{"id":10013,"date":"2020-04-23T04:53:57","date_gmt":"2020-04-23T01:53:57","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/cofactorul-pentru-ristocetina\/"},"modified":"2025-07-11T14:24:43","modified_gmt":"2025-07-11T11:24:43","slug":"cofactorul-pentru-ristocetina","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/cofactorul-pentru-ristocetina\/","title":{"rendered":"\u0420\u0438\u0441\u0442\u043e\u0446\u0435\u0442\u0438\u043d \u043a\u043e\u0444\u0430\u043a\u0442\u043e\u0440"},"content":{"rendered":"

\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/em><\/strong><\/span><\/p>\n

Factorul von Willebrand (FvW) este o glicoprotein\u0103 de adeziune, cu multiple roluri \u00een coagulare, care circul\u0103 \u00een plasm\u0103 sub forma unui amestec heterogen de multimeri lega\u0163i disulfidic. FvW este sintetizat\u00a0\u00een celulele endoteliale \u015fi megakariocite sub forma unei pre-pro-molecule, con\u0163in\u00e2nd un peptid semnal de 22 aminoacizi, un propeptid de 741 aminoacizi \u015fi protein\u0103 matur\u0103 de 2050 aminoacizi. FvW este neobi\u015fnuit de bogat\u00a0\u00een cistein\u0103, implicat\u0103\u00a0\u00een formarea de leg\u0103turi disulfidice. Monomerii pro-FvW sunt asambla\u0163i la nivelul reticulului endoplasmic\u00a0\u00een dimeri prin leg\u0103turi disulfidice ale capetelor C-terminale, iar multimerizarea are loc\u00a0\u00een aparatul Golgi prin formarea de leg\u0103turi disulfidice ale capetelor N-terminale ale dimerilor adiacen\u0163i, proces ce pare a fi catalizat de o activitate disulfid-izomerazic\u0103 localizat\u0103 \u00een propeptidul FvW4<\/sup>. Clivarea propeptidului are loc dup\u0103 asamblarea multimerilor, \u00een special intracelular, dar poate avea loc \u015fi dup\u0103 secre\u0163ie. Multimerii de FvW variaz\u0103 \u00een m\u0103rime, de la dimerii de 600 000D la multimerii foarte mari de 20 milioane D. FvW este stocat\u00a0 \u00een \u03b1-granulele plachetare \u015fi \u00een corpusculii Weibel-Palade din celulele endoteliale, acestea fiind formele cele mai mari \u015fi mai potente biologic. Rezervele endoteliale de FvW pot fi eliberate terapeutic prin administrarea de desmopre\u015fin\u0103.<\/span><\/p>\n

Timpul de \u00eenjum\u0103t\u0103\u0163ire al FvW plasmatic este de ~8-12 ore. Aproximativ 15% din FvW circulant este localizat\u00a0\u00een compartimentul plachetar, acesta fiind derivat\u00a0\u00een \u00eentregime din sinteza intramedular\u0103, dar ambele pool-uri de FvW sunt necesare pentru hemostaz\u0103. Celulele endoteliale secret\u0103 multimeri mai mari dec\u00e2t cei care circul\u0103\u00a0\u00een plasm\u0103; ace\u015ftia sunt degrada\u0163i de c\u0103tre o metaloproteaz\u0103 specific\u0103, ADAMTS13, rezult\u00e2nd\u00a0reducerea\u00a0\u00een m\u0103rime a celor mai mari multimeri. Sc\u0103derea activit\u0103\u0163ii ADAMTS13, congenital\u0103 sau prin inhibitori dob\u00e2ndi\u0163i, joac\u0103 un rol central\u00a0\u00een patofiziologia purpurei trombotice trombocitopenice3;4<\/sup>.<\/span><\/p>\n

FvW are situsuri de legare pentru FVIII, heparin\u0103, colagen, glicoproteinele plachetare GPIb \u015fi GPIIb-IIIa, de\u0163in\u00e2nd multiple func\u0163ii \u00een hemostaz\u0103. FvW stabilizeaz\u0103 FVIII protej\u00e2ndu-l \u00a0fa\u0163\u0103 de inactivarea de c\u0103tre PC activat\u0103, prelungindu-i astfel timpul de \u00eenjum\u0103t\u0103\u0163ire\u00a0\u00een circula\u0163ie \u015fi localiz\u00e2ndu-l eficient la locul injuriei vasculare1;2;4<\/sup>. Fiecare monomer de FvW are un situs de legare pentru FVIII, totu\u015fi in vivo<\/em> numai 1-2% din monomeri sunt ocupa\u0163i de FVIII, astfel explic\u00e2ndu-se faptul c\u0103 prezen\u0163a multimerilor foarte mari nu este esen\u0163ial\u0103 pentru func\u0163ia de carrier a FVIII. In orice caz, o modificare \u00een nivelul plasmatic al FvW se asociaz\u0103 cu modific\u0103ri concordante ale concentra\u0163iei plasmatice de FVIII2<\/sup>.<\/span><\/p>\n

FvW este o protein\u0103 structural\u0103 \u015fi parte a matricei subendoteliale. De asemenea joac\u0103 un rol important \u00een ata\u015farea plachetelor la suprafe\u0163ele subendoteliale,\u00a0\u00een mod particular la for\u0163e de forfecare moderate-mari (func\u0163ie explorat\u0103 par\u0163ial in vivo<\/em> prin m\u0103surarea timpului de s\u00e2ngerare), ac\u0163ioneaz\u0103 ca punte \u00eentre plachete \u015fi promoveaz\u0103 agregarea plachetar\u0103. Ini\u0163ial are loc ancorarea plachetelor la locul injuriei vasculare prin interac\u0163iunea FvW cu GPIb, urmat\u0103 de activarea plachetar\u0103 \u015fi expunerea GPIIb-IIIa, care leag\u0103 fibrinogenul, FvW \u015fi al\u0163i liganzi1;4<\/sup>. Ambele activit\u0103\u0163i de legare ale FvW sunt maxime la multimerii cu greutate molecular\u0103 mare. Interac\u0163iunea dintre GPIb \u015fi FvW poate fi explorat\u0103 in vitro<\/em> prin ad\u0103ugarea antibioticului ristocetin\u01032<\/sup>.<\/span><\/p>\n

