trabajo hemostacia y coagulacion

8/18/2019 Trabajo Hemostacia y Coagulacion

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CARATULA


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ÍNDICE

1. INTRODUCCIÓN2. COMPONENTES DE LA HEMOSTASIA3. FASES DE LA HEMOSTASIA

3.1. HEMOSTASIA PRIMARIA3.1.1. RESPUESTAS VASCULARES3.1.2. VASOCONSTRICCIÓN.

3.2. PLAQUETAS

4. HEMOSTASIA SECUNDARIA O COAGULACIÓN

4.1. CARACTERISTICAS DE LOS FACTORES DE COAGULACION4.2. MODELOS DE LA COAGULACIÓN 4.2. 1. Modelo clá!co. 4.2.2. Modelo de l" c"c"d" de l" co"#$l"c!%&.

4.2.3. Modelo cel$l"' de l" co"#$l"c!%&4.3.ETAPAS O FASES DE LA COAGULACION

4.3.1. LA FASE DE INICIACIÓN4.3.2. LA FASE DE AMPLIFICACIÓN4.3.3. LA FASE DE PROPAGACIÓN

(. FI)RINOLISIS.*. METODOS + TECNICAS DE EVALUACION DE LA ,EMOSTACIA + TROM)OSIS*.1.PRUE)A DEL LA-O RUMPEL LEEDE/*.2.TIEMPO DE SANGRÍA.*.3.RETRACCIÓN DEL COAGULOM0TODO CUALITATIVO/*.4.RECUENTO DE PLAUETAS*.(.TIEMPO DE COAGULACIÓN M0TODO DE LEE ,ITE/

*.*. TIEMPO DETROM)OPLASTINA PARCIAL ACTIVADATTPA/ METODO DE RAPPAPORT/*..TIEMPO DE PROTOM)INA METODO DE UIC/*.5.TIEMPO DE TROM)INA*.6.DOSA7E DE FI)RINÓGENO M0TODO DE CLAUSS*.18. DETERMINACIÓN DE FACTOR 9III PARA PACIENTES CON SANGRADO SIN

ALTERACIÓN DE LAS PRUE)AS DE COAGULACIÓN. AUTOMATI-ACION EN LA)ORATORIO ,EMOSTASIA

.1. LOS PRINCIPIOS UTILI-ADOS EN LOS EUIPOS AUTOM:TICOS PARA LOS ESTUDIOS DE LA

,EMOSTASIA.2. TROM)OELASTOGRAFIA

5. )I)LIOGRAFIA;

METODOS DE LA)ORATORIO DE ESTUDIO DE,EMOSTACIA + COAGULACION

1. INTRODUCCIÓN

La "!" es un mean!sm" #e #e$ensa %ue &'"(e)e a* "')an!sm" #e *as

&+'#!#as san)u,neas %ue se &'"#uen ('as una *es!-n asu*a'. C*/s!amen(e se 0a

#!!#!#" en 0em"s(as!a &'!ma'!a en *a %ue &a'(!!&an $un#amen(a*men(e *as

&*a%ue(as a ('a+s #e *"s &'"es"s #e a#0es!-n 'e*u(am!en(" a(!a!-n


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a)'e)a!-n &a'a $"'ma' e* (a&-n 0em"s(/(!" !n!!a* $ase #e "a)u*a!-n san)u,nea

0em"s(as!a seun#a'!a.

E* (+'m!n" 5co"#$l"c!%&6 se #e'!a #e* *a(,n 5"a)u*a'e6 %ue %u!e'e #e!' ua7a' "

en "('as &a*a8'as &asa' #e* es(a#" *,%u!#" a* s-*!#". As, (enem"s %ue e* s!s(ema #e

*a 0em"s(as!a se su8#!!#e en #"s s!s(emas$!s!"*-)!"s !m&"'(an(es9

1. L" "!" ?'!="'!" #"n#e se **ea a a8" $un#amen(a*men(e *a

!n(e'a!-n en('e e* as" *as &*a%ue(as.2. L" "!" ec$&d"'!" o co"#$l"c!%& #"n#e &a'(!!&an *"s $a("'es #e

"a)u*a!-n %ue !n(e'a!"nan s"8'e una su&e'$!!e a(a*,(!a &a'a $"'ma' una

'e# #e $!8'!na e !n(e)'a' e* "a)u*" san)u,ne" (a&-n 0em"s(a(!" &*a%ue(a'!"

&'!ma'!".

La sa*!#a #e san)'e #e un as" *es!"na#" se (a&"na )'a!as a un &'"es" **ama#"

0em"s(as!a %ue (!ene *u)a' en 3 $ases9

1. En un &'!me' m"men(" (!ene *u)a' una as""ns('!!-n *"a* $a"'e!#a &"'

*a *!8e'a!-n #e se'"("n!na "('as sus(an!as as""ns('!("'as %ue &'"!enen

#e *as &*a%ue(as9 #e es(a mane'a se 'e#ue *a &+'#!#a #e san)'e.2. La se)un#a $ase "ns!s(e en *a a)*u(!na!-n #e *as &*a%ue(as *a $"'ma!-n

#e un a)'e)a#" &*a%ue(a'!" %ue (a&"na '/&!#amen(e *a :"na *es!"na#a.3. Es(e (a&-n es (em&"'a* se ('ans$"'ma en un "/)u*" )'a!as a *a

('ans$"'ma!-n #e* $!8'!n-)en" &'"(e,na s"*u8*e en $!8'!na !ns"*u8*e. Las

m"*+u*as #e $!8'!na "ns(!(uen una 'e# ('!#!mens!"na* en *a %ue %ue#an

a('a&a#"s *"s e*emen("s %ue "m&"nen *a san)'e &*a%ue(as )*-8u*"s

8*an"s )*-8u*"s '"7"s.


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2. COMPONENTES DE LA ,EMOSTASIA

En *a 0em"s(as!a !n(e'!enen 3 (!&"s #e "m&"nen(es9

• C"m&"nen(es (!su*a'es.• C"m&"nen(es &*a%ue(a'!"s.• C"m&"nen(es &*asm/(!"s.

L"s C"m&"nen(es (!su*a'es #e *a 0em"s(as!a s"n *"s as"s san)u,ne"s *"s

$a("'es (!su*a'es #e *a "a)u*a!-n &"' e7m *a ('"m8"&*as(!na (!su*a'

L"s "m&"nen(es &*a%ue(a'!"s #e *a 0em"s(as!a s"n *"s ('"m8"!("s *"s $a("'es

#e *a "a)u*a!-n &"' e7m e* $a("' 3 &*a%ue(a'!"

L"s "m&"nen(es &*asm/(!"s #e *a 0em"s(as!a s"n *"s $a("'es &*asm/(!"s %ue

a(!en " !n0!8en *a "a)u*a!-n *"s %ue a(!an " !n0!8en *a $!8'!n-*!s!s.

3. FASES DE LA ,EMOSTASIA

La 0em"s(as!a se #!!#e en ('es $ases9

3.1. Hem"s(as!a &'!ma'!a3.2. Hem"s(as!a seun#a'!a " "a)u*a!-n3.3. F!8'!n-*!s!s.

3.1. ,EMOSTASIA PRIMARIA

Cuan#" se &'"#ue *a '"(u'a #e un as" san)u,ne" *a san)'e e;('aasa#a

"m&'!me *"s (e7!#"s e!n"s se #esena#ena una as""ns('!!-n 'e$*e7a. La


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as""ns('!!-n "as!"na un en*en(e!m!en(" #e *a !'u*a!-n #e *a san)'e a ('a+s

#e* as" #a 0!#'";!('!&(am!na %ue "n('!8ue a a&'";!ma' *as &a'e#es #e* as"

en('e s,.

Tan(" *a a&'";!ma!-n #e *as &a'e#es asu*a'es %ue "as!"na *a as""ns('!!-n

"m" e* (a&"nam!en(" #e *a *u: asu*a' "'!)!na#" &"' e* a)'e)a#" &*a%ue(a'!"

