PROGNOSTIC VALUE OF HAEMATOLOGIC CHANGES IN HEAD TRAUMA

The present prospective study was undertaken to evaluate the relationship between degree of coagulopathy and prognosis after closed head injury. 55 patients were divided into three groups according to Glasgow Coma Scale (GCS) score: Group 1 (GCS score 13-15), Group 2 (GCS score 8-12), Group 3 (GCS score 3-7). Coagulation studies (platelet count), prothrombin time, activated partial thromboplastin time, fibrinojen, euglobulin lizis time, fibrin degradation products (FDP), D-Dimer, antitrombin III) and computed tomography scan examinations were performed in all patients. Blood samples were taken in 6 hours, 24 hours, 3 days and 7 days after injury. In the operated patients, additional samples were collected immediately before and after surgery and during induction of anesthesia. In the group 1, all coagulation parameters were normal. In the group 2 and 3, FDP and D-dimer levels were abnormally higher and also antitrombin III level was significantly lower in the patients in group 2 and 3(p< 0.01). FDP, D-dimer and antitrombin III had an important value in estimation of prognosis in patient with blunt head injury.

KAFA TRAVMALARINDA HEMATOLOJÝK DEÐÝÞÝKLÝKLER VE PROGNOZ AÇISINDAN ÖNEMLERÝ

Bu prospektif çalýþma kapalý kafa travmalý olgularda koagulasyon bozukluklarýnýn derecesi ile prognozu arasýndaki iliþkinin ortaya konulmasý için planlandý. 55 olgu Glasgow Koma Skalasý (GKS) skoruna göre 3 gruba ayrýldýlar: Grup 1 (GKS skoru 13-151, Grup 2 (GKS skoru 8-12), Grup 3 (GKS skoru 3-7). Koagulasyon testleri (trombosit sayýsý, protrombin zamaný, aktif parsiyel tromboplastin zamaný, fibrinojen, öglobulin yýkým zamaný, fibrin yýkým ürünleri (FYÜ), D-Dimer, antitrombin III) ve bilgisayarlý tomografi tetkiki tüm hastalarda yapýldý. Kan örnekleri travma sonrasý 6 ve 24. saatlerde, 3 ve 7. günlerde alýndý. Cerrahi giriþim yapýlan olgularda, cerrahinin hemen öncesi ve sonrasý ve anestezi indüksiyonu sýrasýnda ek kan örnekleri alýndý. Grup I'de tüm koagulasyon testleri normaldi. Grup 2 ve 3'de FYÜ ve D-Dimer seviyeleri önemli derecede yüksek, antitrombin III seviyeleri düþüktü. Bu deðerler hastanýn prognozuna göre deðiþim gösterdi. FYÜ, D-Dimer ve antitrombin III ün künt kafa travmalý olgularýn prognoz tahmininde önemli olduklarý saptandý.