Nomenclatura recomandat\u0103 de Societatea Interna\u0163ional\u0103 de Hemostaz\u0103 \u015fi Tromboz\u0103 pentru complexul FVIII-FvW este2<\/sup>:<\/span><\/p>\n\n\n\n\n\n\n\n\n
\n

FVIII<\/em><\/strong><\/span><\/p>\n<\/td>\n

\u00a0<\/span><\/td>\n\n

FvW<\/em><\/strong><\/span><\/p>\n<\/td>\n

\u00a0<\/span><\/td>\n<\/tr>\n
\n

Protein\u0103<\/em><\/span><\/p>\n<\/td>\n

\n

VIII<\/span><\/p>\n<\/td>\n

\n

Proteina matur\u0103<\/em><\/span><\/p>\n<\/td>\n

\n

FvW<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Antigen<\/em><\/span><\/p>\n<\/td>\n

\n

VIII:Ag<\/span><\/p>\n<\/td>\n

\n

Antigen<\/em><\/span><\/p>\n<\/td>\n

\n

FvW:Ag<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Func\u0163ie<\/em><\/span><\/p>\n<\/td>\n

\n

VIII:C<\/span><\/p>\n<\/td>\n

\n

Activitatea de cofactor al ristocetinei<\/em><\/span><\/p>\n<\/td>\n

\n

FvW:RCo<\/span><\/p>\n<\/td>\n<\/tr>\n

\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n\n

Activitatea de legare a colagenului<\/em><\/span><\/p>\n<\/td>\n

\n

FvW:CB<\/span><\/p>\n<\/td>\n<\/tr>\n

\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n\n

Capacitatea de legare a FVIII<\/em><\/span><\/p>\n<\/td>\n

\n

FvW:FVIIIB<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Anomaliile func\u0163iei FvW determin\u0103 boala von Willebrand <\/em>(vWD)<\/em>, cea mai frecvent\u0103 boal\u0103 hemoragic\u0103 mo\u015ftenit\u0103, cu o prevalen\u0163\u0103 de aproximativ 1% \u00een popula\u0163ia general\u0103, \u00eens\u0103 cu o prevalen\u0163\u0103 a bolii semnificative clinic de 1:10004<\/sup>. Afec\u0163iunea este caracterizat\u0103 prin hemoragii cutaneo-mucoase, transmitere autosomal dominant\u0103 \u015fi prelungirea timpului de s\u00e2ngerare. Boala nu este omogen\u0103, pe de o parte datorit\u0103 func\u0163iilor fiziologice multiple jucate de FvW, iar pe de alt\u0103 parte prin demonstrarea de modele genetice diferite. Aproximativ 60% din varia\u0163iile nivelului FvW plasmatic sunt atribuite unor factori genetici. Astfel, indivizii cu grup sanguin 0 au niveluri de FvW \u00een medie cu 30% mai mici dec\u00e2t cei cu celelalte grupe sanguine. In plus, nivelul de FvW este sub control hormonal; de asemenea este influen\u0163at \u015fi de al\u0163i factori care complic\u0103 expresia bolii. Varia\u0163ii de p\u00e2n\u0103 la 20% au fost raportate cu ciclul menstrual, nivelurile cele mai sc\u0103zute fiind \u00eenregistrate\u00a0\u00een faza folicular\u0103 precoce. De asemenea nivelul cre\u015fte cu ~15% la fiecare decad\u0103 de \u00eenaintare\u00a0\u00een v\u00e2rst\u01033<\/sup>. Clasificarea actual\u0103 a vWD identific\u0103 dou\u0103 categorii majore2;3;4<\/sup>:<\/span><\/p>\n

    \n
  • Deficien\u0163e cantitative <\/em>ale FvW:<\/span>\n
      \n
    • \u0422\u0438\u043f 1<\/strong>, varianta cea mai comun\u0103 (70-80% din cazurile simptomatice de vWD), caracterizat\u0103 prin deficien\u0163a par\u0163ial\u0103 a FvW, \u00eenso\u0163it\u0103 de reducerea concordant\u0103 a activit\u0103\u0163ii FVIII \u015fi activit\u0103\u0163ii de cofactor la ristocetin\u0103, \u00een general \u00eentre 20 \u015fi 50% din normal, \u00een asociere cu o structur\u0103 normal\u0103 a multimerilor.<\/span><\/li>\n
    • Tipul 3<\/strong> se asociaz\u0103 cu deficien\u0163e severe \u015fi nivele foarte sc\u0103zute sau nedetectabile de FvW. Este o form\u0103 rar\u0103, cu transmitere autosomal recesiv\u0103 \u015fi caracterizat\u0103 prin diatez\u0103 hemoragic\u0103 sever\u0103.<\/span><\/li>\n<\/ul>\n<\/li>\n
    • Anomalii calitative<\/em> ale FvW (tipul 2, <\/strong>reprezent\u00e2nd 20-30% din cazuri), cu 4 subtipuri reflect\u00e2nd mecanisme patofiziologice diferite:<\/span>\n
        \n
      • Tipul 2A<\/strong> se caracterizeaz\u0103\u00a0 prin absen\u0163a multimerilor de greutate molecular\u0103 mare \u015fi intermediar\u0103 din plasm\u0103, rezult\u00e2nd \u00een alterarea interac\u0163iunii FvW cu plachetele \u015fi se asociaz\u0103 cu nivele ale activit\u0103\u0163ii cofactorului la ristocetin\u0103 dispropor\u0163ionat de sc\u0103zute comparativ cu antigenul FvW.<\/span><\/li>\n
      • Tipul 2B<\/strong>\u00a0 se caracterizeaz\u0103 prin afinitate crescut\u0103 a FvW pentru GPIb plachetar\u0103, s\u00e2ngerarea la ace\u015fti pacien\u0163i rezult\u00e2nd paradoxal ca urmare a clearance-ului multimerilor cu greutate moleculara mare \u015fi plachetelor din circula\u0163ie, asociind trombocitopenie.<\/span><\/li>\n
      • In tipul 2M<\/strong> interac\u0163iunea FvW cu GPIb este deficitar\u0103 rezult\u00e2nd din defecte ale domeniului FvW care leag\u0103 GPIb, cu sc\u0103derea func\u0163iei plachetar-dependente, \u00een prezen\u0163a de multimeri normali la electroforeza pe gel.<\/span><\/li>\n
      • In tipul 2N <\/strong>(Normandy) afinitatea sc\u0103zut\u0103 a FvW pentru FVIII determin\u0103 niveluri plasmatice sc\u0103zute ale FVIII. Acest tip este suspectat \u00een prezen\u0163a unei reduceri marcate a nivelului FVIII \u00een compara\u0163ie cu FvW (pseudohemofilia).<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