&'"#uen una 0em"s(as!a &'"!s!"na* %ue es su$!!en(e &a'a "'(a' *a 0em"''a)!a

&'"#u!#a &"' 'u&(u'a #e un as" san)u,ne" #e &e%ue


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A/ F$&c!%& de l" cl$l" e&do>el!"le. E* en#"(e*!" asu*a' es un &a'(!!&an(e

#!n/m!" en mu0"s as&e("s #e *a 0em"s(as!a.

• P'"&!e#a#es an(!('"m8")+n!as. E* en#"(e*!" asu*a' &"see una su&e'$!!e

('"m8"''es!s(en(e a* $*u7" san)u,ne" &"' *a ua* un en#"(e*!" n"'ma* e !n(a("

n" &'"muee *a a#0es!-n &*a%ue(a'!a n! a(!a *a "a)u*a!-n@. Es(a &'"&!e#a#

#e* en#"(e*!" es a('!8u!8*e a9 Mean!sm"s a(!"s. As"!a#"s "n *a &a'(!!&a!-n #!'e(a " !n#!'e(a

#e *as +*u*as en#"(e*!a*es !n(a(as.

Es(as +*u*as e*!m!nan a(!amen(e #e *a !'u*a!-n sus(an!as %ue $a!*!(an *a

a)'e)a!-n &*a%ue(a'!a ADP am!nas as"a(!as &'"a)'e)an(es....

Tam8!+n (!enen una $un!-n #e s,n(es!s #e sus(an!as an(!('"m8-(!as9 ADPasa9 En:!ma %ue !na(!a a* ADP. s(e es un a(!a#"' $!s!"*-)!" #e *as

&*a%ue(as es *!8e'a#" &"' &*a%ue(as (e7!#"s e!n"s #a


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En un #a"ol!=o de l" ?l"$e>" co& 'el"c!%& "l ác!do "'"$!d%&!co AA/;

La &'!n!&a* en:!ma es *a c!cloo!#e&"" CO %ue #e(e'm!na *a $"'ma!-n #e

('"m8";an" %ue &'"#ue a)'e)a8!*!#a# &*a%ue(a'!a as""ns('!!-n.

La !n0!8!!-n #e *a CO **ea a *a &'"#u!-n #e &'"s(a!*!nas %ue ausan

as"#!*a(a!-n #esa)'e)a!-n &*a%ue(a'!a

4. ,EMOSTASIA SECUNDARIA O COAGULACIÓN

La "a)u*a!-n es un &'"es" %ue "n#ue a un am8!" en e* es(a#" $,s!" #e*

&*asma. Es(e am8!" #e* &*asma "ns!s(e en una )e*!$!a!"n #e* m!sm" es #e!' en

un &as" #e su es(a#" *,%u!#" a es(a#" )e*. La )e*!$!a!"n #e* &*asma se &'"#ue

#e8!#" a *a ('ans$"'ma!-n #e una #e *as &'"(e,nas s"*u8*es %ue "n(!ene **ama#"

$!8'!n-)en" en "('a s"*u8*e "n"!#a "m" $!8'!na. La $!8'!na se es('u(u'a en $"'ma

#e 'e# %ue "ns"*!#a e* a)'e)a#" &*a%ue(a'!" #an#" *u)a' a* coá#$lo. La 'e# #e$!8'!na en e* !n(e'!"' #e* "')an!sm" n" s"*" en)*"8a a *as &*a%ue(as s!n" %ue


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(am8!+n !n*ue a "('as +*u*as san)u!neas.De8!#" a es(" e* "a)u*" a#"&(a un

"*"' '"7!:" &'"&!" #e *"s e'!('"!("s.

Un ('"m8" san)u,ne" es un "a)u*" #e san)'e %ue &e'manee a#0e'!#" a *a &a'e#

asu*a' es a''as('a#" &"' *a "''!en(e san)u,nea.

La $"'ma!-n #e *a $!8'!na es e* &un(" $!na* #e una 'ea!-n en a#ena %ue "ns!s(een una se'!e #e a(!a!"nes sues!as #e unas sus(an!as a "('as %ue (!ene

"m" $!na*!#a# *a #e am&*!$!a' e* es(,mu*" %ue 0a #esena#ena#" *a "a)u*a!-n. A

es(" "n('!8ue en"'memen(e *a e;!s(en!a #e !n(e''e*a!"nes en('e *as #"s ,as #e

"a)u*a!-n #e mean!sm"s #e a(!a!-n #e *"s $a("'es me#!an(e un &'"es" #e

'e('"a*!men(a!-n.

A#em/s es(a 'ea!-n en a#ena &ue#e se' a(!a#a " !n0!8!#a a #!s(!n("s n!e*es

&"' *" %ue &ue#e se' $/!*men(e m"#u*a#a &"' e* "')an!sm".Las sus(an!as %ue !n(e'!enen en es(a $ase #e *a 0em"s(as!a 'e!8e e* n"m8'e #e

@"c>o'e de l" co"#$l"c!%&.

La "a)u*a!-n #e* &*asma $!na*!:a a* (+'m!n" #e un (!em&" "m&'en#!#" en('e *"s =

1 m!nu("s "n(a#"s #es#e e* "m!en:" #e *a 0em"''a)!a.

De $"'ma es%uem/(!a se &ue#e 'e&'esen(a' "m" una asa#a en:!m/(!a

'ea*!:a#a &"' s"8'e &'"(e,nas &*asm/(!as.

T!ene a'!as $ases9

1. F"'ma!-n #e &'"('"m8!nasa " a(!a#"' #e &'"('"m8!na

2. F"'ma!-n #e ('"m8!na

3. F"'ma!-n #e $!8'!na

1. L" @o'="c!%& de ?'o>'o=!&"" ?$ede e#$!' do ";

H V" e>'&ec"B e>'""c$l"' o e%#e&"; e' es%uemas #e *a &'esen(a!-n en

ma(e'!a* "m&*emen(a'!".

H V" !&>'&ec"B !&>'""c$l"' o e&d%#e&"; e' es%uemas #e *a &'esen(a!-n en

ma(e'!a* "m&*emen(a'!". Las #"s ,as "!n!#en a(!an#" e* $a("' &a'a a &a'(!'

#e es(e &un(" $"'ma' *a ,a $!na* "m?n. Es(e $a("' 7un(" "n e* $a("' &*a%ue(a'!" 3

e* a*!" e* $a("' $"'ma un "m&*e7" en:!m/(!" #en"m!na#" &'"('"m8!nasa "

a(!a#"' #e *a &'"('"m8!na.


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2. L" @o'="c!%& de >'o=!&" se 'ea*!:a en una ?n!a 'ea!-n s"8'e *a &'"('"m8!na

Fa("' II. En *a san)'e se enuen('a &'esen(e una &'"(e,na !na(!a e* Fa("' I "

$!8'!n-)en".

3. L" >'o=!&" a(a*!:a e* $'a!"nam!en(" #e es(a m"*+u*a $"'man#" m"n-me'"s

#e $!8'!na s"*u8*es e !nes(a8*es %ue en &'esen!a #e Ca Fa("' III a(!a#" se

&"*!me'!:an $"'man#" un &"*,me'" !ns"*u8*e en $"'ma #e 'e# " ma**a ('!#!mens!"na*

%ue !e''a *"s es&a!"s en('e *as &*a%ue(as se**a #e $"'ma #e$!n!(!a e* (a&-n

&*a%ue(a'!" #an#" *u)a' a* ('"m8" '"7" " "/)u*".

