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DIAGNOSIS OF BLEEDING CAUSES
Daminov F.A.– DSc, Ass.Professor, head of the department of clinical
laboratory diagnosis with the course of clinical laboratory diagnostics of PGD;
Djabbarova N.R.- assistant of the department of clinical laboratory diagnosis
with the course of clinical laboratory diagnostics of PGD;
Berdiboyev I.S. cadet of the department of clinical laboratory diagnosis with
the course of clinical laboratory diagnostics of PGD;
Samarkand state medical university
Samarkand, Uzbekistan
Diagnosis of the causes of bleeding, determination of the intensity of
intravascular microclotting and disseminated coagulation syndrome (DIC), as well as
control of antithrombotic and haemostatic therapy is not possible without special
laboratory tests [1,2,3,4].
Keywords: laboratory diagnosis of bleeding, haemocoagulation, blood
coagulation factors;
Based on the principle of method, the following groups of tests can be
distinguished:
1. Clotting, or chronometric tests, which make it possible to determine the
biological activity of the haemocoagulation factors under study. The unit of
measurement used in these methods is the time of fibrin clot formation.
2. Amidolytic methods using chromogenic substrates, in which the time of
hydrolysis of a peptide substrate is analysed [5,6,7].
3. Methods that allow to determine the concentration of the investigated factor
through the use of monoclonal antibodies - immunological methods [8,9,10].
Separately, it is necessary to note the genetic methods that allow to detect the
presence of mutations in genes that determine the formation of individual coagulation
factors and other participants in fibrinolysis and haemocoagulation process. In any
case, the laboratory test should have an established diagnostic significance. Its
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sensitivity and specificity, as well as the method of calibration and standardisation
should be considered. In addition, there should be a procedure for quality control of
tests with an assessment of the correctness and reproducibility of the results obtained.
When interpreting the results of laboratory tests for the diagnosis of disorders of the
haemocoagulation system should be based on modern ideas about the mechanisms of
blood coagulation and individual patient information [11,12,13,14].
Currently, the number of laboratory tests, which are used to study various links
of blood coagulation, exceeds several hundred. However, for a practical doctor who is
trying to answer questions about the possibility of haemorrhagic complications during
surgical interventions, about the cause of bleeding that has already occurred, or about
the intensity of intravascular coagulation and the presence of DIC syndrome, as well
as about the effectiveness of antithrombotic therapy, the number of laboratory tests is
limited to a much smaller number. In this regard, we have divided all laboratory tests,
with the help of which the state of haemocoagulation is investigated, into several
groups depending on the questions posed by the doctor. The first group includes those
laboratory methods that allow to answer the question about the state of blood
coagulation in a healthy person, in a patient in preparation for surgical interventions or
in cases where there are clinical signs of haemocoagulation disorders [15,16,17,18].
For this purpose, it is sufficient to carry out so-called assessment or screening
tests [19,20,21].
These include:
1. Platelet count
2. Bleeding time
3. Prothrombin time
4. Activated partial thromboplastin time
5. Determination of fibrinogen level.
6. D-dimer
The study of bleeding time is not mandatory in all cases. It can be used in
preparation for surgical interventions on ENT organs, especially in children, with
haemorrhagic manifestations and suspected insufficiency of haemostatic function of
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the haemocoagulation system. Performing the test before all interventions as well as in
patients with thrombotic complications is inexpedient. In any case, careful collection
of personal and family haemorrhagic or thrombotic anamnesis is mandatory. Screening
tests can be performed in primary care laboratories. If necessary, these tests can be
centralised, but the time to get the material to the central laboratory should not be too
long and the tests should be started within 4 hours of blood collection [22,23,24].
The second group of studies is represented by sets of additional tests for
different clinical manifestations of disorders of the haemocoagulation and fibrinolysis
system [14,15,16].
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