• The Korean Journal of Blood Transfusion
• /
• v.29 no.3
• /
• pp.240-252
• /
• 2018

Viscoelastic coagulation tests provide simultaneous measurements of multiple aspects of whole-blood coagulation, including interactions between the plasma components and cellular components of the coagulation cascade. This can be carried out immediately using a point of care technique. Viscoelastic tests could predict the patient's outcome, including mortality, and detect coagulopathy more sensitively, resulted in reduced blood loss. The transfusion strategy based on the viscoelastic parameters rather than a conventional coagulation test has been shown to reduce the transfusion requirements. Although there are concerns about the reliability and accuracy of this method, viscoelastic tests, including ROTEM, would be a useful method to guide patient blood management strategies.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.13 no.1
• /
• pp.23-29
• /
• 2010

Purpose: The aim of this study was to assess the benefits of routine pre-endoscopy coagulation screening tests and platelet counts in Korean children. Methods: Between March 2004 and December 2009, children who underwent gastrointestinal endoscopy for the evaluation of various gastrointestinal symptoms were included. All of the subjects included in the study also underwent routine coagulation screening and platelet count determinations prior to endoscopy and biopsy. The clinical records and laboratory tests were retrospectively reviewed in all patients. Results: One hundred sixty-two of 1,476 (11%) patients who underwent endoscopy had abnormal results on pre-screening coagulation tests. Fourteen patients underwent coagulation factor assays due to abnormal clotting results in consecutive tests or due to clinical evidence of a bleeding tendency. Seven patients were diagnosed with factor XII deficiency, one patient was diagnosed with von Willebrand disease, one patient had von Willebrand disease and factor XII deficiency, and one patient was presumed to have mild hemophilia. The remaining 4 patients had normal results with the factor assays. The results of platelet counts were normal with the exception of 1 patient. No patient had significant bleeding during the endoscopic procedures, despite abnormal pre-endoscopic coagulation tests. Conclusion: Routine coagulation screening tests and platelet counts revealed abnormal results in some patients. Most of the patients with abnormal clotting were shown to have a factor XII deficiency, which had no significant associated bleeding tendencies; the other patients were diagnosed with hemophilia or von Willebrand disease. Therefore, although abnormal pre-endoscopic coagulation is not always related to significant bleeding complications, pre-endoscopic coagulation screening may be useful in some children in predicting the risk of bleeding tendency during endoscopic procedures.

• Journal of the Korean Arthroscopy Society
• /
• v.16 no.2
• /
• pp.121-127
• /
• 2012

Purpose: To compare coagulation test results of the arthroscopic surgery patients who received thromboprophylaxis with typical two kinds of anticoagulation drugs, we performed coagulation tests before and after surgery with two groups and then compared the results. Materials and Methods: Forty-seven patients who underwent arthroscopic surgery were randomly divided into two groups to rivaroxaban and enoxaparin group, and we performed coagulation tests before and 5 days after arthroscopic surgery to two drugs groups in order to investigate about the difference in clotting capacity. Results: Preoperative coagulation tests did not differ significantly between the two groups. However, coagulation tests after 5 days of the surgery, the level of prothrombin time-international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT) increased, particularly in patients with rivaroxaban compared with enoxaparin (P<0.05). Conclusion: Anticoagulation for arthroscopic surgery with a drug is effective and has safe range in terms of bleeding tendency, but in the rivaroxaban group, there was one patient who showed high bleeding tendency with abnormal range. Therefore it should be careful of using rivaroxaban for thromboprophylaxis.

• Journal of Chest Surgery
• /
• v.30 no.7
• /
• pp.677-685
• /
• 1997

Thromboelastography(TEG) is the unique measure that gives rapid information about the whole clotting process. Simplifying the diagnosis of coagulopathy during operations, TEG can provide an adequate therapy for postoperative bleeding. Remarkable improvement in hemostasis after cardiopulmonary bypass(CPB) has been achieved by the treatment with proteinase inhibitor aprotinin, but the hemostatic mechanism of aprotinin during CPB is still unclear. This study was designed to evaluate the effects of aprotinin on coagulation system during CPB by using TEG. Forty patients who underwent CPB were divided into two groups: aprotinin(2u 106 kallikrein inhibition units, as a single dose into the cardiopulmonary bypass priming solution) treatment group(male 14, female 8, mean age=50.Byears) and no aprotinin treatment(control) group(male 10, female 8, mean age=53.4 years). TEG, activated clotting time, prothrombin time, activated partial thromboplastin time, platelet counts, fibrinogen an (ibrinogen degradation product(FDP) concentrations were checked before and after CPB(30 minutes after neutralization of heparin effect by protamine sulfate). There was no significant difference in other conventional coagulation tests of two groups except postcardiopulmonary bypass FDP concentration in control group, which was significantly increased compared to that in aprotinin group(p<0.05). In TEG variables of both groups, clot formation time(K) and alpha $angle(\alpha^{\circ})$ were significantly increased and decreased, respectively, after CPB(p<0.05), but fibrinolytic index(LYS60) was not changed during CPB. In aprotinin group, reaction time(R) was decreased significantly after CPB(p<0.05) but maximum amplitude(MA) was not changed(p>0.05). On the contrary, R was not changed markedly but MA was decreased significantly in control group after CPB(p<0.05). This result shows that main change in coagulation system during CPB is not hyperfibrinolysis but cecrease in clot strength by platelet dys unction, and the main effect of aprotinin during cardiopulmonary bypass is the maintenance of clot strength to the pre-CPB level by the preservation of platelet function.