4.1. c"'"c>e'>!c" de lo @"c>o'e de co"#$l"c!%&

La n"men*a(u'a !n(e'na!"na* #e *"s $a("'es &*asm/(!"s #e *a "a)u*a!-n se

&'esen(a en *a (a8*a 1 u(!*!:an#" n?me'"s '"man"s e* n?me'" se as!)n- en e* "'#enen %ue $ue'"n #esu8!e'("s e* $a("' I FI n" 0a s!#" as!)na#". L"s $a("'es %ue

n" se as!)nan "n nume'" '"man" en *a n"men*a(u'a !n(e'na!"na* s"n *a

&'ea*!'e!na su $"'ma a(!a Ca*!'e,na e* !n!n")en" #e a*(" &es" m"*eu*a'

CAPM. L"s $"s$"*,&!#"s &*a%ue(a'!"s n" es(/n !n*u!#"s en es(a *as!$!a!-n.

T"#as *as &'"(e,nas "m&"nen(es e*u*a'es !n"*u'a#"s en *a "a)u*a!-n

san)u,nea e;!s(en 8a7" "n#!!"nes $!s!"*-)!as n"'ma*es en $"'ma !na(!a %ue es

*a $"'ma en %ue !'u*an en e* &*asma. La &'"('"m8!na FII e* $a("' II $a("' I $a("' s"n &'"en:!mas " !m-)en"s "ne'(!#"s a en:!mas &"' 'u&(u'a #e una "

#"s un!"nes &e&(,#!as. E* su$!7" 5a6 #es&u+s #e* n?me'" '"man" !n#!a *a $"'ma

a(!a #e* $a("' &"' e7em&*" Fa. E* FIII F s"n &'""$a("'es s"n "ne'(!#"s

a "$a("'es a(!"s FIIIa Fa &"' 'u&(u'a #e una un!-n &e&(,#!a.

TA)LA 1.

FACTOR SINONIMO IDA

MEDIA

0"'as

CONCENTRACION

PLASMATICAu)m*

CROMOSOMA

Fa("' I F!8'!n-)en" 212 2 4 4Fa("' II P'"('"m8!na 1 > 1= 11Fa("' P'"ae*e'!na $a("'

*/8!*

121 = 1 1

Fa("' I N" as!)na#" Fa("' II P'""ne'(!na 3 = 13


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au("&'"('"m8!na I

Fa("' III Fa("' an(!0em"$!*!"

A )*"8u*!na

an(!0em"$!*!a

12 1

Fa("' I Fa("' #e C0'!s(mas"m&"nen(e

('"m8"&*as(!n!" #e*

&*asma

au("&'"('"m8!na II

$a("' an(!0em"$!*!"

124 4 =

Fa("' Fa("' #e S(ua'(

P'"e'

('"m8"!nasa

au("&'"('"m8!na III

34 1 13

Fa("' I An(ee#en(e

('"m8"&*as(!" #e*

&*asma

=2 = 4

Fa("' II Fa("' #e Ha)eman 3 =Fa("' III Fa("' es(a8!*!:an(e

#e *a

$!8'!na

&'"('ans)*u(am!#asa

$!8'!nasa

$!8'!n"*!)asa

4 1 1.

FT Fa("'

T!su*a'

1

P'ea*!'e,na Fa("' #e F*e(0e' 3= 3 a = 4

C!n!n")en"

#e

a*(" &es"

m"*eu*a'

Fa("' #e F!(:)e'a*#

!**!amsF*au7eau

1= > 3

Pa'a $a!*!(a' e* en(en#!m!en(" #e* s!s(ema #e *a "a)u*a!-n *as!$!a'em"s a *"s

$a("'es #e aue'#" "n sus &'"&!e#a#es )ene'a*es.


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F"c>o'e de?e&d!e&>e de l" !>"=!&" . A*)un"s #e *"s $a("'es #e *a "a)u*a!-n

'e%u!e'en #e !(am!na B &a'a su s,n(es!s "m&*e(a. Es(as &'"(e,nas !n*uen a *"s

$a("'es II II I as, "m" a *as #"s &'"(e,nas 'e)u*a#"'as &'"(e,na C

&'"(e,na S. T"#as (!enen es('u(u'as s!m!*a'es en sus 'e)!"nes "n !e'(a 0"m"*"),a

"n(!enen #e 1 a 12 'es!#u"s G*u *"s ua*es s"n a'8";!*a#"s a /!#"a'8";!)*u(/m!" en &'esen!a #e !(am!na B s"n !m&"'(an(es &a'a *a un!-n #e*

Ca neesa'!"s &a'a *a !n(e'a!-n #e es(as &'"(e,nas !(am!na B #e&en#!en(es "n

mem8'anas &*a%ue(a'!as $"s$"*,&!#"s &*a%ue(a'!"s.

En ausen!a #e !(am!na B " en e* as" #e ('a(am!en(" "n an(!"a)u*an(e "n

an(a)"n!s(as #e *a !(am!na B *"s $a("'es II II I s"n s!n(e(!:a#"s &e'" es(/n

!n"m&*e("s a'een #e *a un!-n #e a*!" a* /!#" a'8";!)*u(/m!" en e* &*asma

se enuen('an "m" $a("'es n" $un!"na*es !na&aes #e un!'se a#eua#amen(e a*"s !"nes Ca es("s $a("'es s"n "n"!#"s "m" PIBA &"' sus s!)*as en !n)*+s9

&'"(e,nas !n#u!#as &"' ausen!a " an(a)"n!sm" #e *a !(am!na B.

Co@"c>o'e. Se #!!#en en #"s )'u&"s9

P'oco@"c>o'e ?l"=á>!co; Se !n*uen *"s $a("'es III e* CAPM. L"s #"s

&'!me'"s (!enen &'"&!e#a#es 8!"%u,m!as es('u(u'a*es s!m!*a'es s"n s!n(e(!:a#"s

"m" una s"*a a#ena "n &es" m"*eu*a' PM a&'";!ma#amen(e #e 2(!enen ('es 0"m"*"),as ('es #"m!n!"s A un )'an #"m!n!" un &a' 0"m-*")" #e

#"m!n!" C. E* F !'u*a en &*asma "m" una &'"(e,na m"n"m+'!a e* FIII !'u*a

"n e* $a("' #e "n !**e8'an# F a* a(!a'se se #!s"!an &"' &'"(e-*!s!s #e

un!"nes &e&(,#!as. Am8"s s"n s!n(e(!:a#"s "m" &'""$a("'es a* se' a(!a#"s

&"' *a ('"m8!na se "n!e'(en a "$a("'es $"'man#" &a'(e #e *"s "m&*e7"s asa

FIII IIasa F s"8'e *a su&e'$!!e &*a%ue(a'!a "('a &"s!8!*!#a# #e a(!a!-n #e*

F es &"' &a'(e #e* Fa. e!n(!!n" &"' !en(" #e* F se enuen('a en *"s )'/nu*"s #e *a &*a%ue(a un!#" en "m&*e7" a una &'"(e,na mu*(!m+'!a **ama#a

mu*(!me'!na es *!8e'a#" en $"'ma #e &'""$a("'. E* CAPM $ue #es'!(" "n

an(e'!"'!#a#.

