so Y TE THANH HOAB~NH Vq:N DA KHOA TINH

S6 890/BV-KH

CONG HOA xA HOI CHiT NGHiA VIET NAM. . .DQc l~p - Tu' do - Hanh phuc

Thanh Hoa, ngay 23 thang 7 ndm 2018

HUONGDA.NChi djnh xet nghi~m dong mau CO' ban va chuyen sau

Can cir Cong van s6 3238/BHXH-CSYT ngay 19/712013 cua Bao hiem xah<)iViet nam v€ viec thanh toan chi phi xet nghiem dong mau co ban va thu6c h6tro gan;

Can cu chuc nang nhiern vu, quyen han cua Giam d6c Benh vien ducc quydinh trong "Quy chd benh. vien" ban hanh kern thea Quyet dinh s6 1895/QU­BYT ngay 19 thang 9 nam 1997 cua B<)tnrong B<)Y te;

f)S dam bao an toan cho nguoi benh trong khi thuc hien cac phiu thuat, thuthuat va chftn dean, di€u tri cac benh ly lien quan den earn mau- dong mau; Giamd6c benh vien Da khoa tinh Thanh H6a Huang dftn viec thuc hien viec xetnghi~m dong mau cO'ban va chuyen sau nhu sau:

1. Cac phiu thu~t tlr lo~i I tra len va cac trU'ang hgp m6 de, m6 c~p ClmduQ'cchi dinh xet nghi~m dong mau ti€n phiu.

2. Cac lo~i phiu thu~t khac chi dinh lam xet nghi~m dong mau ti€n phftusau khi da duQ'c thong qua m6.

3. Cac thu thu~t tily thea timg lo~i thu thu~t va nguy cO'chay mau dS c6 chidinh xet nghi~m cftm mau - dong mau phil hQ'p.

4. Nhfrng b~nh nhan sau khi khai thac ti€n sir, kham lam sang c6 b~nh lienquan d~n cftm mau- dong mau thi phai ghi chep vao h6 sa b~nh an, tich vao phi~ukhai thac ti€n Slf cftm mau - dong mau va chi dinh lam cac xet nghi~m dong mclucO'ban, chuyen sau dS ch§n doan va di€u trio

Nl1~n dugc Huang dftn nay, dS nghi cilC Khoa, Phung lien quan ph6 biencho CBVC trong khoa bi~t dS thl,l'Chi~n. Cac phong chuc nang tang cucmg kiSmtra, giam sat vi~c thvc hi~n. Trong qua trinh thl,l'chi~n, n~u co vuang m~c phatsinh, xin phan anh kip thai v€ phong KHTH dS bao cao Lanh d~o B~nh vi~n xemxet giai quy~t./.

Nui nhiin:- Oie Khoa, Phong lien quan- Luu VT; KH

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. /~ • , .A .., A , " ,r'U~Nna. :r. at thac tien su cam mau- dong mauDAKHOA

\. \ TINH ~[1 hi~u Co Khfmg

Chay mau bat~di:il ~ho rang, dirt tay, de, phau thuat

Chay mau chan rang, miii, kinh nguyet keo dai, bam tim

Chay mau khop goi, khop hang, co

Dang dieu tri thuoc chong dong

Gia dinh co ai bi chay mau kho cam khong

I BQxet nghiem, ,..,

tien phau

,B9 cau hoi tien sircam man-dong mau

Binh thirong- Khong co ti~~ Slr benh

- Hien khong dung tbu6c lienquan d~n c~m mau- dong,; ,man

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So hrong tieu Can? ,

(Tong phan tich teXetnghi~m

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Xet nghiem

dong man co ban

PT; APTT;Fi 'I

Binh, th;UOngS6 IUQ1lg ti€u du ill 150-

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Binh thuang, (,!-PT: > 70%; IRN < 1,2

- APTT: B~nhI clumg < 1,2, ,

-Fi: ,~2g(1 ' I

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Thoi gian mau chay phirongphap Ivy: 4-8 phut

Ghi chu.- Khi co b~t thuong mot hay nhieu xet nghiern cua b<)xet nghiern ti~n ph~u se duoc h<)i chan chuyen khoa dS giai quyet

- Kham Him sang va khai thac ti~n sir neu co phat hien co mot trong s6 trieu chimg b~t thirong trong earn rnau- dong mau thi

Bac SI di~u tri se phai lam cac xet nghiern cAm mau- dong mau ca ban, chuyen sau dS tim nguyen nhan di~u tri,

HUaNG DAN CHi DJNH vA sir Df)NG xET NGHI~M ROTEM

INTEM

- N~u CT INTEM dai ~ Lam HEPTEM

N~u

- HEPTEM binh {huang ~ Nhi~mHeparin

- HEP'fEM dai ~ Thi~u ySu ttl/dongmallboac khang y~u t6 dong mau

ROTEM

EXTEM

?%~'-¢NHOA I<rl

- Da c.hAn thuong

- J»hfiuth~t tim, ung thir,. ..1

- Phau thu~t chlnh hlnh (thay khop)- Chay mau lieu boa,- CMymau trong, sau ph~u thu~t _ ft:- Chay mali 'kb6ng giai thjoh duoc nguyen nhiin

l' .