        Au fost raportate \u015fi alte subtipuri, incluz\u00e2nd tipul plachetar (pseudo-vWD) care rezult\u0103 din muta\u0163ii la nivelul GPIb plachetare. De asemenea exist\u0103 forme dob\u00e2ndite foarte rare de vWD asociate cu prezen\u0163a de autoanticorpi,\u00a0\u00een asociere cu boli autoimune, prolifer\u0103ri clonale, hipotiroidism4;6;7<\/sup>.<\/span><\/p>\n

        vWD se manifest\u0103 ca un defect hemostatic multifa\u0163etat, deficien\u0163a FVIII \u015fi hemostaza primar\u0103 anormal\u0103 contribuind la tendin\u0163a hemoragic\u0103 \u015fi conduc\u00e2nd la anomalii de laborator caracteristice \u015fi distincte3<\/sup>. Expresia\u00a0 clinic\u0103 este \u00een general u\u015foar\u0103 \u00een tipul 1, cu cre\u015fterea severit\u0103\u0163ii\u00a0\u00een tipul 2 \u015fi tipul 3. Mul\u0163i din pacien\u0163ii cu tipul 1 de vWD pot fi asimptomatici. In general severitatea s\u00e2nger\u0103rii se coreleaz\u0103 cu gradul reducerii activit\u0103\u0163ii FVIII, dar nu cu gradul prelungirii timpului de s\u00e2ngerare sau cu tipul grupului sanguin2<\/sup>. In formele u\u015foare de vWD tabloul clinic este dominat de s\u00e2nger\u0103rile cutaneo-mucoase (epistaxis, echimoze, s\u00e2nger\u0103ri gingivale, menometroragii), iar \u00een formele cele mai severe, \u00een care FVIII este sc\u0103zut, pot ap\u0103rea hemartroze \u015fi hematoame intramusculare, hemoragiile posttraumatice \u015fi postchirurgicale, \u00een primul rand dup\u0103 extrac\u0163ii dentare, constituind riscul principal, ca \u015fi \u00een hemofilia u\u015foar\u01033<\/sup>. vWD poate fi \u00eenalt prevalen\u0163a la pacientele cu menoragie izolat\u01032<\/sup>. In tipul 1 simptomele pot sc\u0103dea \u00een severitate\u00a0\u00een timpul sarcinii, terapiei estrogenice sau cu \u00eenaintarea\u00a0\u00een varst\u0103. Pe de alt\u0103 parte, riscul de s\u00e2ngerare la femeile cu vWD este mare postpartum c\u00e2nd nivelul de FvW scade brusc de la nivelele crescute dezvoltate\u00a0\u00een timpul sarcinii3<\/sup>.<\/span><\/p>\n

        Recomand\u0103ri pentru efectuarea testelor<\/em><\/strong> \u2013 diagnosticul deficitului\/anormalit\u0103\u0163ii FvW, subtiparea vWD \u015fi diferen\u0163ierea de hemofilia A (\u00eempreun\u0103 cu determinarea activit\u0103\u0163ii FVIII); monitorizarea eficacit\u0103\u0163ii terapeutice a tratamentului cu desmopre\u015fina sau concentrat de FvW (FvW:RCo) 7<\/sup>.<\/span><\/p>\n

        Preg\u0103tire pacient<\/em><\/strong> - <\/em>\u00e0 jeun (pe nem\u00e2ncate)5<\/sup>. Se va evita tratamentul cu anticoagulante orale cu 2 s\u0103pt\u0103m\u00e2ni \u00eenainte, iar cu heparin\u0103 cu dou\u0103 zile \u00eenaintea test\u0103rii\u00a0; nu se va recolta de pe un cateter heparinizat6<\/sup>. Testele trebuie efectuate la distan\u0163\u0103 de transfuzii, tratament substitutiv cu FvW, administrarea de desmopre\u015fin\u01037<\/sup>.<\/span><\/p>\n

        Specimen recoltat<\/em><\/strong> - <\/em>\u0432\u0435\u043d\u043e\u0437\u043d\u0430\u044f \u043a\u0440\u043e\u0432\u044c5<\/sup>.<\/span><\/p>\n

        Recipient de recoltare<\/em><\/strong> \u2013 vacutainer cu citrat de Na 0.105M (raport citrat de sodiu \u2013 s\u00e2nge=1\/9). Presiunea realizat\u0103 de garou trebuie s\u0103 fie \u00eentre valoarea presiunii sistolice \u015fi cea a presiunii diastolice \u015fi nu trebuie s\u0103 dep\u0103\u015feasc\u0103 1 minut. Dac\u0103 punc\u0163ia venoas\u0103 a e\u015fuat, o nou\u0103 tentativ\u0103 pe aceea\u015fi ven\u0103 nu se poate face dec\u00e2t dup\u0103 10 minute5<\/sup>.<\/span><\/p>\n

        Cantitate recoltat\u0103<\/em><\/strong> \u2013 se vor recolta 2 vacutainere c\u00e2t permite vacuumul; pentru a preveni coagularea par\u0163ial\u0103 a probei se va asigura amestecul corect al s\u00e2ngelui cu anticoagulantul, prin mi\u015fc\u0103ri de inversiune a tubului5<\/sup>.<\/span><\/p>\n