E* "('" )'u&" *" "ns(!(uen lo P'oco@"c>o'e cel$l"'e; Fa("' (!su*a' FT

('"m8"m"#u*!na TM. E* FT es una &'"(e,na es&e,$!a &'esen(e s"8'e *a mem8'ana

&*asm/(!a #e +*u*as "m" *"s m"n"!("s +*u*as en#"(e*!a*es '!" en

a'8"0!#'a("s es e* ?n!" $a("' #e *a "a)u*a!-n %ue n" se enuen('a n"'ma*men(een *a !'u*a!-n " en "n(a(" "n +s(e. A #!$e'en!a #e *"s "('"s "$a("'es $a("'


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$a("' III e* $a("' (!su*a' n" 'e%u!e'e n!n)?n &'"es" &a'a su a(!!#a# s-*" se

nees!(a e* "n(a(" "n e* FII. Un" #e *"s 0a**a:)"s m/s !m&"'(an(es #e* $a("'

(!su*a' es %ue un!#" a* FII !n!!an *a "a)u*a!-n &*asm/(!a (am8!+n se 0a

"8se'a#" %ue *a !n!!a!-n s"*a #e&en#e #e *a 'u&(u'a #e *a 8a''e'a $,s!a %ue

n"'ma*men(e se&a'a a* FII #e* FT &"' *" (an(" &a'a %ue *a 0em"s(as!a "u''a e*#a'&ec" %ue "ns!s(e #e FIIa FT e* ?*(!m" #e "'!)en e;(',nse"

a *a !'u*a!-n san)u,nea. Am8as ,as #e *a "a)u*a!-n &"#',an a(!a' a* F %ue

7un(" "n e* Fa "ne'(!',an a *a &'"('"m8!na en ('"m8!na. Es("s "ne&("s $ue'"n


13/33

mu !m&"'(an(es s!n em8a')" a'!"s )'u&"s 0an 'e"n"!#" %ue *"s s!s(emas

!n(',nse" e;(',nse" #e *a "a)u*a!-n n" &ue#en $un!"na' #e mane'a

!n#e&en#!en(e un" #e* "('" a %ue ("#"s *"s $a("'es #e "a)u*a!-n se

!n(e''e*a!"nan en('e s, a#em/s "m" se men!"n- &'e!amen(e *"s $a("'es

"n"!#"s "m" #e "n(a(" ena')a#"s #e !n!!a' *a "a)u*a!-n n" (!enen$un!-n en e* s!s(ema #e "a)u*a!-n &"' *"s es(u#!"s *,n!"s es &'"8a8*e %ue su

$un!-n sea en e* s!s(ema $!8'!n"*,(!" en *a )ene'a!-n #e !n!nas. Es !m&"'(an(e

men!"na' %ue n" #e8e',a 0a8*a'se #e asa#a #e "a)u*a!-n s!n" m/s 8!en #e

una se'!e #e am8!"s 8!"%u,m!"s en:!m/(!"s &a'a *a $"'ma!-n #e ('"m8!na

su8seuen(emen(e *a $"'ma!-n #e un "/)u*" #e $!8'!na. En *"s a


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4.3. E>"?" o @"e de l" co"#$l"c!o&;

Se)?n *a !s!-n a(ua* *a "a)u*a!-n se &'"#ue en ('es e(a&as !n(e''e*a!"na#as9

4.3.1. LA FASE DE INICIACIÓN

R"8e'(s "*a8"'a#"'es #em"s('a'"n %ue e* "m&*e7" $a("' IIaFT !n!!a *a

"a)u*a!-n a(!an#" (an(" a* $a("' I "m" a* $a("' en una e(a&a !n!!a* " #e

5a(!a!-n " !)n!!-n6. L"s $a("'es Ia a 'esu*(an(es (!enen $un!"nes mu

#!$e'en(es en *as &'-;!mas 'ea!"nes. E* $a("' a es neesa'!" &a'a %ue (en)a

*u)a' *a a(!a!-n &*a%ue(a'!a m!en('as %ue e* $a("' Ia se 'e%u!e'e &a'a %ue (en)a

*u)a' una &'"#u!-n su$!!en(e #e ('"m8!na .Cuan#" e* "m&*e7" FTFIIa )ene'a

$a("' se a(!a un &"#e'"s" !n0!8!#"' #e *a "a)u*a!-n e* !n0!8!#"' #e *a ,a #e*

$a("' (!su*a' IFT %ue se ena')a #e !n0!8!' a* FT &"' *" (an(" es !nsu$!!en(es"s(ene' *a 0em"s(as!a &"'%ue *a am&*!$!a!-n &'"&a)a!-n #e *a "a)u*a!-n es

&"' "n('"* a(a*,(!". S!n em8a')" es(a $ase #e !n!!a!-n #e *a "a)u*a!-n &e'm!(e

)ene'a' $a("' a %ue a su e: )ene'a &e%ue


15/33

&'"('"m8!nasa &*a%ue(a'!a *a "ns(!(ue e* "m&*e7" IaIIIa &*a%ue(a'!". E* $a("'

a un!#" a *a &*a%ue(a en &'esen!a #e su "$a("' e* Fa "n!e'(en *a &'"('"m8!na

en ('"m8!na en an(!#a#es su$!!en(es &a'a )ene'a' *a $"'ma!-n #e* "/)u*" #e

$!8'!na. En *a a(ua*!#a# e;!s(en !m&"'(an(es "ne&("s s"8'e *a !n!!a!-n #e *a

"a)u*a!-n !n !" en('e e**"s91. E* $a("' (!su*a' FT$a("' IIa IIa FTFIIa s"n *"s !n!!a#"'es #e *a

"a)u*a!-n2. La a(!a!-n #e* $a("' I &"' e* "m&*e7" FTFIIa 3. La !m&"'(an!a #e *"s $a("'es III FIII I FI &a'a s"s(ene' *a

"a)u*a!-n &'"#u!en#" )'an#es an(!#a#es #e ('"m8!na.

(. FI)RINOLISIS.P"' "('" *a#" una e: %ue se 0a &'"#u!#" e* "/)u*" se 0a 'es(au'a#" e* #a


16/33

F!'!&%l!! o 'eol$c!%& >'" l" co"#$l"c!%& .Es(a ?*(!ma $ase (!ene *u)a' una e:

%ue *a &a'e# asu*a' se 0a 'e"ns(!(u!#" #e nue" a n" se 'e%u!e'e *a &'esen!a#e* "/)u*". Es(e &'"es" se #en"m!na $!8'!n-*!s!s "ns!s(e en *a e*!m!na!-n #e *a

$!8'!na. Su !m&"'(an!a es ma"' 8a7" e* &un(" #e !s(a #e "n('"* en *a &'een!-n #e

*a $"'ma!-n #e "/)u*"s %ue en *a e*!m!na!-n #e *"s m!sm"s. E* e%u!*!8'!" en('e *a

$"'ma!-n #e $!8'!na su e*!m!na!-n "n('!8ue a *a *!m!(a!-n #e* &'"es"

0em"s(/(!" a *a 'e)!-n !'un#an(e a* &un(" #e *es!-n. La 'ea!-n $un#amen(a* es

*a "ne's!-n #e una &'"(e,na &*asm/(!a !na(!a e* &*asm!n-)en" en una a(!a *a

&*asm!na. Es(a a(!a!-n es 'ea*!:a#a &"' $a("'es en#-)en"s "m" e* $a("' a(!a#"' #e* &*asm!n-)en" &'esen(e en *as +*u*as en#"(e*!a*es " *a e'!('"!nasa

&'esen(e en +*u*as san)u,neas.


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*. METODOS + TECNICAS DE EVALUACION DE LA

,EMOSTACIA + TROM)OSIS

M>odo de l"o'">o'!o ?"'" el e>$d!o de l" "!".

Pa'a e* "''e(" en$"%ue #!a)n-s(!" #e *"s ('as("'n"s #e *a "a)u*a!-n es

$un#amen(a* *a 'ea*!:a!-n #e una 8uena anamnes!s e;&*"'a!-n $,s!a m!nu!"sa

#e* &a!en(e. L"s #a("s *,n!"s s!)n"s s,n("mas an(ee#en(es 0em"''/)!"s "

0!s("'!a #e "a)u*"&a(,as &ue#en 'esu*(a' #e )'an au#a &a'a un &'!me' en$"%ue

#!a)n-s(!". A#em/s (am8!+n #!s&"nem"s #e una "m&*e(a 8a(e',a #e ana*,(!as

&'ue8as "m&*emen(a'!as %ue &e'm!(en "n"e' e* a*ane *a )'ae#a# #e *a

en$e'me#a#.

ANAMNESIS + E9PLORACIÓN FÍSICA.

