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Control of hemostatic parameters of patients undergoing surgery usually involves only determination of parameters of the coagulation cascade, but not measurement of primary hemostasis. This has mainly methodological reasons. Recently a model of primary hemostasis has been introduced (Kratzer & Bom, Haemostasis 15:357; 1985) now produced under the name “ Thrombostat 4000” (VDG von der Goltz, 8221 Seeon, West Germany). This device measures computerized within minutes “ in vitro” bleeding parameters (vBP) like bleeding volume (V,ul), time (T,sec) and the viscosity depending initial flow (IF,ul/min) in a small sample (0.5-lml) of whole anticoagulated blood (Na citrate 1 to 10). The clinical relevance of the vBP was tested in patients undergoing major surgery.Results : Case 1: A 78 years old woman with osteomyelosarcoma, heavy bleeding and normal coagulation parametrs showed strongly pathological vBP: (V > 800, T > 300, IF 184); control values: (V = 177, T = 105, IF = 145); An improvement of beeding and shortening of vBP was observed after infusion of platelet concentrate: (V = 328, T = 245, IF = 147).Case 2: A 60 years old man with adenocarcinoma undergoing liver transplantation, before operation (OP) vBP: (V = 224, T = 114, IF = 182); displayed a strong increase during OP: (V > 800, T = 360, IF = 277; decreasing values after Oft (V = 348, T = 146, IF = 254); 1. day after OP: (V = 250, T = 127, IF = 221); 13 day after OP normal vBft (V = 160, T = 111, IF 182).Case 3: A 35 years old man with III. grade burnings of the skin (35%) and a massive platelet function defect: (V > 800, T > 180, IF = 328); improvement after infusion of platelet concentrate: (V = 393, T = 164, IF = 239); further improvement some hours later: (V = 240, T = 120, IF = 213); and normalizing of parameters at the 1. day: (V = 197, T = 126, IF = 186) and the 5. day after OP: (V = 130, T = 122, IF = 142).It is interesting to note that patients with heavy burnings reguarly displayed reduced vBP: (V = 120, T = 70, IF = 127) if measured very early after the accident. The new method seems to be a valuable instrument to judge platelet functions. |
