Objective Study on the change of function in coagulation system,anticoagulation system,fibrinolytic system,endothelium system in septicemia patients,and to evaluate the relationship between the change of the parameters and the thrombosis prognosis.Methods The protein C(PC:A),anti- thrombin(AT:A),factor Ⅴ activity(FV:A),factor Ⅶ activity(FⅦ:A),factor Ⅷ activity(FVIH:A), factor Ⅸ activity(FⅨ:A),von Willebrand factor(vWF),fibrinogen(FIB),plasminogen activator inhibitor- 1(PAI-1),D-Dimer,prothrombin time international normalized ratio(PT INR),activated partial thromboplastin time(APTT),and thrombin time(TT)were assayed by the Sysmex CA-7000 blood coagulation instrument in 85 septicemia patients and control group.Results Compared the patients group with the control[ FIB(2 950?870)mg/L,PAI-1(0.6?0.5)Au/ml,vWF(94.1?32.5)%,D-direct (169?94)?g/L,FV:A(97?18)%,FⅦ:A(99?18)%,FⅧ:A(103?22)%,FⅨ:A(102?25)%, PT INR 1.15?0.32,APTT(31?7)s,TT(19?4)s,AT:A(107?9)%,PC:A(101?14)%,t-PA (0.45?0.13)U/ml],the level of the FIB[(3 720?2 290)mg/L],PAI-1[(2.4?1.0)Au/ml],vWF [(167.5?31.2)%],D-Dimer[(355?128)?g/L]were increased obviously(P0.05),the level of the AT:A[(76?17)%],PC:A[(65?19)%],t-PAl(0.22?0.09)U/roll were decreased obviously in patients group(P

Heparin induced thrombocytopenia ( HIT ) is a severe side effect of heparin with antibody-mediation.Laboratory assays can be divided into two major categories, about functional assays and HIT antibodiesdetection.Thefunctional assays, such as the serotonin release assay ( SRA ) and heparin-induced platelet activationassay( HIPA) , are sensitive and specific for HIT.They arethe reference standard assays generally, but have thedeficiencies of complicated operation and time-consuming, and cannot be used as a routine examination. TheHIT antibodiesdetections, such as ELISA, immune turbidimetry assay, chemiluminescent assay and lateral flow immunoassay, have high diagnostic sensitivityandareavailable at routine laboratories.They can exclude the diagnosis of HIT or beused to diagnose HIT effectively combined with the pre-test probability score(4Ts score) of HIT.

The clinical application of the laboratory examination with thrombosis can be divided into four categories,including risk assessment,diagnosis by exclusion,auxiliary diagnosis and therapic monitoring.Theevidence based parameters which subsumed into the international guidelines of thrombosis related clinical management,included the prothrombin time,activited partial thomboplastin time,anti-factor X a activity,D-dimer,coagulation factor Ⅷ,naturally occurring anticoagulants,antiphospholipid syndromeassociative parameters,heparin induced thrombocytopenia antibodies and platelet aggregation test,which provided the important evidence for clinical intervention and establishment of antithrombotic strategy.Theother thrombosis tests are still lack of sufficient evidence,therefore we need to participate in multicentric clinical randomized controlled study actively,and implementing the systematic review and meta-analysis forwardly,solving clinical questions based on PICO (Patients,Intervention,Comparision,Outcome),promoting the clinical application of laboratory parameters.

Platelets is the important hemostatic component in the blood and the critical participants in inflammation. It is an important promoting factor during inflammation and can recruit leukocytes and aggregate in sepsis. Decreasing plate?let count was correlated with reverse clinical outcome. Therefore, the value of the platelets examination in clinical monitor was studied by many researchers. Under circumstance of fungal infections, platelets mediate antimicrobial activity and assist dissemination of the fungi synchronously. Regulating interaction between platelets and fungi is difficult. In allergic inflamma?tion patients, the excessive activating of platelets aggravates airway obstruction and worsen pulmonary function. We reviewed current research in activating platelets during inflammation.