La e;!s(en!a #e an(ee#en(es $am!*!a'es #e en$e'me#a#es 0em"''/)!as

Hem"$!*!a En$e'me#a# #e "n !**e8'an# &ue#e "'!en(a' 0a!a ('as("'n"s

0e'e#!(a'!"s. Se #e8e !n#a)a' ae'a #e *"s an(ee#en(es &e's"na*es #e "('"s

$en-men"s 0em"''/)!"s 'e*a!"na#"s "n !n(e'en!"nes %u!'?')!as e;('a!"nes#en(a'!as &a'("s 0em"''a)!as mu"sas es&"n(/neas e;!s(en!a #e 0ema("mas "

e%u!m"s!s $'euen(es...e(.

La e#a# #e &'esen(a!-n #e* ('as("'n" su 'e*a!-n "n "('as en$e'me#a#es

!n$e!"nes "*a)en"s!s en$e'me#a#es 0ema("*-)!as ("ma #e $/'ma"s

as&!'!na #!uma',n!"s (am8!+n &ue#e au#a'n"s en *a 8?s%ue#a #e *a e(!"*"),a.

L"s ('as("'n"s #e *a 0em"s(as!a &'!ma'!a9 as"s &*a%ue(as se man!$!es(an "n

*,n!a 0em"''/)!a #!$e'en(e #e *as "a)u*"&a(,as &"' #e$e("s #e &'"(e,nas

&*asm/(!as 0em"s(as!a seun#a'!a.

As, en *"s ('as("'n"s &*a%ue(a'!"s *a 0em"''a)!a sue*e se' !nme#!a(a en *"s

&'!me'"s m!nu("s su *"a*!:a!-n m/s $'euen(e es en &!e* mu"sas9 &?'&u'as

e%u!m"s!s e&!s(a;!s )!n)!"''a)!as ('as e;('a!"nes #en(a'!as 0ema(u'!a.

Cuan#" se ('a(a #e "a)u*"&a(,as &"' #+$!!( #e $a("'es #e *a "a)u*a!-n *a

0em"''a)!a &ue#e (a'#a' 0"'as " !n*us" #,as en a&a'ee'. La 0em"''a)!a sue*ea$e(a' a a'(!u*a!"nes m?su*"s -')an"s !n(e'n"s s"n #e ma"' uan(,a


18/33

)ene'a*men(e. La e;&*"'a!-n $,s!a #e(a**a#a es (am8!+n mu !m&"'(an(e

#e&en#!en#" #e* *u)a' $"'ma #e san)'a#" &"#em"s en"n('a'9

• P'?$'"; Se ('a(a #e una 0em"''a)!a u(/nea %ue se #en"m!nan ?e>e$!"

s! s"n &un(!$"'mes #e &""s m!*,me('"s #e #!/me('" e$!=o! s! s"n #e

ma"' (ama


19/33

a!#en(e &"n)a en &e*!)'" su !#a *as #e sus "m&a


20/33

su87e(!a. N" "8s(an(e s! se 'ea*!:a "n u!#a#" &ue#e #a' 'esu*(a#"s

'e&'"#u!8*es 8'!n#a' !n$"'ma!-n !m&"'(an(e &a'a *a ea*ua!-n #e

*"s &a!en(es "n (en#en!a a* san)'a#".M">e'!"l;

• Man)u!(" #e &'es!-n

• Lane(a

A*"0"*• C'"n-me('"• Pa&e* $!*('"

Tc&!c" 1.Se "*"a e* man)u!(" #e &'es!-n en e* 8'a:" #e* &a!en(e se

'e)u*a a 4 mmH) man(en!+n#"*" a es(a &'es!-n a *" *a')" #e ("#a *a

&'ue8a.

2.Des!n$e(a' "n e* a*)"#-n *a &a'(e su&e'!"' #e *a a'a an(e'!"' #e*an(e8'a:". 3.C"n una *ane(a se 'ea*!:a manua*men(e un "'(e a&'";!ma#" #e

1m #e *"n)!(u# &"' 1mm #e &'"$un#!#a# en *a &a'(e su&e'!"' #e *a

a'a an(e'!"' #e* an(e8'a:" en una :"na s!n e**" a*e7a#a #e *as

enas su&e'$!!a*es a&'";. a un"s 3 m &"' #e8a7" #e* &*!e)ue #e* "#"

&a'a*e*" a* m!sm". 4.Inme#!a(amen(e #es&u+s #e 'ea*!:a' *a !n!s!-n se &"ne en ma'0a

e* '"n-me('". =.La san)'e %ue 8'"(a #e $"'ma es&"n(/nea se asean#" "n un &a&e* $!*('" a#a 3 se)un#"s "n *a &'eau!-n #e

%ue e* &a&e* s"*" "n(a(e "n *a san)'e n" "n *a 0e'!#a.. An"(a' e* (!em&" %ue (a'#a en esa' *a 0em"''a)!a %ue se'/ e*

'esu*(a#" #e *a &'ue8a. I&>e'?'e>"c!%& del 'e$l>"do L"s *,m!(es #e 'e$e'en!a &a'a e* (!em&" #e san)'a#" "n *a

me("#"*"),a #es'!(a es #e 2 0as(a m!nu("s s"n *a'amen(e

&a("*-)!"s *"s (!em&"s su&e'!"'es a 1 m!nu("s se "ns!#e'an)'aes *"s su&e'!"'es a 2 m!nu("s. La &'ue8a se a*a')a &"' 'e#u!-n

!m&"'(an(e #e* n?me'" #e &*a%ue(as " &"' a*(e'a!"nes $un!"na*es #e

es(as "n)+n!(as " a#%u!'!#as. Es sens!8*e a *as 'e#u!"nes

ma'a#as #e* 0ema("'!(". E* (!em&" #e san)'a#" &ue#e &'"*"n)a'se

(am8!+n uan#" e;!s(e una 'e#u!-n " una an"'ma*!#a# en !e'("s

$a("'es &*asm/(!"s %ue !n(e'!enen en *a a#0es!!#a# a)'e)a!-n #e

*as &*a%ue(as "m" e* $a("' "n !**e8'an# e* $!8'!n-)en" " e* $a("'

.


21/33

La !n)es(a #e as&!'!na en *"s #,as %ue &'ee#en a *a &'ue8a sue*e

!n#u!' *!)e'as a*(e'a!"nes en *"s 'esu*(a#"s #e su7e("s n"'ma*es &e'"

ma)n!$!a *a &'"*"n)a!-n seun#a'!a a ua*%u!e' #e$e(" 0em"s(/(!".

*. 2. PRUE)A DEL LA-O RUMPEL LEEDE/N"'ma*men(e *a &a'e# asu*a' n" &e'm!(e e;('aasa!-n #e san)'e. S!n

em8a')" en a*)unas s!(ua!"nes an"'ma*es (a*es "m" #esnu('!!-n

!n(";!a!"nes ('"m8"!("&en!as #esa''e)*"s 0"'m"na*es se &ue#e

&'esen(a' una $'a)!*!#a# #e* en#"(e*!" a&!*a' " &a'e# asu*a' %ue &e'm!(e

una sa*!#a an"'ma* #e *a san)'e 0a!a *"s (e7!#"s !'u*an(es *" %ue se

('a#ue en *a a&a'!!-n #e &e(e%u!as. P"' *" (an(" es una me#!#a #e *a

!n(e)'!#a# #e *"s "m&"nen(es asu*a' &*a%ue(a'!".

