DEFINATION
 Prevention of blood loss from a
traumatized blood vessel
Mechanism of Hemostasis
 Vascular constriction
 Formation of platelet plug
 Formation of blood clot
 Growth of fibrous...
Vascular constriction
 Traumatized blood vessels causes
smooth muscle of blood vessels to
contract by
1. Local myogenic s...
PLATELETS
 Thrombocytes formed from
Megakarocytes
 Normal concentration 150,000 to
300,000
 Half life of 8 to 12 days
...
 Cytoplasm contains
1. Actin, myosin and thrombosthenin
2. Residual of endoplasmic reticulum and golgi
apparatus
3. Mitoc...
Formation of platelet plug
 Minute ruptures from small blood vessels
1. Contact of platelet with damaged vascular
collage...
Formation of blood clot
 CLOTTING
FACTORS
INTIATION OF COAGULATION
 EXTRINSIC
PATHWAY
INTRINSIC PATHWAY
FORMATION OF BLOOD CLOT
 Composition of blood clot
1. Meshwork of fibrin fibers
2. Blood cells
3. Platelets
4. Plasma
 Clot Retraction
With in 2...
Growth of fibrous tissue
 After clot is formed it can
1. Invaded by fibroblast which form
connective tissue
2. It can dis...
INTRAVASCULAR ANTICOAGULANT
 ENDOTHELIAL SURFACE FACTOR
1. Smoothness (intrinsic pathway)
2. Layer of Glycocalyx
3. Throm...
 FIBRIN FIBERS
Prevents spread of thrombin
 ANTITHROMBIN III
Inactivates thrombin
 HEPARIN
Binds with antithrombin III
...
ANTICOAGULANT FOR CLINCAL
USE
 HEPARIN
I.V 0.5 to 1 mg/kg of body weight
Increases clotting time to 30 minutes
Action las...
 OUTSIDE THE BODY
1. SILICONIZED GLASS CONTAINERS
Prevents contact activation of platelets and factor
XII
2. HEPARIN
3. D...
FACTORS RESPONSIBLE FOR
INCREASE BLEEDING TENDENCY
 VITAMIN K DEFICIENCY
1. Fat soluble
2. Bacterial intestinal flora
3. ...
HEMOPHILIA
 Genetically transferred through female
chromosome and occurred more
exclusively in males. Bleeding occurs
fro...
 Hemophilia B
1. Due to deficiency of factor IX
 Treatment
Injectable purified factor VIII
Recombinant factor VIII
Fresh...
THROMBOCYTOPENIA
 Very low number of platelets
 Bleeding occurs from small blood vessels
 Small punctate hemorrhages th...
THROMBOSIS AND EMBOLISM
 THROMBUS
Abnormal clot formed
in blood vessels
 Types of thrombus
1. Arterial thrombus
2. Venou...
 Causes
1. Any roughened endothelial surface of
vessels
2. Stasis of blood
 Treatment
T-PA genetically engineered
DISSEMINATED INTRAVASCULAR
COAGULATION (DIC)
 Widespread of clotting mechanism in the
circulation
 CAUSES
1. Large amoun...
Blood Coagulation Tests
 Bleeding Time
1 to 6 minutes
 Clotting time
6 to 10 minutes
Prothrombin Time
1. Removal of blood
2. Addition of oxalate
3. Addition of large quantities of Ca and
tissue factor
4. Act...
International Normalized
Ratio
 Different individuals have different tissue
factor activity
 INR is advised
INR= (PT tes...
Partial Thromboplastin Time (PTT) OR
Activated Partial Thromboplastin Time (aPTT or
APTT)
 Performance indicator measurin...
hemostasis-and-blood-coagulation-by-dr-sadia-zafar
hemostasis-and-blood-coagulation-by-dr-sadia-zafar
hemostasis-and-blood-coagulation-by-dr-sadia-zafar
hemostasis-and-blood-coagulation-by-dr-sadia-zafar
hemostasis-and-blood-coagulation-by-dr-sadia-zafar
hemostasis-and-blood-coagulation-by-dr-sadia-zafar
hemostasis-and-blood-coagulation-by-dr-sadia-zafar
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hemostasis-and-blood-coagulation-by-dr-sadia-zafar

  1. 1. DEFINATION  Prevention of blood loss from a traumatized blood vessel
  2. 2. Mechanism of Hemostasis  Vascular constriction  Formation of platelet plug  Formation of blood clot  Growth of fibrous tissue
  3. 3. Vascular constriction  Traumatized blood vessels causes smooth muscle of blood vessels to contract by 1. Local myogenic spasm 2. Local autacoids factors 3. Nervous reflexes
  4. 4. PLATELETS  Thrombocytes formed from Megakarocytes  Normal concentration 150,000 to 300,000  Half life of 8 to 12 days  Its membrane contains phospholipids and it is coated by Glycoprotein  Don't have nuclei
  5. 5.  Cytoplasm contains 1. Actin, myosin and thrombosthenin 2. Residual of endoplasmic reticulum and golgi apparatus 3. Mitochondrial enzyme system 4. Fibrin-stabilizing factor 5. Growth factor 6. Prostaglandins synthesizing enzymes 7. Thromboxane A2 ( Vasoconstrictor)
  6. 6. Formation of platelet plug  Minute ruptures from small blood vessels 1. Contact of platelet with damaged vascular collagen fibers 2. Platelet swell, protruding pseudopods, contractile protein causes release of granules 3. Becomes sticky with collagen and to a protein called Von Willebrand factor 4. Secretes ADP and Thromboxane A2 which activates other platelets and formed platelet plug 5. fibrin threads makes unyielding plug