Objective　Influence of the function of coagulation and anticoagulation in the elderly patients with thrombotic diseases by activated protein C resistance(APCR) was studied. 　Methods　 Prothrombin fragments 1 and 2 (F1+2),fibrinopeptide A (FPA)，soluble fibrin monomer complex(SFMC) were examined by enzyme linked immunoassay(ELISA); fibrinogen(FIB),antithrombin III antigen(AT-Ⅲ:Ag) and its activity(AT-Ⅲ:A), protein C antigen(PC:Ag) and its activity(PC:A) and APCR were determined using CA 530 blood coagulation analyzer. 　Results　 Compared the elderly patient group with thrombotic diseases with the healthy elderly group, the parameters of coagulation system were obviously increased 〔F1+2(5.4±0.6)nmol/L vs (2.6±1.3)nmol/L,FPA (6.9±1.9)μg/L vs (4.8±2.3)μg/L,SFMC (72.4±8.7)g/L, vs (56.3±11.7)g/L,FIB (5.18±0.68)g/L　vs (3.82±0.74)g/L〕 and that of the anticoagulation system was significantly decreased〔AT-Ⅲ:Ag (212±19)mg/L vs (255±26)mg/L，PC:Ag (63.5±9.2)mg/L vs (82.7±20.1)mg/L〕.The above parameters changed more obviously in the elderly patients with positive APCR than those elderly patients with normal APCR.　Conclusions　APCR accelerated the activation of coagulation system and led to the weakening of the anticoagulation system function in the elderly patients with thrombotic diseases. The positive APCR may be one of the risk factors in the elderly patients who suffered from thrombosis.

Objective:To investigate the clinical value of changes of platelet and anticoagulation function in patients with acute pancreatitis. Methods:β-TG, PF4 ,TXB2 ,GMP-140,antithrombin-Ⅲ,and protein C were measured in all patients. Results:There was no significant difference in all parameters between acute edema pancreatitis group and normal group(P＞0.05).Compared with the control group, parameters of platelet significantly increased in acute necrosis pancreatitis group(P＜0.01),and parameters of anticoagulation significantly decreased(P＜0.01). Conclusion: The platelet system was activated and the level of anticoagulation system decreased in acute necrosis pancreatitis. Parameters are important in understanding and preventing this disease.

The P2Y12 receptor antagonist is used widely in prevention and treatment of cardiovascular and cerebrovascular disease. Monitoring changes of platelet function after treatment can improve the prognosis of patients. The platelet function test is the important way to evaluate high residual platelet reactivity after antiplatelet treatment, including light transmission aggregometry (LTA), whole blood impedance aggregometry assay (WBIA), vasodilator- stimulated phosphoprotein (VASP), thrombelastogram (TEG), platelet function analyzer- 100 (PFA-100) and VerifyNow system (VerifyNow). It is very different for the reflecting ability with residual reactivity of platelets among these tests after anti-platelet therapy, and also significant difference for assessment effect. Among them, LTA is a classic method for the curative effect evaluation of anti-platelet agents, which is convenient and cheap, but it is susceptible to the operating and environment interference. The clinical application of WBIA is less, and which lacks threshold value for assessment. VASP is sensitive for the changes of platelet function, but the test is complex and expensive. TEG can monitor the inhibition ratio of drugs on anti-platelets, but it needs to verify the safety of treatment. It is not clear for sensitivity and specificity with monitoring anti-platelet agent by PFA-100. VerifyNow is effective and reliable, but the cost is high. The evidence of clinical study shows that LTA, VASP and VerifyNow can reflect the effect of platelet inhibition of P2Y12 receptor antagonists sensitively, and is associated with the risk of major adverse cardiac events (MACE) in patients with cadiovascular diseases.

