Резюме.  На основі вивчення показників ТЕГ та традиційних тестів дослідження гемостазу удосконалити лабораторний моніторинг профілактичного лікування препаратами концентратів факторів у хворих на гемофілію А. Матеріали і методи. Дослідження виконано у 9 хворих на тяжку форму гемофілії А без інгібіторів, профілактична доза лікування яких становила 45±5 МО/кг ФVIII 2 рази на тиждень. Визначення проводили на плановому візиті у тесті відновлення (ТВ) (доза 60±5 МО/кг). Аналізували показники ТЕГ у комплексі із показниками гемостазу, активністю ФVIII, антигеном ФVIII (ФVIII:Ag), антигеном фактора Віллебранда (vWF:Ag). Результати. До введення препарату ФVIII тести, які обумовлюють коагуляційний гемостаз є достовірно подовженими порівняно із здоровими особами. У ТВ до введення препарату показники ТЕГ, які залежать від рівня прокоагулянтів є порушеними у бік гіпокоагуляції. Через 30 хв після введення АЧТЧ, І АЧТЧ, активність ФVIII та ФVIII:Ag, R, ТМА, α-Angel, СІ, SP нормалізуються. Висновки. ТЕГ є надійним методом контролю профілактичного лікування та ТВ у хворих на тяжку форму гемофілії А. Аналізу підлягають показники, значення яких залежить від рівня прокоагулянтів: час реакції R, час досягнення максимальної амплітуди ТМА, кут  нахилу до дотичної ТЕГ α-Angel, загальний коагуляційний  потенціал СI, час від початку тесту до утворення перших ниток фібрину SP. Показники ТЕГ, які характеризують силу, якість, гемостатичні можливості, лізис згустку та залежать від вмісту фібриногену і тромбоцитів, не відрізняються від відповідних показників здорових осіб та є неінформативними для контролю замісної трансфузійної терапії та ТВ у хворих на гемофілію. У хворих на гемофілію моніторинг профілактичного лікування та появи інгібіторів до ФVIII може здійснюватись на основі ТВ за допомогою ТЕГ у комплексі із іншими тестами дослідження гемостазу: АЧТЧ, І АЧТЧ, активність ФVIII та ФVIII:Ag.  

In 30 cancer patients with rectal cancer after anterior resection of the rectum, a clinical study of the effect of intravenous infusions of the complex drug Sorbilact multifunctional action on plasma electrolytes in operated patients in the early postoperative period. Studies have shown that intravenous infusions of Sorbilact normalize plasma electrolytes in operated patients with rectal cancer after anterior resection of the rectum in the early postoperative period. Normalization of electrolytes in blood plasma in operated patients is confirmed by the presence in the infusion of Sorbilact ions of potassium, sodium, chloru. Sorbilact infusion is recommended for widespread medical use in cancer patients with rectal cancer after anterior resection of the rectum, especially in the early postoperative period.

