tiu nh plasmin, bnh thng thi gian tiu cc
mu khong 2 ngy. Bng phng php gi li cc cht kch thch to plasmin
(euglobulin) th sau khi ng thi gian tiu cc ng bnh thng l hn 1 gi.
Theo di thi gian tiu cc ng sau khi ng ca huyt tng loi b cht c
ch, gi li cht kch thch to plasmin nh gi mc tiu si huyt.
10.2. ngha
Bnh thng nghim php Von - Kaulla trn 60 pht.
Thi gian tan cc ng di 15 pht l tiu si huyt ti cp; t 15 - 30 pht l tiu
si huyt cp, T 30 - 45 pht l tiu si huyt; trn 45 pht l tiu si huyt tim
tang, trn 60 pht l bnh thng.
11. Nghim php Ethanol (nghim php ru)
11.1. Nguyn l
Khi c qu trnh ng mu tc l chuyn fibrinogen thnh fibrin. Qu trnh chuyn
t fibrinogen thnh fibrin nh sau: u tin l monomer ho cc fibrinogen, sau
7

polymer ho to si huyt. Tuy nhin vn c mt t monomer khng polymer ho

c m kt hp vi fibrinogen v PDF thnh mt phc cht. Phc cht ny s lm
huyt tng to thnh gel trong mi trng ru nhit lnh. Li dng tnh
cht ngi ta cho huyt tng pha trong ru ri 4[sup]0[/sup]C v quan
st gel ho.
11.2. ngha
- C gel ho tc l nghim php ru dng tnh (+). Mc gel ho nhiu th
dng tnh cng mnh.
- Nghim php ru (+) chng t ang c qu trnh chuyn fibrinogen thnh fibrin,
tc l hin tng ng mu trong c th ang xy ra. Do vy dng nghim php
ru chn on ng mu ni mch ri rc.
12. Xt nghim pht hin khng ng lu hnh
12.1. Nguyn l: Nhiu trng hp trong mu xut hin cht khng li yu t ng
mu lm ko di thi gian mu ng. Nh vy khi thi gian xt nghim APTT (ni
sinh) hay PT (ngoi sinh) b ko di c th do thiu yu t ng mu hay do c
cht khng ng. Hai l do ny c th phn bit c nh c im sau:
- Nu trn huyt tng ngi bnh thng vi huyt tng ca ngi b thiu yu
t ng mu ri lm xt nghim th kt qu xt nghim gn bnh thng. S d nh
vy v yu t b thiu c b.
- Nu trn huyt tng ca ngi bnh thng vi huyt tng bnh nhn c cht
khng ng ri lm xt nghim th kt qu thi gian ng s ko di. S d nh vy
v cht khng ng bnh nhn khng li c yu t ng mu ngi bnh thng.
Li dng c im trn ngi ta ly huyt tng ca bnh nhn c thi gian xt
nghim b ko di (xt nghim thm d ni sinh hay ngoi sinh) trn vi huyt
tng ca ngi bnh thng ri thc hin xt nghim (nu bnh nhn c APTT
ko di th trn ri xt nghim APTT, nu c PT ko di th trn ri xt nghim
PT).
Nu kt qu xt nghim ca mu huyt tng trn gn bnh thng tc l khng c
cht khng ng. Nu kt qu xt nghim ca mu huyt tng trn vn ko di
tng t ca bnh nhn tc l c cht khng ng.
12.2. ngha: Bnh thng trong mu khng c cht khng ng (cn gi cht c
ch ng mu bnh l)
Cht khng ng xut hin trong mt s bnh, c bit bnh t min v cn c
iu tr.

13. Xt nghim nh lng yu t

13.1. Nguyn l: Cc xt nghim nh lng yu t c thc hin vi nguyn l
l: Thi gian ng ca huyt tng (APTT hay PT) ph thuc vo nng cc yu
t ng mu tham gia vo xt nghim . C ngha l kt qu xt nghim APTT
ph thuc nng cc yu t VIII, IX, XI v XII. Kt qu xt nghim PT ph
thuc nng cc yu t II, V, VII v X. nh lng mt yu t ngi ta dng
thuc th. Trong thuc th c y cc yu t khc vi nng cao tr yu t
cn nh lng.
Cho thuc th ny vo huyt tng bnh nhn ri thc hin xt nghim. Kt qu
thi gian ng s i chiu trn th ( th cho tng l thuc th do phng xt
nghim v sau khi thc hin xt nghim vi cc nng khc nhau ca yu t cn
nh lng).
V d nh lng yu t VIII th thc hin xt nghim APTT vi huyt tng
bnh nhn sau khi cho thuc th vo. Thuc th nh lng yu t VIII l hp
cht cha y yu t IX, XI, XII. nh lng yu t II th dng thuc th
cha y cc yu t V, VII, X v thc hin xt nghim PT.
13.2. ngha: Tu theo yu t m c nng bnh thng khc nhau
Xt nghim nh lng yu t theo phng php ny l xt nghim chuyn su
nhm xc nh hot tnh tng yu t gip chn on bnh; nht l cc bnh bm
sinh.