Objective To characterize the alteration in peripheral blood endothelial progenitor cells (EPCs) of patients with systemic lupus erythematosus (SLE).Methods Venous blood samples were obtained from 82 female patients with SLE aged (35 ± 10) years and 50 healthy female controls aged (35 ± 13) years.ACL 9000 automated coagulation analyzer was used to determine the level of Von Willebrand factor antigen (vWF Ag).Flow cytometry was performed to detect peripheral blood EPCs and circulating endothelial cells (CECs).Analysis of variance was performed to assess the differences in these parameters between patients with active and stable SLE and the controls,and Pearson correlation analysis was conducted to evaluate the relationship between these parameters.Results The number of CD34+ cells,CD133+ cells and CD34+CD133+cells per 200 000 peripheral blood mononuclear cells was 35.4 ± 16.7,86.5 ± 32.1 and 361.3 ± 176.4 in patients with active SLE,significantly higher than that in the patients with stable SLE (17.1 ± 10.9,28.7 ± 21.5,107.2 ±44.3,respectively,all P ＜ 0.01)) and the controls (13.8 ± 9.6,11.2 ± 5.5,92.3 ± 50.5,respectively,all P ＜0.01).The patients with active SLE exhibited an elevated level of vWF Ag (438.9％ ± 205.3％ vs.130.2％ ±51.5％,P ＜ 0.01),an increased number of EPCs (361.3 ± 176.4 vs.107.2 ± 44.3,P ＜ 0.01) but a similar number of CECs (127±51 vs.118 ± 39,P ＞ 0.05) per 200 000 peripheral blood mononuclear cells compared with the healthy controls.No significant differences were observed in these parameters between the patients with stable SLE and the controls (all P ＞ 0.05).The number of EPCs was positively correlated with the level of vWF Ag (r =0.67,P ＜ 0.01),but uncorrelated with the number of CECs (P ＞ 0.05) in patients with active SLE.Conclusions The quantity of EPCs in peripheral blood is closely correlated with the level of the vascular injury marker vWF Ag,hinting that the number of EPCs can serve as a useful marker of disease severity.

Objective To investigate the value for the level mensuration of von Willebrand factor antigen (vWF:Ag) in stroke risk assessment in the patients with non-valvular atrial fibrillation (AF).Methods 180 non-valvular AF patients were selected from the Tianjin medical university general hospital from the 2009 to 2011 for retrospective cohort study,112 males and 68 females in the group,age 61-87 years.Using the IL ACL-9000 blood coagulation instrument assay the level of vWF:Ag.Using ROC curve to analyze the diagnosis performance of vWF:Ag,using Cox regression analysis model to evaluate the of vWF:Ag effect on prognosis,using x2 test to analyze the relevance between vWF:Ag and clinical pathological factors.Compared the patients group with CHADS2 score with the patients group with CHA2DS2VASc score date using t test.Results vWF:Ag levels were control group (112 ± 34)％,paroxysmal AF group (119 ±31)％,the persistent AF group (179 ± 47)％,permanent AF group (217 ± 56)％,atrial fibrillation associated with stroke group (235 ± 104)％ respectively.There was no difference between the paroxysmal AF group and control group (q =1.75,P ＞ 0.05) ; vWF:Ag level was higher in persistent atrial fibrillation group than in paroxysmal AF group (q =10.10,P ＜ 0.01); permanent atrial fibrillation group was higher than that of the persistent AF group (q =5.21,P ＜ 0.01).The optimum cut-off point with vWF:Ag for stroke diagnosis was 188.5％,the area under ROC curve =O.843 (95％ confidence interval:0.785-0.901).In Cox regression multianalysis,the vWF:Ag (HR =0.405; 95％ CI =0.268-0.716; P =0.026),the congestive heart failure(HR =2.901 ; 95％ CI =1.837-3.951 ; P =0.001),stroke/transienl ischemic attack (HR =4.665 ; 95 ％ CI =2.837-7.291 ; P =0.000),age (HR =0.474 ; 95 ％ CI =0.211-0.765; P =0.039),the Cox analysis showed that vWF:Ag was the independent prognosis factor for stroke in AF patients.Inx2 analysis,there was the relationship between the level of the vWF:Ag and the congestive heart failure/LVdysfunction (x2 =8.227,P ＜ 0.01),hypertension (x2 =3.305,P ＜ 0.05),age (x2 =7.581,P ＜ 0.01),diabetes mellitus (x2 =6.730,P ＜ 0.01),stroke/ transient ischemic attack/thromboembolism (x2 =4.825,P ＜ 0.05),vascular disease (x2 =4.126,P ＜ 0.05).Compared the subjects with CHADS2 (score =1) with the CHA2DS2VASc(score =1),the level of the vWF:Ag was higher in patients with CHADS2 score =1 (t =4.283,P ＜ 0.01).Conclusion There was relationship between the level of vWF:Ag and main pathologic factors in patients with AF,and changed with the condition,high vWF:Ag level was an independent predictor of stroke risk,and had superior reference value for in assessment of stroke in patients with atrial fibrillation.

