From Big Medical Encyclopedia

THROMBOSIS of LASTOGRAFYYa (Greek thrombos a piece, a clot + elastos viscous + grapho to write, represent) — graphic registration of process of a blood coagulation by means of the tromboela-hundred-count. The method allows to determine the nature of disturbance of hemocoagulation by change of viscosity of blood and resilient-elastic properties of the formed blood clot.

Thrombosis of l and about that - the count, or a gemoko-agulograf, allows to observe visually and to automatically register process of a blood coagulation. In 1948 the German scientist Hartert (N. of Nag-tert) for the first time offered the technical device for registration of process of a blood coagulation, as the main measuring converter to-rogo served the mechanical system consisting from ditches of a cylindrical form and the float suspended on the fine torsion steel end polished steel. On thread the mirror discarding a light ray on photosensitive paper is strengthened. Ditch in Hartert's device makes back and forth motions of a certain amplitude around a vertical axis. In the blood poured in a ditch, a poma

shchat a float. While blood is in liquid state, the movements ditches are not transferred to a float. At fibrillation and increase in its viscosity the float is involved in rotation. At formation of a clot, increase in its durability and reduction of elasticity amplitude of movements of a float and consequently, and amplitude of light record, up to obtaining the maximum amplitude keeping certain time identical size grows. Further amplitude decreases that is connected with retraction of a clot. On photographic paper this process is registered in the form of a curve — the tromboelastogramma having the following main indicators — 7?, To, that (fig. 1). R — time of reaction, or a tromboelastogra-fichesky constant of thromboplastin, corresponds to the beginning of process of a fibrillation, i.e. loss of the first fibers of fibrin (see). This indicator reflects the speed of emergence of thromboplastin (see. Coagulant system of blood) in the blood which is in liquid state; R decreases at hypercoagulation and increases at hypocoagulation. To — time svertyva-

Fig. 1. The diagrammatic representation tromboelastogramm is normal also at pathology: and — the tromboelastogramma is normal — at

hemophilia, in — at thrombocytopenia — at hypercoagulation, d — at an acute fibrinolysis; R — time of reaction, or a tromboelastografichesky constant of thromboplastin (an interval from the beginning of record before discrepancy of shoulders of a tromboelastogramma); To — a blood clotting time, or a tromboelastografichesky constant of thrombin (an interval from the moment of the end of time of reaction before discrepancy of shoulders of a tromboelastogramma to 20 mm) \that is the maximum amplitude (the greatest distance between shoulders of a tromboelastogramma).

the niya of blood, or a tromboelastografichesky constant of thrombin (see), reflects the speed of transition of ground mass of fibrinogen (see) in fibrin. Size K depends on concentration of thrombin and fibrinogen, and also on polymerization rate fibrin-monomers; its increase happens at a lack of thrombin or the slowed-down its education, at deficit of fibrinogen, at the increased content in blood of polymerization retarders fibrin-monomers, in particular at surplus

of products of a fibrinolysis in it (see); reduction of size K is observed at excess of thrombin. At the expressed hypercoagulation the indicator To much is reduced or in general is absent. that is the maximum amplitude, characterizes the maximum density of the formed clot.

Indicators of a tromboelastogramma of the healthy person have the following average sizes: R = 9 — 14 min., To = 5 — 8 min., that = 50 — 56 mm. At hemophilia (see) an indicator of R it is sharply raised, To and the tpa — is normal; at thrombocytopenia (see) an indicator of R it is raised, To and that are reduced; at an afibrinogenemiya (see) a trom-boelastogramm represents a straight line; at hypercoagulation the indicator of R is sharply reduced, that is considerably increased; at an acute fibrinolysis (see). L, To, that normal values, further size that have in the beginning decreases (fig. 1).

At assessment of a tromboelastogramma define some other indicators, e.g. R + To — the nonspecific constant of coagulation, edges reflects the general blood clotting time, its reduction indicates excess of thromboplastin and thrombin, and increase — their deficit; R / To ~ the tromboelastografichesky constant of use of a prothrombin (see), expresses the attitude of speed of generation of thromboplastin (R) towards amount of educated thrombin (K) and allows to judge use of a prothrombin thromboplastin at formation of thrombin (normal the relation of R/K more unit, at a row patol. states — it is less).

In the USSR it was created the tromboelasto-columns ISK-64 with mechanical system of primary converter. In this device not direct photorecord of process is carried out, and fluctuations of tension of photoresistance are registered, to-rye through the balance amplifier are transferred to the recorder. By means of such device it is possible to register any process of blood coagulation, plasma, polymerization of organic materials, glues, etc. As ditch with the studied blood termostatiruyegsya at 37 °, the research of hemocoagulation is conducted in optimal conditions. Also highly sensitive electromagnetic primary converters — GKGM4-02 (fig. 2) registering process of a blood coagulation, retraction of a blood clot (see Retraction), and also a fibrinolysis, and gemokoagulometr are created by GKM1-01 (fig. 3) defining quantitative indices of a blood coagulation after registration of this process. Sensitive element electromagnetic preobrazova-

Fig. 2. Habit view of a gemokoagulograf (GKGM4-02): 1 — a paper strip for record of a gemokoagulogramma; 2 — primary converters (sensors); z — ditches for blood or plasma.

Fig. 3. Habit view of a gemokoagulometr (GKM1-01): 1 — the registrar of time of reaction; 2 — a digital board for fixing of characteristics of hemocoagulation; z — the indicator of zero; 4 — primary converter (sensor); 5 — a ditch for blood or plasma.

Fig. 4. Habit view of a termokonduktometri-chesky gemokoagulometr (GKTTs-01): 1 —

the microdoser; 2 — a digital board for fixing of results of a research.

tele the electromagnetic frame which is rigidly connected with the float setting it in motion is. Amplitude of fluctuations of a frame is fixed on paper.

The device of new type is the mechanical analyzer of hemocoagulation AGKM-1 with primary converters of electromagnetic type entering the electric measuring bridge circuitry of the instrument. Quantitative indices decide on digital indication (gemokoagu-logramm) of results of a research automatically.

For definition of protrombinozy time (see), a calcium clotting time of plasma, tolerance of a blood plasma to heparin (see. Coagulant system of blood), etc. apply termokonduktometrichesky gemokoagulometr GKTTs-01 (fig. 4). In the device the termokonduktometrichesky way of definition of a phase condition of the studied blood plasma is used.

Apply a koagulograf of N-334 to mass approximate definitions of process of hemocoagulation, with the help to-rogo process of a blood coagulation is registered on change of the general electric resistance to the studied blood. Liquid blood in shaking thermostatically controlled at 37 ° a ditch, having two electric contacts at a spherical bottom, is poured during the rocking ditches, breaking off an electric chain; in process of a blood coagulation the electric chain is interrupted less and less that is fixed on a paper strip by the recorder in the form of a tromboelastogramma. Bibliography: Tooth and D. M. Biokhimiya's ditch of a blood coagulation, M., 1978;

Ivanov E. P. Diagnosis of disturbances of a hemostasis, Minsk, 1983; Koblov JI. T. Methods and devices for a research of a hemostasis, M., 1975: it, Methods and devices for clinical laboratory trials, M., 1979; Problems and hypotheses in the doctrine of a blood coagulation, under the editorship of O. K. Gavrilov, M., 1981; Khrushcheva E. A. and Titova of M, I. Sistema of a hemostasis at surgical heart diseases, vessels and lungs, M., 1974.

L. F. Koblov; V. I. Belkevich (tekhn.).