• Childhood Kidney Diseases
• /
• v.17 no.2
• /
• pp.149-153
• /
• 2013

We report the case of a 14-year-old girl, diagnosed with atypical thrombotic microangiopathy (TMA). The patient presented with persistent fever, nausea, and newly developed peripheral edema. Her laboratory findings indicated chronic anemia with no evidence of hemolysis, thrombocytopenia, or elevated serum creatinine level. A few days after hospitalization, acute renal failure and fever worsened, and proteinuria developed. On day 40 of hospitalization, she experienced a generalized tonic seizure for 5 min, accompanied by renal hypertension. Brain magnetic resonance imaging revealed posterior reversible leukoencephalopathy syndrome. After steroid pulse therapy, a renal biopsy was performed because of delayed recovery from thrombocytopenia. The biopsy findings showed features of thrombotic microangiopathic hemolysis with fibrinoid change restricted. Current diagnostic criteria for TMA have focused on thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, and diagnosis is based on the clinical presentation and etiology, with the consequence that idiopathic and atypical forms of TMA can be overlooked. Developing effective tools to diagnose TMA, such as studying levels of ADAMTS13 or testing for abnormalities in the complement system, will be the first step to improving patient outcomes.

• The Korean Journal of Blood Transfusion
• /
• v.23 no.2
• /
• pp.145-151
• /
• 2012

배경: 채혈 후 제제 경과시간에 따른 동결혈장의 혈액응고인자의 활성도와 이에 영향을 미치는 요인을 분석하여, 혈액응고인자제제의 원료혈장의 사용범위를 확장 가능한지 확인하고자 동결혈장의 채혈시간과 응고인자 특성을 측정하였다. 방법: ALT 부적격 혈장을 채혈 후 동결시간의 특성에 따라 4단계로 구분하였고, 6종류의 혈액 응고인자 활성도와 혈액형을 검사하였고, SAS 9.2 프로그램을 사용하여 통계처리 하였다. 결과: 혈액제제간 FVIII 활성도를 분석한 결과 PL-A>FFP>FP(8-24)${\approx}$FP(24-72) 순으로 유의하게 낮아졌고 혈액형에 따라서는 AB형이 제일 높고, O형이 제일 낮았다. 대한적십자사의 원료혈장에 대한 FVIII 활성 품질기준을 적용할 경우 PL-A, FFP와 FP24는 각각 85.0%와 82.5%로 적합하였다. 캐나다 퀘백 주처럼 FP24의 FVIII 활성이 0.52 IU/mL 이상을 적용할 경우 PL-A, FFP와 FP24는 각각 95.0%, 96.3%, 82.6%로 적합하였다. 또한 FP(8-24)의 A형과 AB형, FP(24-72)의 경우 AB형이 각각 82.1%, 83.3%, 100%로 적합하였다. 결론: 혈액응고인자제제용 원료혈장의 범위는 외국의 기준에 비추어 채혈 후 24시간 내에 동결된 혈장(FP24)으로 확대 사용이 가능하다. 이를 위해서는 채혈 후 동결시간과 혈액응고인자에 대한 품질기준을 유럽약전 또는 WHO 가이드라인과 비교하여 완화하는 것이 필요하다.

• Korean Journal of Clinical Laboratory Science
• /
• v.51 no.2
• /
• pp.260-264
• /
• 2019

An 84-year-old woman presented to the emergency department with a chief complaint of pressure sores of the anus. She had a urine catheter when she showed pyuria three times but had no fever. A microscopic examination revealed many grapevine-like Gram positive strains and neutrophils. After 24 hours of urine culture on blood agar, non-hemolytic mucous colonies were found and further enlarged after 48 hours of culture. The capsules were identified after India ink stain. The catalase was positive, but the tube coagulase and latex coagulase were both negative. The S. aureus was identified by Vitek-2 and mass spectrometer Vitek MS V-3 IVD. The strain was confirmed by 16S rRNA gene sequencing and multilocus sequence typing (MLST). The phenotypically atypical MRSA found in the tube coagulase and latex coagulase were both negative. MRSA often show no beta hemolysis as in this case but are rarely latex coagulase-negative. We report a woman whose urine culture showed non-hemolytic, tube coagulase-negative, and latex coagulase-negative MRSA.