  7. 7. Formation of blood clot  CLOTTING FACTORS
  8. 8. INTIATION OF COAGULATION  EXTRINSIC PATHWAY
  9. 9. INTRINSIC PATHWAY
  10. 10. FORMATION OF BLOOD CLOT
  11. 11.  Composition of blood clot 1. Meshwork of fibrin fibers 2. Blood cells 3. Platelets 4. Plasma  Clot Retraction With in 20 to 60 minutes clot retracts and expresses fluid devoid of fibrinogen and other clotting factors called SERUM Platelets Thrombin Ca++  Vicious circle of clot formation
  12. 12. Growth of fibrous tissue  After clot is formed it can 1. Invaded by fibroblast which form connective tissue 2. It can dissolve When a clot is formed it entrapped a plasma protein named as PLASMINOGEN that is activated by TISSUE PLASMINOGEN ACTIVATOR (t-PA) to PLASMIN after few days. That digest fibrin fibers, factor I,11,V,VIII,XII
  13. 13. INTRAVASCULAR ANTICOAGULANT  ENDOTHELIAL SURFACE FACTOR 1. Smoothness (intrinsic pathway) 2. Layer of Glycocalyx 3. Thrombomodulin Binds Thrombin Activates protein C (V and VIII)
  14. 14.  FIBRIN FIBERS Prevents spread of thrombin  ANTITHROMBIN III Inactivates thrombin  HEPARIN Binds with antithrombin III Factor XII, XI, X, IX
  15. 15. ANTICOAGULANT FOR CLINCAL USE  HEPARIN I.V 0.5 to 1 mg/kg of body weight Increases clotting time to 30 minutes Action lasts for 1.5 to 4 hours Destroyed by enzyme known as Heparinase  COUMARINS Warfarin Factor II, VII, IX and X levels decreases Inhibits VKOR c1 Vitamin K not in active reduced form
  16. 16.  OUTSIDE THE BODY 1. SILICONIZED GLASS CONTAINERS Prevents contact activation of platelets and factor XII 2. HEPARIN 3. DECREASES Ca ion CONCENTRATION Oxalate compounds Citrate compounds Citrate are better than oxalate, removed from liver But in large quantities and liver failure can lead to TETANY and CONVULSIVE DEATH
  17. 17. FACTORS RESPONSIBLE FOR INCREASE BLEEDING TENDENCY  VITAMIN K DEFICIENCY 1. Fat soluble 2. Bacterial intestinal flora 3. Cause -: decreased absorption of vitamin k from intestine as seen in obstruction of bile 4. II, VII,IX, X and protein C (V, VIII) 5. Liver carboxylase that add a carboxyl group to glutamic acid residues 6. Role of VKOR c1 7. Treatment is IV vitamin K
  18. 18. HEMOPHILIA  Genetically transferred through female chromosome and occurred more exclusively in males. Bleeding occurs from larger vessels  Hemophilia A or Classic hemophilia 1. Smaller component of factor VIII 2. Responsible for intrinsic pathway of coagulation  Von Willebrand’s disease 1. Larger component of factor VIII
  19. 19.  Hemophilia B 1. Due to deficiency of factor IX  Treatment Injectable purified factor VIII Recombinant factor VIII Fresh frozen plasma
  20. 20. THROMBOCYTOPENIA  Very low number of platelets  Bleeding occurs from small blood vessels  Small punctate hemorrhages through out the tissues  Purplish blotches on skin (Thrombocytopenia Purpura)  Frequent bleeding occurs when platelet count decreases to 50,000/µL  IDIOPATHIC THROMBOCYTOPENIA  Fresh whole blood transfusion  Splenectomy
  21. 21. THROMBOSIS AND EMBOLISM  THROMBUS Abnormal clot formed in blood vessels  Types of thrombus 1. Arterial thrombus 2. Venous thrombus  EMBOLI The floating clot in blood Massive pulmonary embolism
  22. 22.  Causes 1. Any roughened endothelial surface of vessels 2. Stasis of blood  Treatment T-PA genetically engineered
  23. 23. DISSEMINATED INTRAVASCULAR COAGULATION (DIC)  Widespread of clotting mechanism in the circulation  CAUSES 1. Large amount of traumatized or dying tissues causes release of tissue factor 2. Widespread septicemia (endotoxin)  EFFECTS 1. Septicemic shock 2. Bleeding
  24. 24. Blood Coagulation Tests  Bleeding Time 1 to 6 minutes  Clotting time 6 to 10 minutes
  25. 25. Prothrombin Time 1. Removal of blood 2. Addition of oxalate 3. Addition of large quantities of Ca and tissue factor 4. Activation of extrinsic pathway 5. Normal prothrombin time is 10 to 12 sec 6. factors I, II, V, VII, and X
  26. 26. International Normalized Ratio  Different individuals have different tissue factor activity  INR is advised INR= (PT test )ISI (PT normal)  International sensitivity index 1.0 to 2.0  Normal INR= 0.9 TO 1.3
  27. 27. Partial Thromboplastin Time (PTT) OR Activated Partial Thromboplastin Time (aPTT or APTT)  Performance indicator measuring the efficacy of both the Intrinsic and the common coagulation pathways. 1. Removal of blood 2. Addition of oxalate 3. Addition of large quantities of Ca and Phospholipids 4. Activation of intrinsic pathway 5. Normal PTT time is 25sec to 32 sec 6. factors: I, II, V, VIII, IX, X, XI, & XII.
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