        Prelucrare necesar\u0103 dup\u0103 recoltare <\/em><\/strong>\u2013 proba va fi centrifugat\u0103 15 minute la 2500g, urmat\u0103 imediat de separarea plasmei \u015fi congelarea acesteia; probele recoltate \u00een afara laboratorului vor fi transportate\u00a0\u00een recipientul destinat probelor congelate5<\/sup>.<\/span><\/p>\n

        Cauze de respingere a probei<\/em><\/strong> - <\/em>vacutainer care nu este plin; proba de s\u00e2nge hemolizat\u0103 sau coagulat\u0103; plasma care nu a ajuns congelat\u0103 la laborator5<\/sup>.<\/span><\/p>\n

        Stabilitate prob\u0103<\/em><\/strong> -<\/em> plasma separat\u0103 este stabil\u0103 4 s\u0103pt\u0103m\u00e2ni<\/em> la\u00a0 \u2013 20\u00baC5<\/sup>.\u00a0<\/strong><\/span><\/p>\n

        Metoda<\/em><\/strong>\u00a0<\/strong><\/span><\/p>\n

        FvW:Ag<\/em> - imunoturbidimetric\u0103<\/span>: m\u0103soar\u0103 nivelul de FvW independent de compozi\u0163ia multimerilor plasmatici (particule de latex \u00eenvelite\u00a0\u00een anticorpi policlonali specifici anti-FvW aglutineaz\u0103 \u00een prezen\u0163a antigenului FvW, determin\u00e2nd cre\u015fterea densit\u0103\u0163ii optice, direct propor\u0163ional cu concentra\u0163ia FvW din plasma testat\u0103)5<\/sup>.<\/span><\/p>\n

        FvW:RCo<\/em> \u2013 plasma pacientului este mixat\u0103 cu plachete fixate \u00een formol,\u00a0\u00een prezen\u0163a ristocetinei, iar extensia agreg\u0103rii plachetare este detectat\u0103 foto-optic \u015fi este propor\u0163ional\u0103 cu activitatea FvW din plasm\u01036<\/sup>.<\/span><\/p>\n

        Valori de referin\u0163\u0103<\/em><\/strong>5<\/sup><\/span><\/p>\n\n\n\n\n\n
        \u00a0<\/span><\/td>\n\n

        FvW:Ag\u00a0\u00a0 <\/em><\/span><\/p>\n<\/td>\n

        		\n

        FvW:RCo<\/em><\/span><\/p>\n<\/td>\n<\/tr>\n

        \n

        Persoane cu grup sanguin 0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n<\/td>\n

        		\n

        42-141%<\/span><\/p>\n<\/td>\n

        		\n

        40-125%<\/span><\/p>\n<\/td>\n<\/tr>\n

        \n

        Persoane cu grup sanguin A, B, AB<\/span><\/p>\n<\/td>\n

        		\n

        66-176%.<\/span><\/p>\n<\/td>\n

        		\n

        49-163%<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

        \u00a0Interpretarea rezultatelor<\/em><\/strong><\/span><\/p>\n

        vWD trebuie luat\u0103 \u00een considerare pentru diagnosticul diferen\u0163ial al oric\u0103rui pacient cu istoric personal \u015fi familial de s\u00e2ngerare \u015fi care are PT \u015fi aPTT normale. aPTT poate fi prelungit\u00a0\u00een formele severe de vWD cu nivele sc\u0103zute de FVIII6<\/sup>. De asemenea num\u0103rul de trombocite este \u00een general normal, \u00eens\u0103 la pacien\u0163ii cu tipul 2B poate s\u0103 apar\u0103 trombocitopenia. Timpul de s\u00e2ngerare este de obicei prelungit, dar poate fi normal \u00een forme u\u015foare de vWD.<\/span><\/p>\n

        In tabel sunt prezentate modific\u0103rile celor dou\u0103 teste specifice pentru FvW \u00eempreun\u0103 cu activitatea FVIII \u00een diferitele tipuri de vWD2;6;7<\/sup><\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n
        \u00a0<\/span><\/td>\n\n

