C ch ng cm mu: xt nghim cn lm sng

S lng tiu cu

S lng tiu cu lun l mt thnh phn quan trng trong vic nh gi cc bt

thng v ng cm mu, v thng l xt nghim u tin c lm nh
gi giai on cm mu nguyn pht. N ch phn nh v s lng tiu cu ch
khng cung cp bt c thng tin no v chc nng ca n. Khong tiu cu bnh
thng vo khong 150.000-440.000/mm3 [1]. Tiu cu t hn 150.000/mm3
c xem l h tiu cu. Chy mu t pht him khi xy ra khi tiu cu >
10.000-20.000/mm3. Chy mu trong phu thut c th nghim trng nu tiu
cu vo khong 40.000 ti 70.000/mm3 [1].

PT

PT phn nh tnh nguyn vn ca con ng ng mu ngoi sinh v con ng

ng mu chung [2].

Bn cnh , ngi ta xut ch s INR chun ho cc kt qu PT gia

cc phng th nghim khc nhau. Gi tr PT bnh thng: 0,9-1,2s. PT ko di
c th xy ra nhng bnh l nh: bnh l gan, thiu ht yu t VII, ang iu
tr warfarin hay thiu vitamin K.

aPTT

aPTT l xt nghim dng nh gi con ng ni sinh v con ng ng

mu chung [2]. Gi tr aPTT bnh thng vo khong 25s v 35s. aPTT bt
thng phn nh thiu hu ht cc yu t ng mu ngoi tr yu t VII [3],
trong nhy cm nht l yu t VIII v yu t IX. aPTT ko di nhng bnh
l nh thiu cc yu t ng mu ni chung, c hin din ca cc cht c ch
ng mu nh heparin, cht chng ng lupus, mt s cc yu t c ch nht
c hiu v cc sn phm thoi bin ca fibrinogen [4].

Fibrinogen

Gi tr bnh thng ca fibrinogen vo khong 160 ti 350 mg/dl. Mc

fibrinogen gim <100 mg/dL c xem nh l thiu fibrinogen, c th do cc
nguyn nhn gim sn xut nh: thiu fibrinogen di truyn, suy gim chc nng
gan, cc hi chng suy dinh dng nng, hay cng c th do c th s dng qu
mc nh trong ng mu ni mch lan to (DIC) v ly gii si fibrin [3]. Mc
fibrinogen c th bnh thng trong tnh trng tng ng nh DIC, nhng m
cng c th tng ng k (>700 mg/dl) p ng vi chn thng v phu
thut [1]. Nu c th tiu th fibrinogen m khng c DIC, th l mt nguyn
nhn quan trng trong chy mu trm trng nhng bnh nhn mt mu sau
chn thng nng [5].

1. Drummond, J.C., C.T. Petrovitch, and T.A. Lane, Hemostasis and

transfusion medicine. Platelets (apheresis, culture tested), 2009. 1: p.
50,000.
2. TF, S., Coagulation, in Miller's Anesthesia, M. RD, Editor. 2010,
Churchill Livingstone: California. p. 176779.
3. Adhikary, S.D. and P. Jacob, Peri-operative clinical tests of haemostasis
and their implications. Indian J Anaesth, 2005. 49: p. 12-6.
4. Curry, A.N. and J.T. Pierce, Conventional and near-patient tests of
coagulation. Continuing Education in Anaesthesia, Critical Care & Pain,
2007. 7(2): p. 45-50.
5. Bolliger, D., K. Grlinger, and K.A. Tanaka, Pathophysiology and
treatment of coagulopathy in massive hemorrhage and hemodilution.
Anesthesiology: The Journal of the American Society of
Anesthesiologists, 2010. 113(5): p. 1205-1219.