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Vliv vrozených hyperkoagulačních stavů na hladinu D-d se zaměřením na gravidní ženy
ŠTÍCHOVÁ, Zuzana
The thesis analyses the female patients' data from Clinical hematology department in České Budějovice hospital from year 2014 to 2015 and tries to statistically confirm connection between D-dimer level and hypercoagulable states described in previous bachelor thesis. D-dimer assay is due to negative predictive value and high sensitivity an initial laboratory test to rule out tromboembolic disease. However, it has low specificity. The elevated level of D-dimer is observed in conditions like infection, trauma, acute cancer, recent surgery or pregnancy and last studies showed increased D-dimer level even in combination with inherited hypercoagulable states. Thus, it is necessary to analyse the level of D-dimer in pregnant women related to specific hypercoagulable states. Moreover, the thesis analyses the influence of other factors like anticoagulation therapy on D-dimer level and tries to find connection between D-dimer level and pregnancy associated complication, birth weight or a type of delivery.
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D-dimers in pregnancy. Influence Leiden mutation and anticoagulation therapy.
FELIXOVÁ, Veronika
In my work D-dimers in pregnancy, influence of Leiden mutation and anticoagulant therapy, I study the D-dimer concentration in pregnant women with Leiden mutation and the potential influence of anticoagulant therapy. In the first part I deal with theory. I describe here the process of fibrinolysis, including its activators and inhibitors that influence the process of fibrinolysis, and in which D-dimers are being created. . I deal with the division of thrombophilia, on the condition congenital, acquired and mixed. .Among congenital thrombophilic states belongs resistance to activated protein C, which in most cases is caused by mutation factor V Leiden. I describe here the emergence of this mutation, the occurrence and the risks with which this mutation is linked. The most discussed risk factor for me was pregnancy, which I mention in my work. Another part deals with anticoagulation therapy. In the methodical part I describe the quantitative determination of the D-dimer level by an immunoturbidimetric test in the Laboratory of Hematology of the Hospital České Budějovice. I split the whole process into a preanalytical, analytical, and postanalytical part. The principle of analysis is the addition of polystyrene particles covalently coated with monoclonal antibodies, where D-dimers are bound together with particles to clump and increase cloudiness. The haze intensity is measured by optical density and is directly proportional to the concentration of D-dimers. In the fourth part of my work I processed the data provided by the Hematology Outpatient Hospital of České Budějovice. These are the investigated levels of D-dimers in women with Leiden mutation and in women without the Leiden mutation. Leiden mutation is a thrombophilic condition with a negative personal history of thromboembolism. This mutation results in a breakdown of the coagulation system, which is manifested by frequent thrombotic complications. The risk of thromboembolism is higher in these patients than in the other population. In pregnancy, it is necessary to check with a hematologist. In the charts and tables I have attempted to confirm the aim of the work that D-dimers in pregnant women with Leiden mutation are higher than in pregnant women without the Leiden mutation. I have also looked at anticoagulant therapy that is recommended to patients to prevent and treat thromboembolic disease. The aim of the work that the level of D-dimers in pregnant women with the Leiden mutation is higher, compared to women without the Leiden mutation, was confirmed to me. The effect of anticoagulant therapy on the level of D-dimers is that pregnant women without anticoagulant therapy achieve higher levels of D-dimers than pregnant patients with anticoagulant therapy.
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D-dimer concentration in pregnancy
ŠTÍCHOVÁ, Zuzana
D-dimers belong to fibrin degradation products (FDP) which we can find in the blood when the blood clot is dissolved. This process is named fibrinolysis. The levels of D-dimer are higher in all conditions connected with increased coagulation activation like deep venous tromboembolis, pulmonary embolism or disseminated intravascular coagulation. So the negative results, when the D-dimer concentration is below predetermined threshold, are one of the useful ways how to rule out tromboembolic disease The problem is that the elevated D-dimer levels are observed in other conditions like infection, trauma, acute cancer, recent surgery or pregnancy. The thesis should confirm that the concentration of D-dimer in pregnancy is elevated and the D-dimer levels were established in particular trimesters. These are compared with the D-dimer levels described in contemporary literature. The levels are determined for two different tests which were used in Hematology laboratory in České Budějovice hospital at different times. Besides the viewpoint of D-dimer and gravidity the thesis also follows up different results of the two tests and their possibility of comparison.