P'!&c!?!o; La &'ue8a #e* *a:" " ("'n!%ue(e "ns!s(e en a&*!a' una &'es!-n &"s!(!a en e*

an(e8'a:" #e* &a!en(e "8se'a' en un (!em&" #e(e'm!na#" *a a&a'!!-n #e

&e(e%u!as en e* an(e8'a:" &"' #e8a7" #e* s!(!" #e *a *es!-n.V"lo'e de 'e@e'e&c!";

• Ne)a(!a9 n" a&a'!!-n #e &e(e%u!as.P"s!(!a9 a&a'!!-n #e &e(e%u!as en e* an(e8'a:" &"' #e8a7" #e* s!(!" #e

*a *es!-n.Esa*a &a'a !n$"'ma' e* n?me'" #e &e(e%u!as9

• a 1 V 1• 1 a 2 V 2• 2 a = V 3• = a m/s V 4

Se &'"#ue ma"' !n$"'ma!-n #e &e(e%u!as en &'esen!a #e T'"m8"!("&en!a

('"m8as(en!a &u'&u'a asu*a' sen!* a*+')!a Es"'8u(" Anem!a A&*/s!a "

Hem"$!*!a. E* n?me'" e* (ama


22/33

m+("#"s en san)'e ("(a* e* )'a#" #e 'e('a!-n es #e&en#!en(e #e*

0ema("'!(" " sea #e* "*umen )*"8u*a' a 'e('ae'. P'!&c!?!o; La 'e('a!-n #e* "/)u*" #e&en#e #e *a a(!!#a# ('"m8"#!n/m!a

&*a%ue(a'!a &"'%ue se nees!(a un n?me'" m,n!m" #e &*a%ue(as n"'ma*es

a(!"nes #!a*en(es. La a(!n"m!"s!na &*a%ue(a'!a ('"m8"s(e'n!na &'"(e,na

"n('/(!* &*a%ue(a'!a &a'ee se' 'es&"nsa8*e #e es(a $un!-n.

Co&d!c!o&e del ?"c!e&>e JKo =$e>'";

San)'e ("(a* ("ma#a en (u8" s!n an(!"a)u*an(e (u8" (a&a '"7a. N" se

ae&(an mues('as 0em"*!:a#"s #e8e an"(a'se *"s me#!amen("s %ue

es(+ ("man#" e* &a!en(e &ues *a (e'a&!a "n an(!"a)u*an(es "('"s

me#!amen("s %ue (!enen e$e(" an(!"a)u*an(e e!(an *a $"'ma!-n #e*

"/)u*".

Me>odolo#"

C"*"a' 1. m* #e san)'e ("(a* en a#a un" #e ('es (u8"s #e 1 ; = mm e

!nu8a' en 8a"do

E* (!em&" #e 'e('a!-n #e* "/)u*" es un !n#!a#"' #e #!s$un!-n

&*a%ue(a'!a " #e *a $un!"na*!#a# #e *as &*a%ue(as. Se 'e%u!e'e %ue e* n!e*

#e* $!8'!n-)en" e* 0ema("'!(" sea n"'ma*. Se "ns!#e'a una &'ue8a #e

(am!:a7e %ue (!ene &"a sens!8!*!#a# es&e!$!!#a#.

Ha 'e('a!-n an"'ma* #e* "/)u*" en9


23/33

T'"m8"!("&en!a ('"m8as(en!a #e G*an:mann "a)u*a!-n !n('aasu*a'

#!sem!na#a CID P"*!!(em!a 0em"$!*!a see'a 0!&"$!8'!n")enem!a

(e'a&!a "n as&!'!na "n an(!a)'e)an(es &*a%ue(a'!"s.

*.4. RECUENTO DE PLAUETASLas &*a%ue(as #esem&e" e& lá=!&"E* 'euen(" en */m!na se 'ea*!:a en un e;(en#!#" &'e!amen(e (e

0ema("'!(" #e* &a!en(e %ue (en)a. La $-'mu*a es *a s!)u!en(e9RCTO DE PLAQUETASV NX PLAQ. CONTADAS EN 1 HEMATIES

HTO DEL PACIENTE CORREGIDOFa("' #e "''e!-n #e* 0ema("'!("9a*"' #e H(" = uan#" e* H(" #e* &a!en(e es men"' " !)ua* a 3=.a*"' #e H(" 3 uan#" e* H(" #e* &a!en(e es(/ en('e 3 3.a*"' #e H(" 1 uan#" e* H(" #e* &a!en(e es(/ en('e 3 4.

a*"' #e H(" uan#" e* H(" #e* &a!en(e es ma"' 4. M>odo de @o&!o; C"ns!s(e en "n(a' &*a%ue(as en 1 0ema(,es

mu*(!&*!a' e* 'esu*(a#" &"' *a an(!#a# #e )*-8u*"s '"7"s #e* &a!en(e.Ee=?lo;GR.93. 1LNX DE PLAQ. EN 1 GR.V ENTONCES9RCTO DE PLAQ V 3. 1L RCTO DE PLAQV 22 1L

*.(. TIEMPO DE COAGULACIÓN M0TODO DE LEE ,ITE/ An(!)uamen(e se em&*ea8a "m" m+("#" #e &es%u!sa #e a*(e'a!"nes #e*

mean!sm" !n(',nse" #e *a "a)u*a!-n &a'a m"n!("'ea' *a (e'a&!a "n


24/33

0e&a'!na. H" se "n"e %ue es(e m+("#" (!ene &"a 'e&'"#u!8!*!#a# es

sens!8*e s"*" a #e$!!en!as )'aes #e $a("'es #e *a "a)u*a!-n &"' *" (an("

su us" en e* *a8"'a("'!" es(/ *!m!(a#". Pue#e es(a' &'"*"n)a#" en *as

0em"$!*!as )'aes en *a a$!8'!n")enem!a en es(a#"s $!8'!n"*,(!"s see'"s.PRINCIPIO; E* (!em&" #e "a)u*a!-n #e *a san)'e ("(a* es e* 'e%ue'!#" &a'a %ue una

an(!#a# #e san)'e #e(e'm!na#a "a)u*e en "n#!!"nes es&e,$!as en un

&e',"#" #e (!em&" en('e = 1 m!nu("s.

E$!?o

• T'es (u8"s #e 13 1 mm 8!en *!m&!"s• C'"n-me('"• a


25/33

&ue#e se' !n#!a#a &"' un TPTA an"'ma* uan#" se em&*ea un (!em&" #e

!nu8a!-n men"' #e = m!n 3 m!n %ue se n"'ma*!:a uan#" se &'"*"n)a *a

!nu8a!-n "n e* a(!a#"' #u'an(e 1 m!n.VALORES DE REFERENCIA;

• N"'ma*9 0as(a s &"' en!ma " &"' #e8a7" #e* "n('"*.

• Du#"s"9 1 s &"' en!ma #e* "n('"*.• P'"*"n)a#"9 m/s #e 1 s &"' en!ma #e* "n('"*.

A"'(a#"9 m/s #e s &"' #e8a7" #e* "n('"*.

*.. TIEMPO DE PROTOM)INA METODO DE UIC/Es un m+("#" )*"8a* %ue e;&*"'a *a "a)u*a!-n e;(',nsea. Es m/s sens!8*e

a *"s #e$e("s #e *"s $a("'es II %ue a *a #e$!!en!a #e &'"('"m8!na.

N" #e(e(a #!sm!nu!"nes m"#e'a#as #e $!8'!n-)en" &e'" s! es(e ?*(!m" es

mu 8a7" " e;!s(e un &"(en(e !n0!8!#"' #e *a 'ea!-n ('"m8!na$!8'!n-)en" se

"8(!ene un TP &'"*"n)a#". Es *a &'ue8a #e e*e!-n &a'a e* "n('"* #e *a

(e'a&!a "n an(!"a)u*an(es "'a*es.P'!&c!?!o;E* TP "ns!s(e en #e(e'm!na' e* (!em&" #e "a)u*a!-n #e un &*asma en

&'esen!a #e ('"m8"&*as(!na (!su*a' #e a*!".V"lo'e de 'e@e'e&c!";

• N"'ma*9 0as(a 3 s &"' en!ma " &"' #e8a7" #e* "n('"*.• P'"*"n)a#"9 m/s #e 3 s &"' en!ma #e* "n('"*.