        FvW:Ag<\/em><\/span><\/p>\n<\/td>\n

        		\n

        FvW:RCo<\/em><\/span><\/p>\n<\/td>\n

        		\n

        FVIII:C (activitatea FVIII)<\/em><\/span><\/p>\n<\/td>\n<\/tr>\n

        \n

        \u0422\u0438\u043f 1<\/strong><\/span><\/p>\n<\/td>\n

        		\n

        sc\u0103zut<\/span><\/p>\n<\/td>\n

        		\n

        concordant sc\u0103zut<\/span><\/p>\n<\/td>\n

        		\n

        sc\u0103zut<\/span><\/p>\n<\/td>\n<\/tr>\n

        \n

        Tipul 2A<\/strong><\/span><\/p>\n<\/td>\n

        		\n

        normal sau u\u015for sc\u0103zut<\/span><\/p>\n<\/td>\n

        		\n

        discordant sc\u0103zut<\/span><\/p>\n<\/td>\n

        		\n

        normal sau sc\u0103zut<\/span><\/p>\n<\/td>\n<\/tr>\n

        \n

        Tipul 2B<\/strong><\/span><\/p>\n<\/td>\n

        		\n

        normal sau u\u015for sc\u0103zut<\/span><\/p>\n<\/td>\n

        		\n

        discordant sc\u0103zut<\/span><\/p>\n<\/td>\n

        		\n

        normal sau sc\u0103zut<\/span><\/p>\n<\/td>\n<\/tr>\n

        \n

        Tipul 2M<\/strong><\/span><\/p>\n<\/td>\n

        		\n

        normal sau u\u015for sc\u0103zut<\/span><\/p>\n<\/td>\n

        		\n

        discordant sc\u0103zut<\/span><\/p>\n<\/td>\n

        		\n

        normal sau sc\u0103zut<\/span><\/p>\n<\/td>\n<\/tr>\n

        \n

        Tipul 2N<\/strong><\/span><\/p>\n<\/td>\n

        		\n

        normal<\/span><\/p>\n<\/td>\n

        		\n

        normal<\/span><\/p>\n<\/td>\n

        		\n

        semnificativ sc\u0103zut (5-30% din normal)<\/span><\/p>\n<\/td>\n<\/tr>\n

        \n

        Tipul 3<\/strong><\/span><\/p>\n<\/td>\n

        		\n

        foarte sc\u0103zut (<5-10%)\u00a0<\/span><\/p>\n

        sau absent<\/span><\/p>\n<\/td>\n

        		\n

        foarte sc\u0103zut (<5-10%)<\/span><\/p>\n

        sau nedetectabil<\/span><\/p>\n<\/td>\n

        		\n

        semnificativ sc\u0103zut (5-30% din normal)<\/span><\/p>\n<\/td>\n<\/tr>\n

        \n

        vWD dobandita<\/strong><\/span><\/p>\n<\/td>\n

        		\n

        normal sau sc\u0103zut<\/span><\/p>\n<\/td>\n

        		\n

        sc\u0103zut<\/span><\/p>\n<\/td>\n

        		\n

        normal sau sc\u0103zut<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

        In tipul 1 de vWD severitatea clinic se coreleaz\u0103 cu FvW:RCo. Un nivel foarte sc\u0103zut al FvW:Ag sugereaz\u0103 tipul 3 de boal\u0103.<\/span><\/p>\n

        FvW:Ag, FvW:RCo \u015fi activitatea FVIII trebuie m\u0103surate pe aceea\u015fi prob\u0103, un raport FvW:Ag : FvW:RCo <0.7 suger\u00e2nd tipul 2, iar un raport FVIII:C : FvW:Ag <0.7 suger\u00e2nd tipul 2N de vWD.<\/span><\/p>\n

        In hemofilie nivelul de FvW este normal2<\/sup>.<\/span><\/p>\n

        Limite \u015fi intreferen\u0163e <\/em><\/strong><\/span><\/p>\n

        FvW este un reactant de faz\u0103 acut\u0103, iar la pacien\u0163ii cu deficit congenital nivelul s\u0103u poate cre\u015fte p\u00e2n\u0103 la valori normale \u00eentr-o serie de condi\u0163ii clinice tranzitorii, cum ar fi: stres, inflama\u0163ie, infec\u0163ii acute, efort fizic, postchirurgical, trimestrele II \u015fi III de sarcin\u0103, precum \u015fi\u00a0\u00een administrarea de estrogeni3;4;6<\/sup>. De aceea, este preferabil\u0103 evaluarea pacientului la distan\u0163\u0103 de aceste situa\u0163ii. Pe de alt\u0103 parte, este improbabil ca sarcina sau o reac\u0163ie de faz\u0103 acut\u0103 s\u0103 mascheze deficitele cantitative severe sau pe cele calitative.<\/span><\/p>\n

        Acidul valproic, hipotiroidismul \u015fi bolile cardiace valvulare pot sc\u0103dea FvW3<\/sup>.<\/span><\/p>\n

        Ob\u0163inerea de nivele la limita inferioar\u0103 a normalului at\u00e2t pentru FvW:Ag c\u00e2t \u015fi pentru FvW:RCo nu exclude diagnosticul de vWD (tipul 1), fiind necesar\u0103 repetarea test\u0103rii7<\/sup>.<\/span><\/p>\n

        Aceste teste nu diferen\u0163iaz\u0103 \u00eentre tipurile 2A versus 2B, respectiv 2M, sau tipul plachetar (pseudo-vWD), fiind necesare testarea agreg\u0103rii plachetare induse de ristocetin\u0103 \u015fi\/sau analiza multimerilor FvW5<\/sup>. De asemenea testele genetice pot fi necesare pentru diferen\u0163ierea unor tipuri 2B de tipul 2A.<\/span><\/p>\n

        Testul care determin\u0103 activitatea cofactorului ristocetinei este diferit de cel care m\u0103soar\u0103 agregarea plachetar\u0103 indus\u0103 de ristocetin\u0103, care utilizeaz\u0103 trombocitele \u015fi plasma proasp\u0103t\u0103 ale pacientului \u015fi care este util \u00een special pentru tipul 2B \u015fi tipul plachetar (pseudo-vWD) 3<\/sup>.<\/span><\/p>\n

        Prezen\u0163a factorului reumatoid, anticorpilor anti-albumina bovin\u0103 sau anti-iepure pot duce la supraestimarea nivelului FvW:Ag.<\/span><\/p>\n

        Plasma tulbure poate duce la subestimarea nivelului de FvW:Ag5<\/sup><\/span>.<\/p>\n

        \u00a0<\/span><\/p>\n

        \u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n

        1. Brummel-Ziedins K, Orfeo T, et al. \u201cBlood Coagulation and Fibrinolysis\u201d. In Wintrobe`s Clinical Hematology, Greer J, Foerster J, Lukens J, Rodgers G, Pareskevas F, Glader B, 11th ed, Lippincott Williams & Wilkins, 2004, 553-4.<\/span><\/div>\n
        2. Castaman G, Tosseto A, Rodeghiero F. \u201evon Willebrand Disease\u201d. In Practical Hemostasis and Thrombosis, O\u2019Shaughnessy D, Makris M, Lillicrap D eds, Blackwell Publishing, 2008, 51-56.<\/span><\/div>\n
        3. Friedman K, Rodgers G. \u201eInherited Coagulation Disorders\u201d. In Wintrobe`s Clinical Hematology, Greer J, Foerster J, Lukens J, Rodgers G, Pareskevas F, Glader B, 11th ed, Lippincott Williams & Wilkins, 2004, 1386-92.<\/span><\/div>\n
        4. Johnsen J, Ginsburg D. \u201evon Willebrand Disease\u201d. In Williams Hematology, Lichtman M, Beutler E, Kipps T, Seligsohn U, Kaushansky K, Prchal J., 7th ed, McGraw-Hill Medical, 2006, 1929-37.<\/span><\/div>\n
        5. Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate, 2010. Ref Type: Catalog.<\/span><\/div>\n
        6. Laboratory Corporation of America. Directory of Services and Interpretive Guide. von Willebrand Profile. www.labcorp.com. 2010. Ref Type: Internet Communication.<\/span><\/div>\n
        7. Mayo Clinic, Mayo Medical Laboratories. Reference Laboratory Services for Health Care Organizations. von Willebrand Disease, von Willebrand Factor Antigen, Ristocetin Cofactor, Plasma. www.mayomedicallaboratories.com. 2010. Ref Type: Internet Communication.<\/span><\/div>","protected":false},"excerpt":{"rendered":"

