Anticoagulants & Plasma By Prof. Dr. R. R. Deshpande • This PPT has following Imp Contents – 1) What is Anti Coagulant ? 2) Uses of Anti Coagulants 3) Examples of Anticoagulants –Coumerin & Heparin 4) Laboratory or in Vitro use of Anti Coagulants 5) Three Main Plasma Proteins as Albumin, Globulin & Fibrinogen 6) Properties of Plasma Proteins 7) Functions of Plasma Proteins 8) Pathology of Plasma Proteins 9) Plasmapheresis or Therapeutic Plasma Exchange • Visit – www.ayurvedicfriend.com Phone – 922 68 10 630

1. Anti Coagulants & Plasma Proteins
• Presented By –
• Prof.Dr.R.R.Deshpande
• (M.D in Ayurvdic Medicine & M.D. in
Ayurvedic Physiology)
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
• professordeshpande@gmail.com
10/10/2017 1Prof.Dr.R.R.Deshpande

2. Contents of this PPT
• 1) What is Anti Coagulant ?
• 2) Uses of Anti Coagulants
• 3) Examples of Anticoagulants –Coumerin &
Heparin
• 4) Laboratory or in Vitro use of Anti
Coagulants
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3. Contents of this PPT
• 5) Three Main Plasma Proteins as Albumin,
Globulin & Fibrinogen
• 6) Properties of Plasma Proteins
• 7) Functions of Plasma Proteins
• 8) Pathology of Plasma Proteins
• 9) Plasmapheresis or Therapeutic Plasma
Exchange
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4. What is Anticoagulant ?
• An anticoagulant is a substance that prevents
coagulation or clotting of blood
• Such substances found naturally in leeches
• Anticoagulants can be used as a medication
for thrombotic disorders
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5. Types of Anticoagulants
• 1) Which prevent blood clotting in vivo ( inside
the body)
• 2) Which prevent blood clotting in vitro (
outside the body)
• 3) Which prevent blood clotting in vivo & in
vitro both
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6. Heparin
• Naturally produced by mast cells in the body .
• Mast cells are abundant in Liver & Lungs
• Basophils also secrete Heparin
• Commercial heparin is prepared from the liver
and other organs of animals. It is available in
liquid form or dry form as sodium, calcium,
ammonium or lithium salts.
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7. Heparin Action
• Prevents blood clotting by its anti thrombin
activity. It suppresses the activity of thrombin
• Inactivates the active form of other clotting
factors like IX, X, XI and XII
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8. Uses of Heparin
• 1) Anticoagulant –both in Vivo & in Vitro
• 2) It prevents intravascular blood clotting during
surgery.
• 3) To prevent clotting ,While passing the blood
through artificial kidney for dialysis.
• 4) Prevent clotting ,during cardiac surgery, which
involves heart lung machine.
• 5) Used to preserve the blood before transfusion
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9. Dose of Heparin
• 0.5 to 1 mg/kg body weight
• Postpones clotting for 3 to 4 hours
• Till Heparin is destroyed by the enzyme
heparinase
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10. Coumarin Derivatives
• Warfarin and dicoumoral
• Action -- Prevent blood clotting by inhibiting the
action of vitamin K.
• Vitamin K is essential for the formation of various
clotting factors, namely II, VII, IX and X.
• Commonly used as oral medicine
• Warfarin --- used to prevent myocardial infarction
(heart attack), strokes and thrombosis.
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11. Coumarins (vitamin K antagonists)
• These oral anticoagulants are derived from
coumarin, which is found in many plants
• A well known example from this group is
warfarin (coumadin).
• It takes at least 48 to 72 hours for the
anticoagulant effect to develop.
• Where an immediate effect is required,
heparin Can be used
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12. EDTA
• EDTA = Ethylene diamine tetra acetic acid
• This is strong anticoagulant.
• Available in two forms:
• i. Disodium salt (Na2 EDTA).
• ii. Tripotassium salt (K3 EDTA).
