Disease control coagulation

CDC Centers for Disease Control and Prevention CFU colony forming unit CNS central nervous system CSF cerebrospinal fluid CT computed tomographic DIC disseminated intravascular coagulation EV-PCR enterovirus-specific reverse-transcriptase polymerase chain reaction... 

CDC U.S. Centers for Disease Control and Prevention CSF colony-stimulating factor DIC disseminated intravascualr coagulation EORTC European Organization for the Research and Treatment of Cancer... 

Mechanism of Action An electrolyte that is essential for the function and integrity of the nervous, muscular, and skeletal systems. Calcium plays an important role in normal cardiac and renal function, respiration, blood coagulation, and cell membrane and capillary permeability. It helps regulate the release and storage of neurotransmitters and hormones, and it neutralizes or reduces gastric acid (increase pH). Calcium acetate combines with dietary phosphate to form insoluble calcium phosphate. Therapeutic Effect Replaces calcium in deficiency states controls hyperphosphatemia in end-stage renal disease. 

A (congenital or acquired) and type 1 von Willebrand disease, in which the VWF protein structure is normal but the plasma concentration is reduced (1). By contrast with conventional coagulation factor concentrates, desmopressin is cheap and is free from the risk of transmission of viral infections, which have proved such a problem in the past. It is also very useful in the treatment of carriers of hemophilia A, many of whom have significant reductions in the baseline concentration of factor VIII. By contrast, desmopressin has no effect on the concentration of factor IX, and is thus of no value in hemophilia B (Christmas disease). It is also of little value in type 2 (abnormal VWF structure) von Willebrand s disease, which accounts for about 15-20% of all cases. The administration of desmopressin to patients with type 2B von Willebrand s disease can be hazardous, as it is likely to cause thrombocytopenia (2). The use of desmopressin in bleeding disorders has been reviewed (3). Tachyphylaxis develops if desmopressin is used for prolonged periods to control bleeding disorders, because desmopressin causes release of stored factor VIII and von Willebrand factor, after which it takes time for them to accumulate again. 

Fig. 11.13 Coagulation flow chart Blood coagulation events are divided into initiation, extrinsic and intrinsic path activation, and the common path to fibrin. Controls are fibrinolysis as healing begins and inhibition of clotting factors in a healthy (uninjured) blood vessel. Diseases are excessive bleeding (hemophilia) and excessive clotting (Original figure)...

Therapy for the control or prevention of the acute events in death due to vascular disease can be approached in several ways. One general approach would be to control the interaction of blood components with the diseased blood vessel or with each other. In both these cases antithrombotic agents of diverse mechanism should be helpful. Whether control of fibrin formation, fibrinolysis or platelet function is desirable, each patient s problem would dictate the therapy best suited. Several reviews are available in which the different blood coagulation mechanisms that may be helpful in such therapy are discussed s " Reviews have also been published in which methodology is discussed for the testing of compounds and for the determination of abnormalities in platelet function. ... 

The editors concept of clinical chemistry, as stated in previous volumes of this serial publication, encompasses a wide field of subjects— from the mechanism of blood coagulation to the microbiological assay of vitamins, and from the significance of trace metals in health and disease to the therapeutic application of increased gas pressure. The natural history of clinical conditions and their comparison with normal controls share one common feature, namely, the central position of some species of molecules, be they small or large, all of them the natural subject of chemical research. Hence, practical methods develop, either manual or mechanized, the results of which become increasingly more useful for the clinician in diagnosis, therapy, and prognosis. 

Thromboplastin formation is the most mysterious phase of blood coagulation. Compared to the formation of thrombin and fibrin, thromboplastin formation is slow and may therefore be critical in controlling diseases resulting from increased rates of blood coagulation. In his review, Pool [3] distinguishes between the formation of extrinsic and intrinsic thromboplastin activators (see Figs. 7-1 and 7-2). 

Although the factors in the blood probably play a central role in blood coagulation, other factors—the platelet count and vascular reaction—are involved in controlling hemostasis. Consequently, hemorrhagic disease may result from interference with the activity of one or more factors involved in blood coagulation, from absent platelets, or from vascular disorders. At this point, we will only discuss those hemorrhagic diseases that result from transient reduction of coagulating factors. 

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