3. Blood is liquid connective tissue which mainly
composed of
plasma and solid i.e blood cells (RBC’s,WBC’s and
Platelets)
1.Liquid plasma - 55%
2.Plasma cells - 45%
• It carries O2 from lungs to tissue and co2 from
tissue to lungs
• Transporting of nutritive material
• Vehicles for enzyme,vitamines, minerals,
• Maintanance of the acid-base balance
• Devlopes antibodies against microorganism
• It has strong clotting property
4. When blood shades,it looses its fluidity and get
converted in semisolid mass called CLOTS.
The process of formation of clots is called as clotting
or coagulation.
When blood vesseles damaged the blood comes out
Clotting mechanism prevents bleeding of blood
Four substances are essentially required to it
a) Prothrombin
b) Fibronogen
c) Calcium
d) Thromboplastin
5. Prothrombin (Inactive) + Thromboplastin Thrombin (Active)
Fibrinogen (Inactive) + Thrombin Fibrin (Active)
Fibrin + blood cell and Debris Clots
Blood Disorders
Leucocytosis :- Increase in TLC
Leucopenia :- Decrease in TLC
Leukemia :- Blood Cancer i.e. tremendous
Increase in TLC
Thrombosis :- Blood clots in vessels
6. There are substances which promote coagulation, and are
indicated in hemorrhagic states called as “coagulants.”
Coagulating factors –
i) Fibrinogen
ii) Prothrombin
iii) Thromboplastin
iv) Calcium
v) Proaccelerin
vii) Proconvertin
viii) Antihaephillic Factor A
ix) Antihaemophillic Factor B (Christmas factor or plasma
thromboplastin component)
x) Stuart factor or Thrombokinase
xi) Plasma Thromboplastin Antecedent or Antihaemophillic factor C
xii) Haegeman factor
xiii) Fibrinase
7. factor no vi is not known yet. In all above factor II,VII,IX,X are
dependant on vitamin K for their synthesis in liver.
Coagulation process involves two main pathways as
follows -
1.Extrinsic Pathway – It is occurs very rapidly, within few
seconds after the tissue trauma
2.Intrinsic Pathway – It occurs more slowly and requires
several minutes, in this pathway factor and activators contained
with or within blood.
8. Vitamin K
K1 (Vitamin) Ex :-Phytonadione
K3 (synthetic) Ex :- Menadione
(Fat soluble) Ex :- Acetomenapthone
Water soluble Ex :- i) Menadione Sod.Bisulfite,
ii) Menadione Sod.Disulfite.
Miscellaneous
Fibronogen
Antihaemopholic factor
Desmopressin
Adrenochrome Monosemicarbazone, Rutine,Ethamsylate
9. Vitamin K
It is a fat soluble dietary principle required for the synthesis of clotting
factors.
Sources :-
Green leafy vegetables.
Ex : Cabbage, spinach, liver, cheese etc.
Action :-
Vitamin K is acts as cofactor at late stage in syntheses by liver of
coagulation proteins prothrombin.
Vitamin K dependent change (ϒ cardoxylation of glucomate residue of
these zymogene proteins) confers on them the capacity to bind ca++
and to get bound to phospholipids surface properties which is essential
for coagulation.
Uses :-
It used in treatment of bleeding due to clotting factore deficiency in
followings
Dietary Deficiency : 5-10 mg/day (orally or parentrally)
Liver Disease : Viral haepatitis
10. Newborns :-
Newborns have low level of prothrombin and other
clotting factor, It again decreases after few days along with
it Vit.K deficiency also seen thus it is useful to recover these
condition.
Miscellaneous
Fibronogen – Fibronogen is fraction of human plasma is
employed to control bleeding in haemophilia
Ex. Fibrinal-0.5 gm/bottle for i.v infusion
Rutine – It is plant glycoside claimed to reduce capillary
bleeding
EX. Kerutin-100mg tab
Desmopressin - desmopressin is used to treat mild Hemophilia A
Ethamsylate – It increases capillary wall stability by exerting
Antihyaluronidase activity. It is used to prevent bleeding in
postpartum hemorrhage
11. These are drugs used to reduce the coagulablity of blood.
I) Used in Vivo –
A. Parentral Anticoagulants
Ex: i) Heparin
ii) low molecular weight heparin.
iii) Thrombin inhibitors
B. Oral Anticoagulants
i) Coumarin Derivative - Ex: Bishydroxycoumarin (dicumard) warfarin
sod., Acenocumarol
ii) In - Dandione Derivative- Ex: Phenindione
II) Used in Vitro
A. Heparin – 150 U to prevent clotting of 100 ml blood
B. Cal. Complexing Agent - Ex: Sod.Citrate
Sod.Oxalate (10 mg for
1 ml blood)
Sod.Edetate (2 mg for
1 ml blood)
Used in blood Investigation
12. Actions :-
Anticoagulant - Heparin is powerful and instantaneous acting
anticoagulant effective both in vivo and in vitro.
It acts by activating plasma antihrombin and
may e other similar cofactors.
Antiplattelets – Heparin in higher doses inhibits platelets
aggregation and prolong bleeding time.
Adverse effect :-
1. Bleeding due to overdose is most serious
complications of Heparin.
2. Thrombocytopenia is one another common
problem,Generaaly it is mild an transient
3. Hypersensitivity reactions are urticaria fever and
anaphylaxis, patient with allergic diathesis are more
liable.
13. It has been fractioned in LMW heparin by various techniques
Uses :-
Minimized response variability
Used in unstable angina
Used in treatment of deep vein thrombosis
Herudin, Lepirudine, Bivalirudin, Desirudin
Herudin and Lepirudin – Herudin is a specific irreversible
inhibitors of Thrombin obtained from the salivary gland of leech,
Lepirudine is recombinant form of Hirudin.
Bivarudine – Bivarudine is another thrombin inhibitor given.
It has a rapid onset of action but of shorter duration.
Desirudin – Lepirudine block catalytic activity of Thrombin
and is used to treat deep vein thrombosis.
14. Action :-
1. Oral Anticoagulant acts indirectly by
interfering with the synthesis of Vit.K ,
dependant clotting factor in liver
2. These apparently behave as competitive
antagonist of vit.K and reduce the plasma
levels of functional clotting factors in a dose
dependant manner
3. They interferes with regeneration of active
Hydroquinone form of Vit k which carries out
the final step of y carboxylating glucomate
residues of prothrombin and factors.
15. Coumarin derivative :-
I) Bishydroxy Coumarin –
i) It is slowly and unpredictably absorbed orally
ii) It’s metabolism is dependant on dose.
Ex.- Dicoumarol
II) Acenocoumarol –
It has 8 hours half life but because of rapid metabolism,
overall half life is about 24 hour.
III) Warfarin-
Warfarin and its analogous act by competitively
therefore inhibit synthesis of clotting factor.
Uses :-
To prevent thrombus extension and embolic complications
by reducing rate of formation of fibrin.
16. Adverse effect
1. Ecchymosis -
Escape of blood into tissue from ruptured Vessels
is Ecchymosis
2. Epitaxis –
Bleeding from Nose, Blood drains come out from
Nostrils is called as Epitaxis.
3. Haematuria –
Presence of blood in urine is known as Haematuria