• Prevent blood clotting by removing calcium
from blood
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13. EDTA Uses
• 1) I.V – In lead poisoning
• 2) In Laboratory -- 0.5 to 2.0 mg of EDTA per
mL of blood --- sufficient to preserve the
blood for at least 6 hours
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14. Oxalate Compounds
• Oxalate combines with calcium and forms
insoluble calcium oxalate
• So , oxalate removes calcium from blood and
lack of calcium prevents coagulation
• Used only in Vitro –Because Oxalate is
Poisonous ,so can not be used in Vivo
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15. Citrates
• Sodium, ammonium and potassium citrates
• Citrate removes calcium from blood and lack
of calcium prevents coagulation
• It is used to store blood in the blood bank as:
Acid citrate dextrose (ACD)
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16. Laboratory use
• Bulbs used for laboratory blood tests will have
chemicals added as Anticoagulant
• Like Wintrobe bulb or Fluoride bulb
• Wintrobe Bulb = Double Oxalate bulb
=Ammonium oxalate 6 mg + Potassium
Oxalate 4 mg –Used for collecting blood for
Haemogram + ESR PCV
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17. Laboratory use
• Fluoride Bulb = Sodium fluoride + Potassium
Oxalate
• Used for collecting blood for Blood sugar Test
• EDTA Bulb = Ethylene Diamino Tetra Acetic
Acid – Used for collecting blood for Platelet
count
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18. Laboratory use
• But in Plain bulb there is no anticoagulant
• Plain bulb is used for collecting blood for
serological Tests like Liver Function Test,
Renal Function Test.
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19. General indications – To Conclude
• Therapeutic uses of anticoagulants include --
• Atrial fibrillation
• Pulmonary embolism
• Deep vein thrombosis
• Venous thrombo embolism
• Congestive heart failure
• Stroke, myocardial infarction
• Genetic or acquired hypercoagulability
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20. Food & herbal supplements
• Foods & food supplements with blood-
thinning effects include ---
• Alfalfa, avocado, beer, celery, cranberries, fish
oil
• Garlic, ginger, ginseng, grapefruit, green tea,,
licorice, niacin, onion, papaya, pomegranate,
soybean, turmeric, wheatgrass
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21. Other Anti Coagulants
• Proteins from venom of viper snake --
Peptone, C-type lectin
• Hirudin --- from the leach -- Hirudinaria
manillensis
• Reducing the temperature to about 5°C
postpones the coagulation of blood.
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22. Blood Clotting Tests
• To diagnose blood disorders.
• To monitor the patients treated with
anticoagulant drugs such as heparin and
warfarin.
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23. Bleeding Time( BT)
• Time interval from oozing of blood after a
prick till arrest of bleeding.
• Determined by Duke method using blotting
paper
• Normal = 3 to 6 minutes.
• It is prolonged in Purpura.
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24. Clotting Time ( CT)
• Time interval from oozing of blood after a
prick till the formation of clot.
• Determined by capillary tube method.
• Normal = 3 to 8 minutes
• It is prolonged in Hemophilia.
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25. Prothrombin Time ( PT)
• Time taken by blood to clot after adding tissue
thromboplastin to it
• Normal = 10 to 12 seconds.
• It is prolonged in deficiency of prothrombin
and other factors like factors I, V, VII and X.
• However, it is normal in hemophilia.
• Prothrombin time indicates the total quantity
of prothrombin present in the blood
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26. General indications for Anti coagulants
• Therapeutic uses of anticoagulants include --
• Atrial fibrillation
• Pulmonary embolism
• Deep vein thrombosis
• Venous thrombo embolism
• Congestive heart failure
• Stroke, myocardial infarction
• Genetic or acquired hypercoagulability
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27. Market Products
Sr.No Generic Name Brand Name Availability
1 Heparin Nuparin 1000 & 5000 Units /ml in
5 ml vials for Injection
2 Low molecular
Weight Heparins
Enoxaparin = Clexane 20 mg (0.2 ml) & 40 mg
(0.4 ml) Prefilled syringes
–20 to 40 mg OD –S/C
3 Oral Anti coagulants Warfarin =Uniwarfin 1,2,5 mg tab
4 Oral Anti coagulants Bishydroxycoumarin
( Dicumarol) =
Dicoumarol
50 mg Tab
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28. 3 Main Plasma Proteins
• 1. Serum albumin
• 2. Serum globulin
• 3. Fibrinogen
• Note –Fibrinogen is not present in serum
,because it is converted into fibrin during
blood clotting
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29. Normal Values
• Total proteins = 7.3 g/ 100 ml
• Serum albumin : 4.7 g/ 100 ml
• Serum globulin : 2.3 g/ 100 ml
• Normal A/G ratio is 2 : 1.