I r , - 'I-:A5dai -7 Thieu yeu to dong lJ,lclU; .

, "" I,-A5 giam -7 Thieu Tieu cau, Fibrinogen

Lam them' FITEM

I + A5 FI Binh thireng -7 Giam ti8u c~u

+ A5 FI Giam -7 Giam Fibrinogen

BiI ti~u c§u: Khi A5 EX < 35 mm BiI tua lanh: Khi A5 FI < 8 mm BiI huyet turrng turri dong lanh:- 25< A5 EX < 35 mm: bu 1 dv TC (Bu tua lanh d~ A5 FI dat 12 mm) Bu khi: A5 EX < 35mm hoac CT Fib> 600s- 15< A5EX< 25 mm: Bu 2 dv TC - M6i dan vi rua lam A5 FI tang 2mm Li~u: 10 -15 mmllKg

- A5 EX < 15 mm: 2 dv TC + Tua lanh Ho~c

- S6 dv ilia lanh = (12mm - x mm)/2

x = la chi s6 A5 FI xet nghiern diroc

Lam them APTEMA5EX<35mm

ho~cCTFib> 600s

ho~c

t.'Neu

- BT-7Tieu soi huyet

- Khong d6i-7Thi8UML ~ 15%l:h Fibrinogen nahg

Ghi chu: TruOng hQ'pd~c bi~t co th~ hQichAn chuyen khoa HH-TM

SU Dl)NG SQ XET NGHI~M DONG MAu CO BAN

IDGNGMAu:<]0 BXN'Ii

PT APTI

PT Binb tbuOng PT BAtthuong APTTBinb APTTB§t Fib bit tharong- Thai gian: 10-14 Gap trong tlureng tbu<mg 2-4g11 - Giarn trong: XO'

I' gan; Suy gan; DIe- Suy gan - Thai g~an:30-40 Gap trangI

gi~¥ - ThiSu y~o td: - Tang trong:- T:5'l~: > 70% - Thi~u VitaminKNhi~m khuan; Thai'- IRN: < 1,2 - Thu6c khang - 1:5'lQbenh VIII; rx "

ngqen'T;..~_;_ T clnrng: - Khano V~l1 til:

~lI('mg dong maunoi sinh'

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C~€u-t6 VITI; IX;'Xl;XlI "

Duong dong maungo~.isinh

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Ghi chu: Truong hop co nhirng bAt thirong khong giai thich diroc co the hQichan chuyen khoa HH-TM

~,"~r:OA-rt,A~

mauI ,

(ye~ t6 1)

soDO XET NGHI~M KHANG DONG N(U SINH

Ghi chu: Truong hqp co nhfrng bAt thu<mg kh6ng giiti thich duQ'c co th~ hQi ch~n chuyen khoa HH-TM

APTT Bit thmrng. .

Khi co- Thai gian: dai han chirqg 10.giay- Ty l~: Benh/ chimg > 1,2

Xet nghiem khang dong- Phat hi~: rh~t lIe chS phu thudc ~i1j gian, ~hi~t dQ

dUOng dong mau nQi sinh. T

- Phat hi~n ch~t lIe chS duong dong mau nQi sinh khOngpll~ thm)c thOi gian, 'nhi~t dQ_

,Khang dong dirong tinh

(Khong phu thuQc thM gian, nhi~t dQ)Khang d&ng am tinh

KL:- Thi~u y~u t6 dong mau huyet nrong

- Dinh lU:Q'Dgyau t6 dong mau "

- KL: Theo d5i b~nh h~th6ng~ Xet ngliiern chiln dOImb~nh h~ th6ng.- DT: Theo phac d6DT: Btl HTTDL

Khang dong duong tinhI ,

(Ph\l thuQc thM gian, nbi~t dQ)

-KL: Khang y~u t6 VITI va hoac IX '- E>T:- Bu HTTDL+ (Tc chS mi~n djch

- Bu ySu t6 vn+Dc chS rni~n dich I