凝血2

1102的抽血結果1109知道了，
凝血相關的廣泛檢查中，各數據都在及格邊緣或OK的狀態。

每週要報到的化療中心護士告訴我，
醫生這次都檢查到了，肝功能腎功能（因為凝血因子12個分別由二者產製）
一方面看是製造端出了問題，
又或是血凝了卻又分解掉了（D-dimer）。

因為數據顯示都不是太嚴重，
當天又抽了血檢查fribrinogen，double check。
如果再測數值正常，應該可以歸類為type1 or type2 error，
就和醫生專心把血紅素拉回正常值就好了。

很遺憾的，1109抽血的結果1116知道了，
我的fribrinogen二次數值，140→112，真的是不進反退。
於是醫生回頭看看那些及格邊緣的凝血因子：factor X、factor XI、factor XII。
三個都是在肝臟合成，但肝的相關指數卻又都可以接受。

最後，醫生決定先治標了。
醫生開了斷血炎Transamin，並增測其它凝血相關檢查：

●Thrombin Time（凝血酶時間）16.9~22.3秒
The Thrombin Time (TT), is a blood test which measures the time it takes for a clot to form in the plasma from a blood sample in anticoagulant which had added an excess of thrombin. This test is repeated with pooled plasma from normal patients. The difference in time between the test and the 'normal' indicates an abnormality in the conversion of fibrinogen(a soluble protein) to fibrin an insoluble protein. This test is also known as the Thrombin Clotting Time (TCT).
Thrombin time compares a patient's rate of clot formation to that of a sample of normal pooled plasma. Thrombin is added to the samples of plasma. If the plasma does not clot immediately, a quantitative (fibrinogen deficiency) or qualitative (dysfunctional fibrinogen) defect is present. If a patient is receiving heparin, a substance derived from snake venom called reptilase is used instead of thrombin. Reptilase has a similar action to thrombin but unlike thrombin it is not inhibited by heparin.
The thrombin time is used to diagnose bleeding disorders and to assess the effectiveness of fibrinolytic therapy. Reference values for thrombin time are 10 to 15 seconds or within 5 seconds of the control. If reptilase is used, the reptilase time should be between 15 and 20 seconds. Thrombin time can be prolonged by: heparin, fibrin degradation products, factor XIII deficiency, and fibrinogen deficiency/abnormality.
●
Platelet Function Assay CT-ADP（血小板功能檢測）小於122秒
Platelet Function Assay CT-EPI（血小板功能檢測）小於183秒
目前臨床上測試血小板功能都使用「Bleeding Time」，但不論DUKE method 或IVYmethod 其特異性、敏感度都不是很好，加上人為操作的變異因素太大，測試結果往往不符合臨床所需；後來發展出「血小板凝集試驗」雖然結果較為準確，但操作技術難度高且費時，無法廣泛應用於臨床檢驗室；在1998 年由德國德靈(DADE BEHRING)公司發展出PFA-100 血小板功能分析儀，可以快速且準確評估血小板功能。

The PFA test is performed with a laboratory analyzer termed the PFA -100. This instrument uses small membranes coated with either collagen and epinephrine (Col/Epi) or collagen and ADP (Col/ADP).number, and (to some extent) the hematocrit.
The PFA test is initially performed with the Col/Epi membrane. A normal Col/Epi closure time
(<183>183 sec onds), the Col/ADP test is automatically performed. If the Col/ADP result is normal (<122>183 seconds, Col/ADP >122 seconds) may indicate
the follow ing;
　• Anemia (hematocrit <0.28)
　• Thrombocytopenia (platelet count < 100 x 109/L)
　• A significant platelet function defect other than aspirin
Once anemia and thrombocytopenia have been excluded, further evaluation to exclude von Willebrand disease and inherited/acquired platelet dysfunction such as renal failure storage pool disease, release defect, Bernard-Soulier disease, and Glanzmann thromboasthenia should be considered. Long-term aspirin therapy may modestly prolong the Col/ADP.

●Euglobulin Clot Lysis Test（真球蛋白血纖溶解）大於2hr
The euglobulin lysis time (ELT) is a test that measures overall fibrinolysis.
The ECLT is a clot-based test of the fibrinolytic system. A result less than 2 hours indicates an increase in fibrinolysis that could correlate with bleeding. Prolonged results indicate inadequate fibrinolysis. Follow-up Test are Plasminogen activity, plasminogen activator inhibitor 1, tissue plasminogen activator.