Department of Pediatrics, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, Georgia.
Semin Thromb Hemost. 2021 Mar;47(2):120-128. doi: 10.1055/s-0041-1723798. Epub 2021 Feb 26.
Hemostasis is a complex wound-healing process involving numerous mechanical and biochemical mechanisms and influenced by many factors including platelets, coagulation factors, and endothelial components. Slight alterations in these mechanisms can lead to either prothrombotic or bleeding consequences, and such hemostatic imbalances can lead to significant clinical consequences with resultant morbidity and mortality. An ideal hemostasis assay would not only address all the unique processes involved in clot formation and resolution but also take place under flow conditions to account for endothelial involvement. Global assays do exist; however, these assays are not flow based. Flow-based assays have been limited secondary to their large blood volume requirements and low throughput, limiting potential clinical applications. Microfluidic-based assays address the aforementioned limitations of both global and flow-based assays by utilizing standardized devices that require low blood volumes, offer reproducible analysis, and have functionality under a range of shear stresses and flow conditions. While still largely confined to the preclinical space, here we aim to discuss these novel technologies and potential clinical implications, particularly in comparison to the current, commercially available point-of-care assays.
止血是一个复杂的创面愈合过程，涉及许多机械和生化机制，并受到许多因素的影响，包括血小板、凝血因子和内皮细胞成分。这些机制的轻微改变可能导致血栓形成或出血后果，这种止血失衡可能导致严重的临床后果，从而导致发病率和死亡率。理想的止血测定法不仅要解决血栓形成和溶解过程中涉及的所有独特过程，还要在流动条件下进行，以考虑内皮细胞的参与。确实存在全球性的测定法；然而，这些测定法不是基于流动的。由于其对大量血液体积的需求和低通量，基于流动的测定法受到限制，限制了潜在的临床应用。微流控测定法通过利用需要少量血液体积、提供可重复分析且在一系列剪切应力和流动条件下具有功能的标准化设备来解决上述全球性和基于流动的测定法的局限性。尽管它们仍然主要局限于临床前领域，但在这里，我们旨在讨论这些新技术和潜在的临床意义，特别是与当前商业上可用的即时检验测定法相比。