A"'(a#"9 m/s #e 3 s &"' #e8a7" #e* "n('"*.

*.5. TIEMPO DE TROM)INAEs(a &'ue8a &e'm!(e e;&*"'a' #e $"'ma '/&!#a s!m&*e e* (!em&" &a'a *a

$"'ma!-n #e $!8'!na. Es(e !n#!a#"' se man(!ene n"'ma* en #e$!!en!as #e*

$a("' III #e8e se' #e(e'm!na#" an(es #e ua*%u!e' uan(!$!a!-n ana*,(!a en

as" #e &'"*"n)a!-n !ne;&*!a8*e #e *"s (es( )*"8a*es TP TPTA F!). 3. P'!&c!?!o; La &'esen!a #e una an(!#a# #e ('"m8!na #e(e'm!na#a en un &*asma n"'ma*

$"'ma un "/)u*" en un (!em&" #e$!n!#" "ns(an(e %ue &e'm!(e !nes(!)a' *ae(a&a #e $!8'!n"$"'ma!-n. V"lo'e de 'e@e'e&c!";No'="l; 0as(a 3 s #e8a7" #e* "n('"*. P"' *a !n$"'ma!-n %ue 'ee*an es("s es(u#!"s su !m&"'(an!a

"ns!#e'am"s %ue *a !n"'&"'a!-n e7eu!-n #e a#a una #e es(as &'ue8as

en *"s #!$e'en(es n!e*es #e a(en!-n #e sa*u# &e'm!(!'/ e*ea' *a a*!#a# #e *a

a(en!-n #e *"s &a!en(es #e $"'ma m/s '/&!#a "')an!:a#a se)u'a *" %ue

&e'm!(!'/ aan:a' 0a!a *a e;e*en!a en *"s se'!!"s.


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*.6. DOSA7E DE FI)RINÓGENO M0TODO DE CLAUSS

FUNDAMENTO

E* m+("#" #e C*auss m!#e e* ,n#!e #e "ne's!-n #e* $!8'!n-)en" en $!8'!na en

&'esen!a #e un e;es" #e ('"m8!na es(e m+("#" 0a #em"s('a#" se' una&'ue8a '/&!#a sens!8*e e;a(a. Cuan#" e* &*asma #!*u!#" se "a)u*a &"'

e;es" #e ('"m8!na e* n!e* e* $!8'!n-)en" es !ne'samen(e &'"&"'!"na* a*

(!em&" #e "a)u*a!-n.

TECNICA

E* 'ea(!" &ue#e em&*ea'se en $"'ma manua* " "n s!s(emas

sem!au("m/(!"s #e #e(e!-n #e* "/)u*". Se)u!' *as !ns('u!"nes #e us"

#e *"s !ns('umen("s em&*ea#"s. Es 'e"men#a8*e 'ea*!:a' *a me#!!-n &"'

#u&*!a#".

1. A(em&e'a' a (em&e'a(u'a am8!en(e e* "*umen su$!!en(e #e 'ea(!"

'e"ns(!(u!#".2. P'e&a'a' una #!*u!-n 191 #e *a mues('a #e &*asma " &*asma "n('"* "n

Tam&-n #e Im!#a:"* &.e. 2= YL 22= YL.3. P!&e(ea' 1 YL #e &*asma #!*u!#" en una u8e(a #e &'ue8as.4. Inu8a' e* &*asma a 3" C #u'an(e 2 m!nu("s.=. A#!!"na' = YL #e* 'ea(!" &'ea*en(a#". S!mu*(/neamen(e &"ne' en ma'0a

e* '"n-me('" #e* !ns('umen(".. Re)!s('a' e* (!em&" #e "a)u*a!-n.

VALORES DE REFERENCIA Ran)" n"'ma*9 24 )L. Es("s a*"'es s"n "'!en(a(!"s. Es 'e"men#a8*e %ue a#a *a8"'a("'!"

es(a8*e:a sus &'"&!"s a*"'es #e 'e$e'en!a

*.18 . DETERMINACIÓN DE FACTOR 9III PARA PACIENTES

CON SANGRADO SIN ALTERACIÓN DE LAS PRUE)AS

DE COAGULACIÓN

E* FIII es una )*!"&'"(e,na "n un &es" m"*eu*a' #e

a&'";!ma#amen(e 2 BDa. Se enuen('a en e* 0,)a#" e* 8a:". E* FIII

!'u*a en a* &*asma $"'man#" un "m&*e7" n" "a*en(e "n e* $a("'

"n !**e8'an# FIIIF. La ('"m8!na e* $a("' a a(!an e* $a("'

III &a'a %ue es(e #esena#ene *a a(!a!-n #e* $a("' &"' e* $a("' Ia en &'esen!a #e $"s$"*,&!#"s !"nes #e a*!". La #e$!!en!a


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"n)+n!(a #e* $a("' III se man!$!es(a "m" 0em"$!*!a A ua )'ae#a#

#e&en#e #e *a a*!#a# #e* $a("' III &'esen(e9 J 1Z Hem"$!*!a see'a 1

=Z Hem"$!*!a m"#e'a#a =2=Z Hem"$!*!a *ee

PRINCIPIO.

Des&u+s #e a


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=.A


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!manes en m"!m!en(" %ue se #e(!enen a* )e*!$!a'se e* &*asma *" %ue !n#!a e*

$!na* #e *a 'ea!-n. Es(e es e* &'!n!&!" m/s u(!*!:a#" &"' su e*ea#a sens!8!*!#a#.

E&"Jo c'o=o#&!co. L"s aanes en *"s "n"!m!en("s #e *"s mean!sm"s

#e *a "a)u*a!-n en e* se' 0uman" e;!)!e'"n %ue *as (+n!as %ue (e'm!nan "n

*a $"'ma!-n #e un "/)u*" n" $ue'an *as ?n!as a #!s&"s!!-n #e* *a8"'a("'!" #e

0em"s(as!a. En es(as 'ea!"nes ua*%u!e' $a**" en e* &'"es" #e8!#" a

!n0!8!#"'es " a(!a#"'es 0a,a #!$,!* *a !n(e'&'e(a!-n #e *"s 'esu*(a#"s #e *as

&'ue8as. De es(a $"'ma a&a'e!e'"n *"s ensa"s '"m")+n!"s %ue n" s"n m/s

%ue 'ea!"nes 8!"%u,m!as a!s*a#as es&e,$!as. En es(as n" se 'e%u!e'e una

("(a* es(a8!*!#a# #e* s!s(ema "m" "u''e en *as %ue (e'm!nan "n *a $"'ma!-n

#e un "/)u*"

A#'e#"c!%& >'o=oc!>"'!". L"s 'euen("s ('"m8",(!"s #u'an(e a


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8!"*-)!a %ue se (!ene s"8'e ("#" #e *a 'e*a!-n "s("8ene$!!" %ue se es&e'a as,

"m" #e *as &"s!8!*!#a#es e"n-m!as "n %ue se uen(a.

P"' *" )ene'a* *"s e%u!&"s #e ?*(!ma (en"*"),a &a'a !nmun"ensa" &'"esan

"*?menes #e mues('as #e a*'e#e#"' #e mues('as &"' 0"'a 0as(a 12 mues('as

&"' 0"'a "n mu 8uena e$!!en!a. Es("s &ue#en #esa''"**a' a'!"s ensa"s &a'a *a

m!sma mues('a. A(ua*men(e se es(/n !m&"n!en#" *"s au("ana*!:a#"'es %ue usan

%u!m!"*um!n!sen!a &"' sus en(a7as en uan(" a *a sens!8!*!#a# #e *"s m+("#"s #e

*e(u'a *a 'a&!#e: #e* &'"esa#".

