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[疑似出血性疾病的诊断]

[Diagnostics on suspicion of a bleeding disorder].

作者信息

van Vulpen Lize F D, Wichers Iris M, Urbanus Rolf T, van Galen Karin P M

机构信息

UMC Utrecht, Van Creveldkliniek, Utrecht.

Medisch Centrum Czaar Peter, Amsterdam.

出版信息

Ned Tijdschr Geneeskd. 2020 Mar 3;164:D4181.

Abstract

Bleeding symptoms occur frequently in the general population, but the possibility of an underlying bleeding disorder is not always recognised. Women with a bleeding disorder are disproportionally affected due to blood loss during menstruation and giving birth. Taking a thorough family history and a history of bleeding are most important in the workup to detect a potential underlying bleeding disorder. In patients with a bleeding disorder, potentially life-threatening complications due to bleeding can be prevented by compiling an individualized treatment plan and timely targeted blood coagulation treatment. If a bleeding disorder is suspected, initial diagnostic testing consists of determining the aPTT, PT, platelet count and von Willebrand factor activity; global tests for disorders of haemostasis, such as the coagulation time and platelet function are not of any added value. It cannot be excluded that a patient in whom test results are normal may still have a platelet function disorder or a rare bleeding disorder. If there is a strong suspicion of a bleeding disorder this should always be discussed with a coagulation specialist.

摘要

出血症状在普通人群中经常出现,但潜在出血性疾病的可能性并不总是能被认识到。患有出血性疾病的女性因月经和分娩期间失血而受到不成比例的影响。在检查潜在的出血性疾病时,详细询问家族史和出血史最为重要。对于患有出血性疾病的患者,通过制定个性化治疗方案并及时进行针对性的凝血治疗,可以预防因出血导致的潜在危及生命的并发症。如果怀疑患有出血性疾病,初步诊断测试包括测定活化部分凝血活酶时间(aPTT)、凝血酶原时间(PT)、血小板计数和血管性血友病因子活性;止血障碍的全面检测,如凝血时间和血小板功能检测并无额外价值。不能排除检测结果正常的患者仍可能患有血小板功能障碍或罕见出血性疾病。如果强烈怀疑患有出血性疾病,应始终与凝血专家进行讨论。

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