        \u0424\u0430\u043a\u0442\u043e\u0440 \u0412\u0438\u043b\u043b\u0435\u0431\u0440\u0430\u043d\u0434\u0430 \u2013 \u043e\u0434\u0438\u043d \u0438\u0437 \u0432\u0430\u0436\u043d\u0435\u0439\u0448\u0438\u0445 \u0444\u0430\u043a\u0442\u043e\u0440\u043e\u0432 \u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u043d\u0438\u044f \u043a\u0440\u043e\u0432\u0438. \u0421\u0432\u043e\u0435 \u043d\u0430\u0438\u043c\u0435\u043d\u043e\u0432\u0430\u043d\u0438\u0435 \u043f\u043e\u043b\u0443\u0447\u0438\u043b \u043f\u043e \u0438\u043c\u0435\u043d\u0438 \u0432\u0440\u0430\u0447\u0430, \u0432\u043f\u0435\u0440\u0432\u044b\u0435 \u0432\u044b\u044f\u0432\u0438\u0432\u0448\u0435\u0433\u043e \u0438 \u043e\u043f\u0438\u0441\u0430\u0432\u0448\u0435\u0433\u043e \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0435 \u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u043d\u0438\u044f \u043a\u0440\u043e\u0432\u0438, \u043a\u043e\u0442\u043e\u0440\u043e\u0435 \u043f\u043e\u0437\u0434\u043d\u0435\u0435 \u0431\u044b\u043b\u043e \u043e\u0431\u044a\u044f\u0441\u043d\u0435\u043d\u043e \u043d\u0435\u0434\u043e\u0441\u0442\u0430\u0442\u043e\u0447\u043d\u044b\u043c \u043a\u043e\u043b\u0438\u0447\u0435\u0441\u0442\u0432\u043e\u043c \u0438\u043b\u0438 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0435\u043c \u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0430 \u0434\u0430\u043d\u043d\u043e\u0433\u043e \u0444\u0430\u043a\u0442\u043e\u0440\u0430. \u042d\u0442\u043e \u043a\u0440\u0443\u043f\u043d\u044b\u0439 \u043c\u0443\u043b\u044c\u0442\u0438\u043c\u0435\u0440\u043d\u044b\u0439 \u0438 \u043c\u043d\u043e\u0433\u043e\u0444\u0443\u043d\u043a\u0446\u0438\u043e\u043d\u0430\u043b\u044c\u043d\u044b\u0439 \u0431\u0435\u043b\u043e\u043a, \u043a\u043e\u0442\u043e\u0440\u044b\u0439 \u043f\u0440\u0438 \u043f\u043e\u0432\u0440\u0435\u0436\u0434\u0435\u043d\u0438\u0438 \u044d\u043d\u0434\u043e\u0442\u0435\u043b\u0438\u044f \u0441\u043e\u0441\u0443\u0434\u043e\u0432 \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u0435\u0442 \u0443\u0447\u0430\u0441\u0442\u0438\u0435 \u0432 \u0437\u0430\u043f\u0443\u0441\u043a\u0435 \u043c\u0435\u0445\u0430\u043d\u0438\u0437\u043c\u0430 \u0430\u0434\u0433\u0435\u0437\u0438\u0438 (\u0441\u043b\u0438\u043f\u0430\u043d\u0438\u044f) \u0442\u0440\u043e\u043c\u0431\u043e\u0446\u0438\u0442\u043e\u0432 \u043c\u0435\u0436\u0434\u0443 \u0441\u043e\u0431\u043e\u0439 \u0438 \u0441 \u043a\u043e\u043b\u043b\u0430\u0433\u0435\u043d\u043e\u043c, \u043e\u0431\u043d\u0430\u0436\u0430\u044e\u0449\u0438\u043c\u0441\u044f \u0432 \u0437\u043e\u043d\u0435 \u043f\u043e\u0432\u0440\u0435\u0436\u0434\u0435\u043d\u0438\u0438 \u0441\u043e\u0441\u0443\u0434\u0438\u0441\u0442\u043e\u0439 \u0441\u0442\u0435\u043d\u043a\u0438.<\/p>\n

