Clinical analysis and laboratory findings in a patient with acquired hemophilia A / 中国实验血液学杂志

In order to analyze the clinical features and laboratory findings in patients with acquired hemophilia A, one case of acquired hemophilia A was studied, the medical history, clinical features, ultrasonography and laboratory examination including activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) and FVIII:C, FIX:C, FXI:C, FXII:C ratio, as well as medical treatment were analyzed. The results showed 99.3 sec of APTT, 13 sec of PT, and 13.5 sec of TT, 2% of FVIII:C, 7% of FIX:C, 9% of FXI:C and 21% of FXII:C. The prolongation of APTT could not be completely corrected by mixing the patient plasma with an equal volume of normal fresh plasma; the APTT increased with prolongation of incubation time, when patient plasma was mixed with an equal volume of normal fresh plasma and incubated at 37 degrees C. The plasma FVIII:C, FIX:C, FXI:C and FXII:C levels in patient were 6%, 75%, 95% and 123% respectively, when patient's plasma was diluted by tenfold and mixed with an equal volume of non-diluted normal plasma. FVIII inhibitor in the patient's serum was at a level >32.0 Bethesda units/ml after acquired hemophilia was diagnosed, the patient was admitted to hospital and given orally prednisone and azathioprine therapy. One month later, clinical status of the patient were improved with 33.3 seconds of APTT, 128% of FVIII level and elimination of FVIII inhibitor. In conclusion, inquiring case history, analyzing imaging results, detecting level of APTT, performing dilution test and assaying titer of FVIII inhibitor can reduce misdiagnosis and wrong therapy for patients with acquired hemophilia A. The FVIII inhibitor can be eliminated and function of clotting can be recovered by using immunosuppressive therapy.

Dynamic change of plasma prethrombotic state molecular marker levels in perioperative period of patients and its clinical significance / 中国实验血液学杂志

This study was aimed to investigate the dynamic changes of plasma prethrombotic state molecular marker levels during perioperation of patients and to provide laboratorial evidence for clinical diagnosis of these patients so as to take intervenient measure to high risk patients. 40 patients with gynecological and urological malignant tumors (without metastasis) and 20 patients with benign tumors and 20 healthy individuals were selected for analysis. The levels of plasm prethrombotic state molecular markers including TF, TFPI, TpP, PAI-1, P-S, TAT and D-D were measured by using ELISA method and transmission immunity nephelometry. The results showed that the levels of TF, TpP, D-D, P-S and TAT in plasma of patients with malignant tumors at 6 hours after operation were higher than that before operation, but the levels of TFPI and PAI-1 in these patients after operation were lower than before operation, and there was significant difference as compared with the levels of these markers before operation. At day 3 after operation, the levels of TF, TpP and D-D continuously increased; the level of PAI-1 begins to elevate, there were significant difference in comparison with that before operation; the levels of P-S and TAT decreased, but still were higher than that before operation. At day 7 after operation, the levels of TpP, TAT, P-S, TFPI and PAI-1 returned to levels before operation, but the levels of TF and D-D were still higher than that before operation, and showed significant difference from that before operation. In patients with benign tumors and non-operation patients, the levels of prethrombotic state molecular markers mentioned above at different points of time after operation did not present difference, except levels of TF and D-D that at 6 hours after operation were higher than that before operation. It is concluded that at 6 hours after operation of patients with gynecological and urological malignant tumours, the plasma levels of prethrombotic state molecular markers are in higher state of coagulation and fibrinolysis, at 3 days after operation these levels are mainly in coagulation state. At 7 days after operation, the level of these markers returned to levels before operation. At 6 hours after operation the levels of these markers in patients with benign tumors are in mild coagulation state.