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[犬弥散性血管内凝血的实验室诊断与鉴别诊断]

[Laboratory diagnosis and differential diagnosis of disseminated intravascular coagulation in the dog].

作者信息

Mischke R, Nolte I

机构信息

Klinik für kleine Haustiere, Tierärztlichen Hochschule Hannover.

出版信息

Berl Munch Tierarztl Wochenschr. 1992 Dec 1;105(12):401-10.

PMID:1492834
Abstract

The laboratory diagnostic possibilities for characterization of disseminated intravascular coagulation (DIC) in dogs are reviewed. A DIC can be demonstrated by means of: 1. Simultaneous consumption of platelets, fibrinogen, coagulation factors and inhibitors of coagulation 2. Increased plasma levels of the specific reaction products fibrin monomers and fibrinopeptides 3. Secondary hyperfibrinolysis, especially an increase in plasma concentrations of fibrin(ogen) degradation products 4. Presence of schistocytes in the blood smear 5. Improvement in the coagulation values during an efficacious anticoagulant therapy 6. Indication of enhanced turnover and formation of microthrombi in different organs by radioisotopically detected coagulation components. Different principles of the laboratory diagnostic procedure in DIC are illustrated by the results of an animal experiment and clinical case reports. Concerning differential diagnosis among other things a deprivation- and dilution effect as well as a disturbance of synthesis have to be considered. One must especially bear in mind that a DIC may also be caused by different coagulator disturbances, e.g. of prothrombin complex synthesis. A DIC can mask such a defect in laboratory diagnostic findings, thereby complicating the diagnosis.

摘要

本文综述了犬弥散性血管内凝血(DIC)的实验室诊断方法。DIC可通过以下方式证实:1. 血小板、纤维蛋白原、凝血因子及凝血抑制剂同时消耗;2. 血浆中特异性反应产物纤维蛋白单体和纤维蛋白肽水平升高;3. 继发性纤溶亢进,尤其是血浆纤维蛋白(原)降解产物浓度增加;4. 血涂片中有裂体细胞;5. 有效抗凝治疗期间凝血指标改善;6. 通过放射性同位素检测凝血成分表明不同器官中微血栓形成和周转增强。动物实验和临床病例报告结果说明了DIC实验室诊断程序的不同原理。在鉴别诊断方面,必须考虑剥夺和稀释效应以及合成障碍等因素。尤其要牢记,DIC也可能由不同的凝血障碍引起,例如凝血酶原复合物合成障碍。DIC可能会掩盖实验室诊断结果中的此类缺陷,从而使诊断复杂化。

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