• Clinical and Experimental Pediatrics
• /
• v.45 no.12
• /
• pp.1512-1518
• /
• 2002

Purpose : Twins have a higher mortality and morbidity than singletons. Co-twin with one fetal death is particularly at risk. We investigated the neonatal outcome of live co-twins when one fetus had died after the 20th gestational week, and associated risk factors. Methods : A retrospective study was performed in fifteen cases of twin pregnancy with single intrauterine fetal deaths after the 20th gestational week during the period from January 1996 to December 2000 at Chonnam University Hospital. Results : Gestational age was $33.7{\pm}3.2weeks$, birth weight was $1,992{\pm}592g$. Interval between one fetal death being detected and the delivery of a live co-twin was $32.4{\pm}29.5days$. There were 11 cases(73.3%) of premature babies less than 37 gestational weeks. Main causes of preterm delivery were preterm labor and premature rupture of membranes. Hematologic findings suggesting disseminated intravascular coagulopathy(DIC) were not found in all mothers before delivery, and was not associated with DIC and encephalomalacia of the live co-twin. Perinatal outcome of fifteen live co-twins was as follows : six were normal(40%), three were DIC(20.0%), three were encephalomalacia(20.0%), one suffered intrauterine growth retardation, there was one case of twin to twin transfusion syndrome, and one of congenital heart disease(atrial septal defect with pulmonary stenosis). The occurrence of DIC and encephalomalacia in live co-twins was not related to placental chorionicity, birth weight, gestational week, and the interval between the detection one fetal death and the delivery of a live co-twin. Conclusion : We could not find any maternal hematologic problems in twin pregnancies complicated by one fetal death. Twenty percent of live co-twins showed DIC and encephalomalacia. However, its associated risk factors were not found. We need to investigate more closely the cases of live co-twins with one intrauterine fetal death.

• Korean Journal of Food Science and Technology
• /
• v.26 no.1
• /
• pp.26-30
• /
• 1994

The purpose of this study was to investigate the effects of heating times of soy protein isolate(SPI) and mixing ratio of coagulants mixture on water holding capacity(WHC) and oil absorption capacity (OAC) of SPI, texture properties and yield of tofu. The effect of heating at $100^{\circ}C$ on the amounts of coagulants required for coagulation showed that the amounts of $CaCl_{2},\;MgCl_{2}$ and GDL decreased as the heating time extended to $6{\sim}9$ minutes while $CaSO_{2}$ was changed little. The tofu yield showed maximum for the tofu prepared by 6 minutes boiling and coagulation with $CaSO_{4}$. The WHC of SPI was significantly reduced by heating at $100^{\circ}C$ while OAC was rather increased until 9 minutes of heating. The textural properties of SPI tofu coagulated with mixed coagulants$(CaSO_{4}-GDL,\;CaSO_{4}-CaCl_{2},\;CaCl_2-GDL)$ showed that softer tofu was obtained as the ratio of $CaSO_{2}$ increased and harder tofu as the ratio of $CaCl_{2}$ and GDL increased. The maximum and minimum tofu yields were prepared from 100% of $CaSO_{2}$ and 100% of GDL, respectively. Organoleptic properties showed that more uniform and tender tofu were obtained with higher portion of $CaSO_{2}$ in the mixed coagulants and higher intensity of sourness and bitterness were scored as the GDL and $CaCl_{2}$ added more.

• Journal of Chest Surgery
• /
• v.37 no.3
• /
• pp.245-251
• /
• 2004

Hemostatic function is regarded to be preserved after an off-pump coronary artery bypass grafting (CABG), compared to conventional CABG, and the preserved hemostatic function may increase thrombotic occlusion of the graft. We studied the changes of hemostatic variables in patients undergoing off-pump CABG, and compared to those of on-pump CABG. We studied the changes of coagulation function in 11 patients who underwent off-pump CABG (group I), and compared them with those of 11 patients who underwent on-pump CABG and Dor procedure (group II). Coagulation status was evaluated by thromboelastography and blood coagulation test preoperatively, postoperative 1$^{st}$ day, 2$^{nd}$ day, 3$^{rd}$ day, and 5$^{th}$ day, respectively. Among the variables measured by thromboelastography (such as r time, k time, $\alpha$ angle, and MA value) and blood coagulation test (such as factor Ⅶ, protein S, protein C, antithrombin III, activated protein C resistance test, plasminogen, D-dimer, prothrombin time, activated partial thromboplastin time, platelet count, hemoglobin, and fibrinogen), there were significant differences in the MA value, $\alpha$ angle, and platelet counts between the two groups. MA values were 140$\pm$72% and 153$\pm$98% in group I, and 87$\pm$27% and 78$\pm$28% in group II, at postoperative 3$^{rd}$ and 5$^{th}$ days, respectively (p<0.05). $\alpha$ angle was 122$\pm$92% in group I and 69$\pm$23% in group II at postoperative 3$^{rd}$ day (p=0.09). Platelet count was 63$\pm$55% in group I and 33$\pm$13% in group II at postoperative 3$^{rd}$ day (p<0.05). Patients who underwent off-pump CABG showed increased coagulability during postoperative periods, compared to those who underwent on-pump CABG. Our data suggest that aggressive perioperative anticoagulation therapy is warranted in patients undergoing off-pump CABG. CABG.