N’chifukwa chiyani machubu a seramu angagwiritsidwenso ntchito kuzindikira kuchuluka kwa D-dimer? Padzakhala kupangika kwa fibrin clot mu chubu cha seramu, kodi sichidzawonongeka kukhala D-dimer? Ngati sichidzachepa, n’chifukwa chiyani pali kuwonjezeka kwakukulu kwa D-dimer pamene machubu a magazi amapangidwa mu chubu choletsa magazi kuundana chifukwa cha kusatenga bwino magazi kuti ayesedwe magazi kuundana?
Choyamba, kusasonkhanitsa bwino magazi kungayambitse kuwonongeka kwa mitsempha yamagazi, komanso kutulutsidwa kwa subendothelial tissue factor ndi tissue-type plasminogen activator (tPA) m'magazi. Kumbali imodzi, tissue factor imayatsa njira yolumikizirana yakunja kuti ipange fibrin clots. Njirayi ndi yachangu kwambiri. Ingoyang'anani nthawi ya prothrombin (PT) kuti mudziwe, yomwe nthawi zambiri imakhala pafupifupi masekondi 10. Kumbali ina, fibrin ikapangidwa, imagwira ntchito ngati cofactor kuti iwonjezere ntchito ya tPA ndi nthawi 100, ndipo tPA ikalumikizidwa pamwamba pa fibrin, sidzalepheretsedwanso mosavuta ndi plasminogen activation inhibitor-1 (PAI-1). Chifukwa chake, plasminogen imatha kusinthidwa mwachangu komanso mosalekeza kukhala plasmin, kenako fibrin imatha kuwonongeka, ndipo kuchuluka kwa FDP ndi D-Dimer kumatha kupangidwa. Ichi ndichifukwa chake kupanga magazi mu vitro ndi zinthu zowononga fibrin kumawonjezeka kwambiri chifukwa cha kusatenga magazi bwino.
Ndiye, n’chifukwa chiyani kusonkhanitsa kwabwinobwino kwa chubu cha seramu (popanda zowonjezera kapena ndi coagulant) zitsanzo zinapanganso ma fibrin clots mu vitro, koma sizinawonongeke kuti zipange kuchuluka kwa FDP ndi D-dimer? Izi zimadalira chubu cha seramu. Kodi chinachitika n’chiyani chitsanzocho chitasonkhanitsidwa: Choyamba, palibe kuchuluka kwa tPA komwe kumalowa m’magazi; chachiwiri, ngakhale kuchuluka kochepa kwa tPA kukalowa m’magazi, tPA yaulere idzamangiriridwa ndi PAI-1 ndipo idzataya ntchito yake pasanathe mphindi 5 isanagwirizane ndi fibrin. Panthawiyi, nthawi zambiri sipamakhala kupangika kwa fibrin mu chubu cha seramu popanda zowonjezera kapena ndi coagulant. Zimatenga mphindi zoposa khumi kuti magazi opanda zowonjezera azikangana mwachibadwa, pomwe magazi okhala ndi coagulant (nthawi zambiri ufa wa silicon) amayamba mkati. Zimatenganso mphindi zoposa 5 kupanga fibrin kuchokera munjira yolumikizira magazi. Kuphatikiza apo, ntchito ya fibrinolytic kutentha kwa chipinda mu vitro idzakhudzidwanso.
Tiyeni tikambiranenso za thromboelastogram pankhaniyi: mutha kumvetsetsa kuti magazi omwe ali mu chubu cha seramu sawonongeka mosavuta, ndipo mutha kumvetsetsa chifukwa chake mayeso a thromboelastogram (TEG) samakhala ozindikira kuti awonetse hyperfibrinolysis - zochitika zonse ziwiri. Ndi zofanana, ndithudi, kutentha panthawi ya mayeso a TEG kumatha kusungidwa pa madigiri 37. Ngati TEG imakhala yozindikira kwambiri kuti iwonetse momwe fibrinolysis ilili, njira imodzi ndikuwonjezera tPA mu kuyesa kwa in vitro TEG, koma pali mavuto okhazikika ndipo palibe kugwiritsidwa ntchito konsekonse; kuphatikiza apo, imatha kuyezedwa pambali pa bedi nthawi yomweyo mutatenga sampling, koma zotsatira zake zimakhala zochepa kwambiri. Mayeso achikhalidwe komanso ogwira mtima kwambiri poyesa ntchito ya fibrinolytic ndi nthawi yosungunuka ya euglobulin. Chifukwa cha kukhudzidwa kwake ndi chapamwamba kuposa cha TEG. Mu mayesowa, anti-plasmin imachotsedwa posintha pH ndi centrifugation, koma mayesowa amawononga. Zimatenga nthawi yayitali ndipo zimakhala zovuta, ndipo sizimachitika kawirikawiri m'ma laboratories.
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