        \u0420\u0430\u0437\u0432\u0435\u0440\u043d\u0443\u0442\u044b\u0435 \u043c\u043e\u043b\u0435\u043a\u0443\u043b\u044b \u0444\u0430\u043a\u0442\u043e\u0440\u0430 \u0412\u0438\u043b\u043b\u0435\u0431\u0440\u0430\u043d\u0434\u0430 \u043e\u0431\u0440\u0430\u0437\u0443\u044e\u0442 \u043f\u0443\u0447\u043a\u0438, \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u043f\u0440\u0438\u043a\u0440\u0435\u043f\u043b\u044f\u044e\u0442\u0441\u044f \u043a \u043a\u043e\u043b\u043b\u0430\u0433\u0435\u043d\u0443 \u0438 \u043e\u0442\u043a\u0440\u044b\u0432\u0430\u044e\u0442 \u0443\u0447\u0430\u0441\u0442\u043a\u0438 \u0434\u043b\u044f \u0441\u0432\u044f\u0437\u044b\u0432\u0430\u043d\u0438\u044f \u0441 \u0431\u043b\u0438\u0436\u0430\u0439\u0448\u0438\u043c\u0438 \u0442\u0440\u043e\u043c\u0431\u043e\u0446\u0438\u0442\u0430\u043c\u0438. \u0421\u0432\u044f\u0437\u044b\u0432\u0430\u043d\u0438\u0435 \u0441\u043f\u0435\u0446\u0438\u0430\u043b\u044c\u043d\u044b\u0445 \u0434\u043e\u043c\u0435\u043d\u043e\u0432 \u0444\u0430\u043a\u0442\u043e\u0440\u0430 \u0412\u0438\u043b\u043b\u0435\u0431\u0440\u0430\u043d\u0434\u0430 \u0441 \u0442\u0440\u043e\u043c\u0431\u043e\u0446\u0438\u0442\u0430\u043c\u0438 \u043f\u0440\u043e\u0438\u0441\u0445\u043e\u0434\u0438\u0442 \u0447\u0435\u0440\u0435\u0437 GP1b \u0440\u0435\u0446\u0435\u043f\u0442\u043e\u0440\u044b \u0442\u0440\u043e\u043c\u0431\u043e\u0446\u0438\u0442\u043e\u0432, \u0447\u0442\u043e \u043f\u0440\u0438\u0432\u043e\u0434\u0438\u0442 \u0442\u0430\u043a\u0436\u0435 \u043a \u0430\u043a\u0442\u0438\u0432\u0430\u0446\u0438\u0438, \u0432\u044b\u0431\u0440\u043e\u0441\u0443 \u0441\u043e\u0434\u0435\u0440\u0436\u0438\u043c\u043e\u0433\u043e \u0433\u0440\u0430\u043d\u0443\u043b \u0438 \u0430\u0433\u0440\u0435\u0433\u0430\u0446\u0438\u0438 \u0442\u0440\u043e\u043c\u0431\u043e\u0446\u0438\u0442\u043e\u0432. \u041a\u0440\u043e\u043c\u0435 \u0442\u043e\u0433\u043e, \u0432\u0430\u0436\u043d\u043e\u0439 \u0444\u0443\u043d\u043a\u0446\u0438\u0435\u0439 \u044d\u0442\u043e\u0433\u043e \u0431\u0435\u043b\u043a\u0430 \u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u0442\u043e, \u0447\u0442\u043e \u043e\u043d \u0441\u043b\u0443\u0436\u0438\u0442 \u0441\u043f\u0435\u0446\u0438\u0444\u0438\u0447\u043d\u044b\u043c \u043f\u0435\u0440\u0435\u043d\u043e\u0441\u0447\u0438\u043a\u043e\u043c \u0444\u0430\u043a\u0442\u043e\u0440\u0430 \u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u043d\u0438\u044f VIII (FVIII) \u0432 \u043f\u043b\u0430\u0437\u043c\u0435 \u0438 \u043f\u0440\u0435\u0434\u043e\u0445\u0440\u0430\u043d\u044f\u0435\u0442 \u0435\u0433\u043e \u043e\u0442 \u043f\u0440\u0435\u0436\u0434\u0435\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0439 \u043f\u0440\u043e\u0442\u0435\u043e\u043b\u0438\u0442\u0438\u0447\u0435\u0441\u043a\u043e\u0439 \u0438\u043d\u0430\u043a\u0442\u0438\u0432\u0430\u0446\u0438\u0438.<\/p>\n

        \u0420\u0438\u0441\u0442\u043e\u0446\u0435\u0442\u0438\u043d \u043a\u043e\u0444\u0430\u043a\u0442\u043e\u0440\u043d\u0430\u044f \u0430\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c \u0444\u0430\u043a\u0442\u043e\u0440\u0430 \u0412\u0438\u043b\u043b\u0435\u0431\u0440\u0430\u043d\u0434\u0430 \u2013 \u0442\u0435\u0441\u0442, \u043f\u043e\u0437\u0432\u043e\u043b\u044f\u044e\u0449\u0438\u0439 \u043e\u0446\u0435\u043d\u0438\u0442\u044c \u0430\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c \u0444\u0430\u043a\u0442\u043e\u0440\u0430 \u0412\u0438\u043b\u043b\u0435\u0431\u0440\u0430\u043d\u0434\u0430, \u0441\u0432\u044f\u0437\u0430\u043d\u043d\u0443\u044e \u0441 \u0442\u0440\u043e\u043c\u0431\u043e\u0446\u0438\u0442\u0430\u043c\u0438. \u0420\u0438\u0441\u0442\u043e\u0446\u0435\u0442\u0438\u043d \u2013 \u0430\u043d\u0442\u0438\u0431\u0438\u043e\u0442\u0438\u043a, \u043f\u0440\u0438\u043c\u0435\u043d\u044f\u0432\u0448\u0438\u0439\u0441\u044f \u0441 60-\u0445 \u0433\u043e\u0434\u043e\u0432 \u0434\u043b\u044f \u043b\u0435\u0447\u0435\u043d\u0438\u044f \u0440\u0430\u0437\u043b\u0438\u0447\u043d\u044b\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439, \u0432\u043f\u043e\u0441\u043b\u0435\u0434\u0441\u0442\u0432\u0438\u0438 \u043e\u0442\u043e\u0437\u0432\u0430\u043d\u043d\u044b\u0439 \u0441 \u0440\u044b\u043d\u043a\u0430. \u041d\u0435\u0440\u0435\u0434\u043a\u0438\u043c \u043f\u043e\u0431\u043e\u0447\u043d\u044b\u043c \u044d\u0444\u0444\u0435\u043a\u0442\u043e\u043c \u0442\u0430\u043a\u043e\u0439 \u0442\u0435\u0440\u0430\u043f\u0438\u0438 \u0431\u044b\u043b\u0430 \u0442\u0440\u043e\u043c\u0431\u043e\u0446\u0438\u0442\u043e\u043f\u0435\u043d\u0438\u044f, \u043e\u0431\u0443\u0441\u043b\u043e\u0432\u043b\u0435\u043d\u043d\u0430\u044f \u0432\u0437\u0430\u0438\u043c\u043e\u0434\u0435\u0439\u0441\u0442\u0432\u0438\u0435\u043c \u0444\u0430\u043a\u0442\u043e\u0440\u0430 \u0412\u0438\u043b\u043b\u0435\u0431\u0440\u0430\u043d\u0434\u0430 \u0441 \u0442\u0440\u043e\u043c\u0431\u043e\u0446\u0438\u0442\u0430\u043c\u0438. \u0414\u0435\u043c\u043e\u043d\u0441\u0442\u0440\u0430\u0446\u0438\u044f \u044d\u0442\u043e\u0433\u043e \u0444\u0430\u043a\u0442\u0430 \u043b\u0435\u0433\u043b\u0430 \u0432 \u043e\u0441\u043d\u043e\u0432\u0443 \u043c\u0435\u0442\u043e\u0434\u043e\u0432 \u043e\u0446\u0435\u043d\u043a\u0438 \u0430\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u0438 \u044d\u0442\u043e\u0433\u043e \u0444\u0430\u043a\u0442\u043e\u0440\u0430, \u0441\u0432\u044f\u0437\u0430\u043d\u043d\u043e\u0439 \u0441 \u0442\u0440\u043e\u043c\u0431\u043e\u0446\u0438\u0442\u0430\u043c\u0438. \u0423\u0441\u043b\u043e\u0432\u0438\u044f \u0434\u043b\u044f \u0432\u0437\u0430\u0438\u043c\u043e\u0434\u0435\u0439\u0441\u0442\u0432\u0438\u044f \u043c\u0435\u0436\u0434\u0443 \u0442\u0440\u043e\u043c\u0431\u043e\u0446\u0438\u0442\u0430\u0440\u043d\u044b\u043c \u0440\u0435\u0446\u0435\u043f\u0442\u043e\u0440\u043e\u043c GPIb \u0438 \u0444\u0430\u043a\u0442\u043e\u0440\u043e\u043c \u0412\u0438\u043b\u043b\u0435\u0431\u0440\u0430\u043d\u0434\u0430 \u0432 \u0442\u0430\u043a\u0438\u0445 \u0442\u0435\u0441\u0442\u0430\u0445 \u0438\u043c\u0438\u0442\u0438\u0440\u0443\u044e\u0442\u0441\u044f \u043f\u0443\u0442\u0435\u043c \u0434\u043e\u0431\u0430\u0432\u043b\u0435\u043d\u0438\u044f \u0440\u0438\u0441\u0442\u043e\u0446\u0435\u0442\u0438\u043d\u0430, \u043a\u043e\u0442\u043e\u0440\u044b\u0439 \u0441\u043f\u043e\u0441\u043e\u0431\u0441\u0442\u0432\u0443\u0435\u0442 \u0441\u0432\u044f\u0437\u044b\u0432\u0430\u043d\u0438\u044e \u0444\u0430\u043a\u0442\u043e\u0440\u0430 \u0412\u0438\u043b\u043b\u0435\u0431\u0440\u0430\u043d\u0434\u0430 \u0441 \u0440\u0435\u0446\u0435\u043f\u0442\u043e\u0440\u043e\u043c GPIb,<\/p>\n