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Diagnostics of Hypercoagulation Status by D-dimer Concentration Measurement
STIEBLEROVÁ, Romana
In common thrombofilia is the state of the vessel system in arterial, venous or microcirculation part when the probability of thrombs-creation is increased, but thrombs are not present yet. It is the pre-state of thrombotization. Thrombofilia is denoted as hypercoagulation status. Thrombofilia also is a common term for hereditary and acquired prothrombotic states in arterial, venous and microcirculation system. Progress in thrombotic and anticoagulation treatment and high-powered clinical research in pathogenesis together enable the radical progress in modern conception of pathophysiology in clinical diagnostic and introduce usage of very efficient treatments. Results of big multi-central studies show clearly how the precise fibrinolytic and coagulation tests and treatments can help in long-term surviving of patients with thrombosis. The search part of this study shows a summary of last information in pathophysiology and last potentialities in laboratory tests and interpretations focused on clinical exposure and diagnostic of PE and DVT. Inspiration for this study are results published in JOURNAL OF THROMBOSIS AND HAEMOSTASIS 10 (7): Penaloza, A., Roy, P. -M., Kline, J., Verschuren, F., Le Gal, G., Quentin-Georget, S. , Delvau, N. , Thys, F. Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. 1291-1296, 2012. doi:10.1111/j.1538-7836.2012.04769.x and HAEMATOLOGICA-THE HEMATOLOGY JOURNAL 97(10) Douma, Renee A.; Tan, Melanie; Schutgens, Roger E. G.; et al. Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded. 1507-1513, 201, doi:10.3324/haematol.2011.060657. In this part also the need of Good Laboratory Praxis for pre-analytics extraction and transportation of whole blood samples for coagulation and fibrinolytic tests is highlighted. The practical part of this study covers either the laboratory results aimed to confirm the diagnosis or the results of D-dimer concentration done for preventive reasons and selected in specific files. D dimer is the specific fissile product of fibrin and the presence of D-dimer in plasma testifies the activation of coagulation and fibrinolysis. D-dimer tests were done on the automatic coagulation analyzer ACT Elite Pro. D-dimer test has been done by immunological method based on reaction between antigen and antibody. Analyzer ACL Elite PRO uses nephelometry for detection of blood clogs and reads the intensity of scattered 90° angle light in the sample. Results of sonography are from data stored in hospital information system FONS Akord STAPRO Hospital Jindřichův Hradec a.s. All data were collected in several data-files. This study verificates the hypothesis of predicted difference of D-dimers in patients from preventive file and patients in file with thrombofilia diagnosis. The hypothesis of D-dimer test positivity in venous thrombosis was confirmed as well, D-dimer as a marker of thrombofilia shows an actual activation in-vivo system and increased D-dimer concentration confirmed venous thrombosis DVT together with a positive sonography. The most interesting and the most important result of this study is the confirmation of the hypothesis of using an age-dependent D-dimer cut-off in patients over 50 of age with suspect DVT or/and PE diagnosis. The importance of using an age-dependent D-dimer cut-off was published in articles in JOURNAL OF THROMBOSIS AND HAEMOSTASIS 10 (7): Penaloza, A., Roy, P. -M., Kline, J., Verschuren, F., Le Gal, G., Quentin-Georget, S. , Delvau, N. , Thys, F. Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. 1291-1296, 2012. doi:10.1111/j.1538-7836.2012.04769.x and HAEMATOLOGICA-THE HEMATOLOGY JOURNAL 97(10) Douma, Renee A.; Tan, Melanie; Schutgens, Roger E. G.; et al. Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded.
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Examination of D-dimer in patients from the district Jindřichův Hradec
PROCHÁZKOVÁ, Veronika
Investigation of level (concentration) of d-dimer in the plasma is used to capture several pathological conditions. The most common is venous thrombosis and pulmonary embolism. Just thrombosis is diagnosed in 71 patients out of 100 000 inhabitants per year, pulmonary embolism in the same population in 69 inhabitants. Thanks to determine levels of d-dimer we can also determine the risk thrombophilia, a tendency to thrombosis. Thrombosis is the third most common pathological condition after myocardial infarction and stroke. Another states we can diagnose are undoubtedly disseminated intravascular coagulation, tumors, acute coronary syndromes, inflammatory disease. Increased level of d-dimer is found in pregnancy. My main objectives were to: 1. Acquisition of method for the examination of d-dimer, which is used in the Hospital Jindřichův Hradec, a.s. the Department of Haematology and Blood Transfusion, during one month. 2. Processing of at least 30 samples. D-dimer is one of the fission products of fibrin. It occurs in fibrinolysis, which was preceded by a sequence of reactions coagulation cascade. Its presence in the blood shows a fibrinolytic activity in the vascular system. Its level is increased after trauma or surgery. People taking hormonal therapy may suffer from increased coagulation and subsequently induced fibrinolysis. I deal in the tehoretical part of my thesis what is d-dimer, when arises. I mentioned also the coagulation cascade, which precedes the fibrinolysis. I focused on the main thrombotic condition in which the levels of d-dimer increased, from what causes these conditions arise, how they can be diagnosed. I was considering which diseases can develope because of thrombotic states and thrombophilia, what the symptoms are. In this section there is also the types of thrombotic conditions treatment, material, conditions of work with it, the types of hematological examination, the possibility of establishing d-dimer and preparation of antibodies. The practical part describes the receiption of material, its preparation for analysis, analysis, description of the apparatus, required reagents, the principle of work. I worked in the Department of Haematology and Blood Transfusion in the Hospital in Jindřichův Hradec. It was allowed to me to examine 100 patient samples, in most of the outpatient department of the hospital. I worked on the automatic coagulation analyzer ACL Elite Pro and I examined the levels of d-dimer. The latex-enhanced method is used to determine the d-dimer in routine practice in Jindřichův Hradec. D-dimer contained in the plasma forms a complex with the monoclonal antibody, which is bound to the latex particle. The principle of measurement is immunoturbidimetry, at 405 nm. The light beam is absorbed on the immune complexes and decrease of the transmitted light intensity, which passed through the reaction cell with a sample to be analyzed, is measured. I processed the measured values of d-dimer in tables and graphs using a computer program to separate part of the thesis. I divided the results according to gender, cut-off value of d-dimer used in hospital in Jindřichův Hradec, according to risk age of 45. I created graphs and tables and I evaluated the research. Increased level of d-dimer was showed in 56 patients, while the proportion of men and women was the same. I did not notice dependence on increased concentration with increasing age. Unconfirmed of two hypotheses may be due to the fact that I investigated samples from a small group of patients who were diagnosed with a pathological condition. Increased concentrations of d-dimer are most often caused by lifestyle and heredity. By working in the laboratory I have developed latex-agglutination d-dimer determination in plasma.
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