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Altered clotting essays

Blood Coagulation Clotting Process Biology Essay

causes of a prolonged ACT include: Causes of a Prolonged ACT Heparin Hypothermia Hypofibrinogenaemia Other clotting factor deficiencies Haemodilution Aprotinin Thrombocytopaenia Qualitative platelet abnormalities Reference Ranges The reference range for the ACT. Extrinsic: Clotting, is initiated when collagen eddie within the tissue becomes exposed due to reportage an injury. Method. Hypothermia Hypothermia prolongs the APTT even in the absence of heparin. The clotting cascade is the made up of a number of protein factors which ultimately generates fibrin, the protein basis of a clot (a)) form is the activated form. Fresh whole blood is added to a tube containing a negatively charged 'activator' and this results in the formation of a clot. The extrinsic and intrinsic pathway. When patients are rewarmed following bypass there is an increase in the clearance of UFH and more frequent ACTs to monitor the degree of anticoagulation may be necessary. Both positive and negative. Second, many steps allows for many foci of regulation, via the extrinsic pathway, there are 2 pathways by which these factors may be activated, by performing an ACT with/without heparinase ohio when patients come off bypass - any remaining heparin that has not been neutralised with protamine can be established. The type of activator affects the clotting time.

Altered clotting essays

In some patients the presence of a lupus anticoagulant has been shown to interfere with and prolong the ACT but in other cases the ACT may be relatively unaffected. Factor deficiencies The ACT is sensitive to deficiencies in FVIII ( 25 of normal IX, X, XI, XII deficiency, in patients receiving oral anticoagulants or with liver disease. Historically the ACT has been used to monitor factor replacement therapy in haemophilia and to monitor anticoagulation with heparin. Oral Anticoagulants The ACT is sensitive to oral anticoagulants because of the fall in the vitamin K dependent clotting factors. During cardiopulmonary bypass, heparin is titrated to maintain an ACT of between 400 and 600s. During ECMO, heparin is titrated to maintain the ACT between 220 and 260s. Interpretation. The ACT is less precise than the APTT and lacks high correlation with the APTT or with heparin anti-Xa levels. The minimum safe ACT is in the region of 300 seconds based upon observations that above this level blood clots rarely occur in the extracorporeal circuit. In most cases of CPB a dose of UFH in the region of 300-400 IU/kg is administered prior to CPB with additional boluses given as required to maintain the ACT 400s. Activated Clotting Time ACT Introduction The Activated Clotting Time (ACT) was first described by Hattersley in 1966 and is essentially a point of care test (POCT ) of coagulation that is used to monitor the anticoagulant effect of unfractionated heparin (UFH) in patients on bypass surgery, on ECMO extracorporeal membrane oxygenation, undergoing percutaneous transluminal coronary angioplasty, on. However, limited data comparing the ACT and APTT suggests that these two tests are not equivalent and may result in discordant clinical studies. Heparinase. Heparinase can be used to neutralise UFH in the ACT allowing monitoring of the underlying coagulation and which would otherwise be masked by the heparin.

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Altered clotting essays
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