        \u0411\u043e\u043b\u0435\u0437\u043d\u044c \u0412\u0438\u043b\u043b\u0435\u0431\u0440\u0430\u043d\u0434\u0430<\/strong><\/p>\n

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        \u041a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0430\u044f \u043a\u0430\u0440\u0442\u0438\u043d\u0430 \u043c\u043e\u0436\u0435\u0442 \u0432\u043a\u043b\u044e\u0447\u0430\u0442\u044c:<\/p>\n

          \n
        • \u043b\u0435\u0433\u043a\u0438\u0435 \u043a\u0440\u043e\u0432\u043e\u043f\u043e\u0434\u0442\u0435\u043a\u0438;<\/li>\n
        • \u043a\u0440\u043e\u0432\u043e\u0442\u043e\u0447\u0438\u0432\u043e\u0441\u0442\u044c \u0434\u0435\u0441\u0435\u043d;<\/li>\n
        • \u043e\u0431\u0438\u043b\u044c\u043d\u044b\u0435 \u043c\u0435\u043d\u0441\u0442\u0440\u0443\u0430\u0446\u0438\u0438;<\/li>\n
        • \u0434\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0435 \u043a\u0440\u043e\u0432\u043e\u0442\u0435\u0447\u0435\u043d\u0438\u0435 \u043f\u043e\u0441\u043b\u0435 \u043d\u0435\u0437\u043d\u0430\u0447\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u0442\u0440\u0430\u0432\u043c\u044b;<\/li>\n
        • \u0438\u0437\u0431\u044b\u0442\u043e\u0447\u043d\u043e\u0435 \u043a\u0440\u043e\u0432\u043e\u0442\u0435\u0447\u0435\u043d\u0438\u0435 \u043f\u043e\u0441\u043b\u0435 \u0441\u0435\u0440\u044c\u0435\u0437\u043d\u043e\u0439 \u0442\u0440\u0430\u0432\u043c\u044b \u0438 \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u044b \u0430\u043d\u0435\u043c\u0438\u0438.<\/li>\n<\/ul>\n

          \u041e\u0442\u043c\u0435\u0447\u0430\u0435\u0442\u0441\u044f \u0441\u0435\u043c\u0435\u0439\u043d\u044b\u0439 \u0430\u043d\u0430\u043c\u043d\u0435\u0437 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u044f \u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u0435\u043c\u043e\u0441\u0442\u0438 \u043a\u0440\u043e\u0432\u0438.<\/p>\n

          \u041f\u0440\u0430\u0432\u0438\u043b\u0430 \u043f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u043a\u0438 \u043a \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044e<\/strong><\/p>\n

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          \u0418\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435 \u043d\u0435 \u043f\u0440\u043e\u0432\u043e\u0434\u0438\u0442\u0441\u044f \u0432 \u043f\u0435\u0440\u0438\u043e\u0434 \u043e\u0441\u0442\u0440\u044b\u0445 \u0432\u043e\u0441\u043f\u0430\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439 \u0438\u043b\u0438 \u043e\u0431\u043e\u0441\u0442\u0440\u0435\u043d\u0438\u044f \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0432\u043e\u0441\u043f\u0430\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u043f\u0440\u043e\u0446\u0435\u0441\u0441\u043e\u0432.<\/p>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[951],"product_tag":[],"class_list":{"0":"post-10013","1":"product","2":"type-product","3":"status-publish","5":"product_cat-teste-de-hemostaza","7":"first","8":"instock","9":"sold-individually","10":"shipping-taxable","11":"purchasable","12":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/10013","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=10013"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10013"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=10013"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=10013"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=10013"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}