5.2. TROM)OELASTOGRAFIA

La ('"m8"e*as(")'a$,a TEG #es'!(a 0ae m/s #e a


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a'$a'!na 0e&a'!nas $'a!"na#as n" $'a!"na#as an(es #e **ea' a *"s &a!en(es

a &'"e#!m!en("s (am8!+n &a'a ea*ua' *a 'ee's!-n #e *a 0e&a'!na "n &'"(am!na

as, "m" &a'a e* mane7" e* se)u!m!en(" #e &a!en(es en un!#a#es #e U')en!as

es&e!a*men(e en ('auma en *as un!#a#es #e u!#a#"s !n(ens!"s . La TEG se

'ea*!:a "*"an#" 3 m* #e san)'e ("(a* &'e!amen(e me:*a#a "n a"*,n en unau8e(a en *a ua* en('a un &!n "ne(a#" a una )u,a #e ("'s!-n. La u8e(a "s!*a 4X

a#a 1 se)un#"s "n *a $"'ma!-n #e* "/)u*" se &'"#ue una a#0es!-n

&'")'es!a #e *a u8e(a "n e* &!n *" ua* )ene'a e* m"!m!en(" #e +s(e #!0"

m"!m!en(" es )'a$!" en un "m&u(a#"' &'"#ue *"s s!)u!en(es #a("s9

\ R; T!e=?o de Re"cc!%&; Pe'!"#" ('ansu''!#" en('e *a "*"a!-n #e *a san)'e e*

"m!en:" #e *a $"'ma!-n #e $!8'!na. Re*e7a *a a!-n #e *as &'"(e,nas $a("'es #e *a

"a)u*a!-n. Se &'"*"n)a en9 an(!"a)u*a!-n "n 0e&a'!na a'$a'!na en #+$!!( #e*"s $a("'es #e "a)u*a!-n a sea "n)+n!(" " a#%u!'!#" &"' 0em"''a)!a "

0em"#!*u!-n u "('a en(!#a# *,n!a %ue 0a)a #!s$un!"na*es *as &'"(e,nas #e *a

"a)u*a!-n. L"s a*"'es n"'ma*es s"n en('e 4 m!nu("s.

H ; T!e=?o de Co"#$l"c!%&; T!em&" #es#e e* "m!en:" #e *a $"'ma!-n #e*

"/)u*" 0as(a *a m/;!ma $ue':a #e +s(e. Se a"'(a uan#" 0a aumen(" en *a

$un!-n &*a%ue(a'!a " aumen(" #e $!8'!n-)en" se &'"*"n)a a* e;!s(!' #+$!!( #e

&'"(e,nas #e "a)u*a!-n an(!"a)u*an(es " an(!a)'e)an(es &*a%ue(a'!"s. E* a*"'

n"'ma* es #e 4 m!nu("s.

H :$lo "l@"; Es(/ $"'ma#" &"' e* 8'a:" #e R *a &en#!en(e #e B. Re&'esen(a *a

e*"!#a# #e $"'ma!-n #e* "/)u*". Aumen(a en 0!&e'a)'e)a8!*!#a# &*a%ue(a'!a "

en e*ea!-n #e* $!8'!n-)en" &"' e* "n('a'!" #!sm!nue "n 8a7as "nen('a!"nes

&*asm/(!as #e $!8'!n-)en" an(!"a)u*an(es " an(!a)'e)an(es &*a%ue(a'!"s. E* a*"'

n"'ma* es #e 4X 4X.

H MA; A=?l!>$d Má!="; Ea*?a *a !n(e'a!-n en('e *a $!8'!na *as &*a%ue(as en

es&e!a* *a $un!-n &*a%ue(a'!a. D!sm!nue en &'esen!a #e an(!a)'e)an(es

&*a%ue(a'!"s " ('"m8"!("&en!a ma'a#a aumen(a en 0!&e'a)'e)a8!*!#a#

&*a%ue(a'!a. E* a*"' n"'ma* es #e ==3 mm.

L+38; Re*e7a e* &"'en(a7e #e *a *!s!s #e* "/)u*" &"s(e'!"' a *a MA *" %ue e;&'esa *a

es(a8!*!#a# #e es(e. Se !n'emen(a en $!8'!n-*!s!s. E* a*"' n"'ma* es #e* Z a* Z.

H G; M!#e #e $"'ma )*"8a* *a $!'me:a #e* "/)u*". E* a*"' n"'ma* es #e 13 #!nas

&"' m2.


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H IC; ]n#!e #e "a)u*a!-n9 M!#e #e $"'ma )*"8a* e* es(a#" #e *a "a)u*a!-n. E*

a*"' n"'ma* es #e 3 a 3. L"s a*"'es !n$e'!"'es a 3 s"n !n#!a#"'es #e

0!&""a)u*a8!*!#a# *"s ma"'es a 3 !n#!a#"'es #e 0!&e'"a)u*a8!*!#a#.

H" en #,a a#a e: m/s a menu#" *a TEG se u(!*!:a en m?*(!&*es s!(ua!"nes

*,n!as su us" se am&*,a a#a #,a m/s.

Den('" #e *as &'!n!&a*es en(a7as #e *a u(!*!:a!-n #e *a TEG se enuen('an9

• Ra&!#e: #e *"s 'esu*(a#"s m!nu("s.• Fa!*!#a# &a'a 'ea*!:a'*a &a'a !n(e'&'e(a'*a.• Re%u!e'e s"*amen(e 1 m* #e san)'e &a'a su 'ea*!:a!-n.• Ea*?a en $"'ma )*"8a* *a "a)u*a!-n #es#e *a $"'ma!-n #e* "/)u*" 0as(a

su #es('u!-n $!8'!n-*!s!s.

• Au#a en *a #!$e'en!a!-n en('e san)'a#" #e8!#" a a*(e'a!-n #e *a"a)u*a!-n 0em"s(as!a %u!'?')!a !na#eua#a.

• De(e(a *a 0!&e'"a)u*a8!*!#a# es&e!a*men(e en ('auma en !'u),a s!'e

"m" &'e#!("' #e een("s ('"m8-(!"s &"s("&e'a("'!"s.• T!ene en uen(a *a (em&e'a(u'a 'ea* #e* &a!en(e.• Ra!"na*!:a *a u(!*!:a!-n #e &'"#u("s san)u,ne"s a)en(es 0em"s(/(!"s.• Se &ue#en e$e(ua' ensa"s (e'a&+u(!"s !n !('" en e* ('"m8"e*as(-)'a$"

an(es #e a&*!a'*"s a* &a!en(e.

O'!)!na*men(e *a TEG $ue #!se


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Inmun"*"),a Hem"(e'a&!a. 212 229 1411=. L!. ane(0 bam"'a

G"n:/*e:. Ins(!(u(" #e Hema("*"),a e Inmun"*"),a. La Ha8ana Cu8a.4. Mean!sm"s #e a(!a!-n #e *a "a)u*a!-n P'!me'a e's!-n9 4 #e 7u*!" #e

2 e's!-n #e$!n!(!a9 1 #e 7u*!" #e 2 Ae&(a#"9 2= #e 7u*!" #e 2.=. De(e!-n (em&'ana #e *a "a)u*a!-n !n('aasu*a' #!sem!na#a en un

se'!!" #e u')en!as en e* en('" m+#!" !ssemm Ea(e&e se)u!m!en("

a8'!* 212 $e8'e'" 213 !ns(!(u(" #e se)u'!#a# s"!a* #e* es(a#" #e M+;!"

mun!!&!"s en('" m+#!" Ea(e&e &a'a "8(ene' e* #!&*"ma #e *a

es&e!a*!#a# en me#!!na #e u')en!as &'esen(a m `"s+ *emen(e Ga',a

a**e7" #!'e("' #e (es!s m. en . e. en "('". R!a'#" $*"'es Os"'!" e. en m!

$'an!s" A*$a'" L-&e: e. en um% Ra$ae* *!'a &e

trabajo hemostacia y coagulacion

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