OBJECTIVETo assess the value of thrombotic biomarkers in estimation of venous thromboembolism (VTE) risk in cancer patients.

METHODSA total of 1473 cancer patients treated in the Tianjin Medical University General Hospital from 2009 to 201 were selected, including 845 males and 628 females in the age of 56 ± 17 years. The activities of von Willebrand factor antigen (vWF:Ag), factor VII (F VII:A), factor VIII (F VIII:A), antithrombin (AT:A), protein C (PC:A) and protein S (PS:A) were assayed using an ACL TOP 700 blood coagulation analyzer. The level of D-dimer (D-D) was assayed using the Biomerieux Mini Vidas Automated Immunoassay Analyzer. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic performance of the parameters. Cox regression analysis model was applied to evaluate the effect on prognosis, and Kaplan-Meier curve was used to implement the survival analysis.

RESULTSThe levels of vWF:Ag, D-D, and F VIII:A were significantly higher in all the specified tumor groups ( except the other tumor group ) than that of the control groups (P < 0.05). F VIII:A was significantly higher than that in the control group in all tumor groups except the renal carcinoma, prostatic cancer, lymphoma groups and the other tumor group (P < 0.05). The PC:A level was significantly lower in all tumor patients groups than in the control group, except glioma, breast cancer, gastric carcinoma, renal carcinoma and the other tumors groups (P < 0.05). The PS: A level was significantly lower in all tumor groups than in the control group, except the glioma, breast cancer, prostatic cancer, lymphoma and the other tumors groups (P<0.05). The AT: A level was significantly lower in all tumor groups than in the control group (P<0.05). When the optimum cut-off point of vWF:Ag for VTE diagnosis was 192% in the cancer group, the area under ROC curve = 0.828 (95% CI: 0.716 to 0.939). When the optimum cut-off point of D-dimer for VTE diagnosis was 1484 ng/ml in the cancer group, the area under ROC curve = 0.915 (95% confidence interval: 0. 840 to 0.988). When the optimum cut-off point of PC: A for VTE diagnosis was 75.2% in the cancer group, the area under ROC curve = 0.764 (95% confidence interval: 0.630 to 0.898). The Cox analysis showed that age, surgery, chemotherapy and D-dimer were independent risk factors for VTE event within three months in cancer patients. The cumulative probability of VTE was increased significantly in the cancer patients if whose plasma D-dimer level was over the cut-off value.

CONCLUSIONSThe plasma D-dimer level is obviously increased in cancer patients, and there is a relevance to thrombosis risk stratification and VTE cumulative probability. It is with good diagnostic performance, and may be used as an effective marker in estimation of VTE risk within 3 months in cancer patients.

Aged ; Antithrombins ; blood ; Biomarkers ; blood ; Factor VII ; analysis ; Factor VIII ; analysis ; Female ; Fibrin Fibrinogen Degradation Products ; Humans ; Male ; Middle Aged ; Neoplasms ; blood ; Prognosis ; Protein C ; analysis ; Protein S ; analysis ; ROC Curve ; Regression Analysis ; Risk Assessment ; Risk Factors ; Venous Thromboembolism ; etiology ; von Willebrand Factor ; analysis