Background: Epidemiological data in Haemophilia A (HA) report an improvement in haemophilia care over the last 50 years; the life expectancy of these patients now approaches that of the general population but evidence-based guidelines for the acute management and secondary prophylaxis of cardiovascular diseases in haemophilia patients are still lacking, Aims: We report the surgical and haematological strategies used in a mild haemophilia A patient who successfully underwent endovascular aortic aneurysm repair (EVAR) because very little is known about how to handle the increased risk of bleeding associated with invasive procedures and antithrombotic agents Methods: Case report: To our knowledge, about six other haemophilic patients treated with open surgery or EVAR were reported in the literature Results: A 64-year-old man with mild-moderate HA (F8:C 6.9%), without inhibitor was referred for treatment of a symptomatic infrarenal aortic aneurysm that had enlarged from 5.6 cm to 6 cm in diameter in 6 months. Among the personal antecedents: Acute Coronary Syndrome (1997), allergy to FVIII Concentrate of plasmatic origin, traumatic amputation of right lower limb and Arterial Hypertension on treatment.He are VIH positive on antiretroviral triple therapy. The patient was successfully treated with EVAR, Femoro-femoral bypass and right common iliac artery embolization with Coils (Endurant 32 * 14 mm) associated with perioperative administration of titrated doses of recombinant full length 3rd generation factor VIII concentrate (Octocog Alfa, Advateâ, Takeda Lab)(rCF8), administered on bolus The surgery was carried out under general anaesthesia and anticoagulation with bolus of unfractionated heparin(UFH)(Heparin Leoâ 5000 UI) administered inmediately before the surgery and after the perioperative administration of a bolus of aproximately 55 UI by kilogram of Advateâ to achieve a secure level of FVIII presurgery (105 %). 3 hours after the first bolus, an intraoperative control of FVIII was performed (using a chromogenic technique) and a new bolus of rCF8 was administered (aprox 20 UI by kilogram). At the end of surgery the UFH was reversed with protamine sulfate in a 1:1 ratio. To reduce the risk of hematoma, local dry weight and cold were applied after the withdrawal of the introducers. In the first 48 h post he received rCF8 to maintain minimum level of 80% and after, every 12 h/7 days (minimum level 50%) and another 7 days, every 24 h (minimum level 30%), performing antithrombotic prophylaxis (Enoxaparin sodium 40 mg / day) and concomitant antiaggregant therapy(Acetylsalicylic acid 100 mg / day, 2 months).The determination of the postoperative levels of FVIII was carried out by one stage coagulative assay (ACL Top). There were no perioperative complications and he was discharged at day 14, performing the determination of inhibitor at 15 days and 2 months after surgery, being negative (< 0.4 Bethesda units) Summary/Conclusion: This case report shows that EVAR is a relatively safe procedure in haemophilic patients by mean...

Background: In order to control the treatment of haemophilia patients, classical coagulation methods (APTT, FVIII (IX)) and global tests are used. One of the tests for a comprehensive coagulation assessment is thromboelastography (TEG), which can provide immediate results and reflect the hemostatic status of the patient during therapy. Some of the parameters obtained from the TEG can be compared with the coagulation tests since they describe similar processes of coagulation. Purpose: To carry out a correlation analysis of TEG parameters with coagulation test parameters to determine the role of TEG in the control of prophylactic treatment and the development of inhibitors in patients with severe haemophilia A. Materials and methods: 9 haemophilia A patients were treated with 45 ± 5 IU/kg of FVIII of body weight twice a week prophylactically an incremental recovery test (IR) at a dose of 60 ± 5 IU/kg body weight was performed. Prior to and after administration, TEG was performed and the PT, APTT, fibrinogen, FVIII, FVIII:Ag, vWF:Ag and the platelet count were measured. The possible dependencies of 10 TEG parameters (R, K, α-Angle, MA, TMA, SI, SP, G, LY30, TPI/c) and coagulation tests results were analyzed. Results: Significant direct correlation of the R and SP on the PT and APTT was found (r > 0.71) prior to the administration of the FVIII concentrate. The negative average correlation between R and FVIII:Ag (r =-0.56) was established. The elongation of the PT and APTT and the decrease in the activity of FVIII:Ag causes a decrease in the total hemostatic potential of the SI in the direction of hypocoagulation (r = 0.75). Prior to administration of the calculated dose, the concentration of MA, TMA and α-Angel inclination strongly and directly depends on the level of vWF:Ag and platelet count (in all cases r > 0.7). After administration of the FVIII concentrate in haemophilia A patients, a significant positive correlation between the response time R and the APTT (r = 0.64) was found. The growth of the CІ coagulation index is associated with an increase in the level of FVIII: Ag (r = 0.75) and a shortening of the APTT (r =-0.76). Other dependencies between TEG parameters and hemostatic tests have not been established. Conclusion: Correlation of TEG parameters and results of traditional coagulation tests characterized similar processes of coagulation and was revealed in haemophilia A patients on prophylactic treatment. For R, SI,

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