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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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Activity of the radiographer at the emergency department.
PIŠTĚKOVÁ, Martina
A patient with urgent condition which threatens his life or health requires special approach of a radiology assistant to executed diagnostic performances. In this bachelor thesis, I describe procedures in case of these conditions. Because the given topic is quite extensive, I preferred a detailed description of the most serious conditions. I chose the topic because of its timeliness. The number of patients with urgent condition has an upward character for sure because of accelerated life pace and related traumas as well as diseases of civilization. My work describes three researches. The first one finds out the share of different investigations in the radiodiagnostic department as regards patients with urgent condition per one year in one hospital. The second one is related to the refresher courses of radiology assistants in relation to patients with urgent condition. The third one investigates algorithms of investigations in the radiodiagnostic department in different medical facilities. The bachelor thesis is divided into a theoretical and practical part. The theoretical part explains the term "urgent condition" and basic description of the approach to a patient in the given situation. I mention brief principles of cardiopulmonary resuscitation. I analyse individual modalities used in the radiodiagnostic department. Other subchapters are focused on the description of concrete conditions and sequence of investigations. The practical part begins with the chapter called "Targets, Hypothesis". It is concentrated on the description of the main role of my work which is discovery of radiology assistants´ approach to patients with urgent condition and the situation in education of radiology assistants in the Czech Republic. Some parts compare the condition with the situation in other countries of the European Union. The chapter called "Discussion" is devoted to the general evaluation of researches. It mentions also the important role of radiology assistants when treating patients with urgent condition. The "Conclusion" evaluates meeting of targets of this thesis and outlines possible solutions.
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Problems of Nursing Care of Patients with Leiden Mutation and Prevent Complikations
BROMOVÁ, Jana
Factor V Leiden mutation is a hereditary disorder of the hemostatic mechanism, which may lead to an increased occurrence of trombones in the blood-vessel tree. This disorder is classified among hypercoagulation conditions. It is one of the most frequent inborn disorders of blood coagulation associated with venous thromboembolism. The objective of the present Bachelor Thesis is to determine if nurses of surgical branches have knowledge of the above disorder and complications there of. Further, another objective of this Bachelor Thesis is to discover if education of nurses affects their knowledge of the disorder. The final objective is to ascertain if patients have cognizance of their disease and know how to prevent complications. Hypotheses and research questions have been stipulated in relation to the above-mentioned objectives. H1: Nurses with a longer work experience in surgical branches have more information of Leiden mutation and prevention of complications related to this disorder than nurses with a shorter work experience. H2: Nurses with a higher-level education in surgical branches have more information of Leiden mutation and prevention of complications related to this disorder than nurses with a lower-level education. RQ1: Are patients informed of occurrence of complications and prevention of an acute breakout of the disorder? RQ2: Do nurses provide patients with informationof regimen measures related to this disease? RQ3: Have any complications occurred during hospitalization in relation to Leiden mutation? The empirical part of the Bachelor Thesis consists of two sections.The first section comprises a quantitative research survey. The research was conducted in form of an anonymous non-standardized questionnaire for nurses of surgical branchesin Nemocnice České Budějovice, a.s. [Hospital České Budějovice, joint-stock company] and Nemocnice Prachatice, a.s. [Hospital Prachatice, joint-stock company]. The questionnaire contained 20 questions, divided into closed, semi-closed and open questions. Results were processed in the computer programme Microsoft Excel and the data acquired were used for parametric statistical analysis. The results are presented in graphs. The other section of the empirical part contains a qualitative research survey. The research was carried out with five respondents, in form of a semistandardized interview, with 20 questions prepared in advance, and these questions were in turn completed according to replies given by the respondents. The interviews were recorded in a written in a record sheet. Data obtained from the interviews were processed by coding and a subsequent categorization of data. The categorization was done on the basis of internal similarity of codes.The author views the problems of nursing care of patients with Leiden mutation mainly in connection with complications that might occur. These complications involve deep venous thrombosis and pulmonary embolism.This Bachelor Thesis attempts at pointing out these problems and bringing this disease into more widespread awareness among nursing personnel.
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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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Statistical investigation of CT pulmonary angiography in terms of development and depending on age and sex in District Kroměříž 2006-2010
OPLUŠTIL, Vladimír
CT pulmonary angiography is, together with ventilation-perfusion scintigraphy, the main diagnostic methods for recognition as pulmonary embolism. This is a very dangerous disease, which may end up even in death. Its share of deaths in hospitals, including subsequent ? complications, is around 4%. Therefore, emphasis is placed on early diagnosis. Clinical and laboratory symptoms are unspecific (including D Dimer).(10) Pulmonary embolism after ischaemic heart disease and arterial hypertension the frequency of its occurrence, the third most serious cardiovascular diseases. Cause of death in pulmonary embolism is usually the exhaustion of the right heart, seeking to overcome suddenly increased the resistance of the pulmonary circulation. This is the pulmonary artery or its branches is embolism blood clot-trombus, resulting in the venous system or in the heart, a saddle embolus, patched up a significant part of the lung. The most common place of trombs, which embolizated to the lungs, are deep veins of lower limbs if they are affected by the flebotrombolitis.(16) In addition to the acute embolism are frequent and chronic embolism. They are equally dangerous. By gradually and subtly clog small blood vessels, reduces the total cross-sectional area of open pulmonary artery, which have blood flow, and since the volume of blood must be maintained even in the smaller section of the vascular bed, should permanently increase the blood pressure in a small circulation, which is also dangerous.(16) In my work is the methods of mathematical statistics processed file 1966 CT pulmonary angiogramy (CTPA), carried out on the CT work in Kroměříž in the years 2006-2010. The work is focused on the statistical survey of the influence of age, sex, and the time evolution of the CTPA during that period.
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Thromboembolic disease in pregnancy
ŠOTOVÁ, Karolína
This thesis was about thrombomebolic disease in pregnancy. The incidence of venous thromboembolism (VTE) probably increases 2- to 4-fold when a woman becomes pregnant. I looked on this problem from many aspects. I looked on health care from her gynaecologist and eventually hematologist, recognition her VTE risk, laboratory tests and her medication. I looked on effectivity of medication too.
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The Role of Nurses within the Nursing Care Provided for Pulmonary Embolism Patients in Subsequent Care.
STEJSKALOVÁ, Jana
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has traveled from elsewhere in the body through the bloodstream. This results into the obstruction of the blood flow through the lungs leading to the failure of hemodynamics and ventilation. Despite great advances in the diagnosis and treatment, pulmonary embolism is still the third leading reason of death and number of people affected by this disease is increasing. The aim of this thesis was to investigate whether the nurse can influence patients in a way that they are instructed about the pulmonary embolism and also whether the people affected by this disease follow guidance in respect to minimize and prevent any complications. The thesis also focuses on the readiness of patients being treated for pulmonary embolism to be discharged from hospital into a care home.
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