• Fibrinogen : 0.3 g/ 100 ml
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30. Separation of Plasma Proteins
• 1. Precipitaion method
• 2. Salting out method
• 3. Electrophoretic method
• 4. Cohn’s fractional precipitation method
• 5. Ultracentrifugation method
• 6. Gel Filtration Chromatography
• 7. Immuno electrophoretic method
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31. Where Plasma Proteins are Synthesized ?
• 1) In Embryo –By mesenchyme cells. First
albumin is synthesized and then other
proteins are synthesized later.
• 2) In Adults – Mainly from reticuloendothelial
cells of liver. Also from spleen, bone marrow,
disintegrating blood cells and general tissue
cells. Gamma globulin is synthesized from B
lymphocytes.
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32. Plasma Proteins –Properties
• 1) Molecular Weight
• 2) Oncotic pressure
• 3) Specific Gravity = 1.026
• 4) Buffer Action
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33. Molecular Weights of plasma Proteins
• Albumin = 69,000
• Globulin = 1,56,000
• Fibrinogen = 4,00,000
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34. Oncotic pressure of plasma Proteins
• Osmotic pressure exerted by proteins in the
plasma is called colloidal osmotic (oncotic)
pressure
• In this -- Albumin plays a major role
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35. Buffer Action of plasma Proteins
• Buffer action means -- acceptance of
hydrogen ions
• 1/6 of total buffering action of the blood is
contributed by Plasma Proteins
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36. Functions of Plasma Proteins
• 1) Coagulation of Blood – Fibrinogen has a
major role
• 2) Immunity or Defense mechanism – Gamma
Globulins or Immuno-globulins act as anti
bodies to fight with microorganisms ,which
cause diseases like Typhoid, Mumps,
Influenza, Measles, Hepatitis, Polio
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37. Functions of Plasma Proteins
• 3) Transport -- Albumin, alpha globulin and
beta globulin do the transport of the
hormones, enzymes, etc.
• The alpha and beta globulins transport of
metals in the blood
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38. Functions of Plasma Proteins
• 4) Maintain Osmotic pressure in the blood --
• At the capillary level, substances are exchanged between the
blood and the tissues. But the plasma proteins cannot pass
through the capillary membrane easily because of their large
size and remain in the blood. In the blood, these proteins
exert the colloidal osmotic or oncotic pressure.
• Osmotic pressure exerted by the plasma proteins is about 25
mm Hg.
• Albumin ,Globulin ,Fibrinogen exert pressure in descending
order
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39. Functions of Plasma Proteins
• 5) Regulation of Acid Base Balance – Albumin
is important in regulating the acid base
balance in the blood due to it’s buffering
action
• 6) Maintain Viscosity of blood -- Albumin
• provides maximum viscosity than the other
plasma proteins, which helps in maintaining
Blood Pressure
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40. Functions of Plasma Proteins
• 7) Useful For ESR Test – ESR is Good
Prognostic Test in the disease like TB ,RA .
Rouleaux formation is responsible for ESR .
• Rouleaux formation is accelerated by Globulin
and fibrinogen
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41. Functions of Plasma Proteins
• 8) Help in Suspension Stability of RBCs –
• Globulin and fibrinogen help RBCs to remain
during circulationsuspended uniformly in the
blood
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42. Functions of Plasma Proteins
• 9) Last source of Energy -- The plasma
proteins are used by the body as the last
source of energy during fasting or inadequate
food intake or inadequate protein intake.
Tissue Macrophages split Plasma proteins into
amino acids ,which are taken up by blood
.They are distributed in the body to form
cellular proteins. So Plasma proteins are called
as Reserve Proteins
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43. Plasma Proteins –Pathology
Sr.N
o
Plasma
Proteins
When Increased ? When
Decreased ?
1 Total Proteins Dehydration ,Acute
infections like acute
hepatitis and acute
nephritis ,Excess of
glucocorticoids
Leukemia
Rheumatoid arthritis
Diarrhea
Hemorrhage
Burns
Pregnancy
Malnutrition
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44. Plasma Proteins –Pathology
Sr.No Plasma Proteins When Increased ? When Decreased ?
2 Albumin Dehydration ,CCF Cirrhosis,
Malnutrition
3 Globulin Cirrhosis, RA Glomerulonephritis
Emphysema
4 Fibrinogen MI ,Stroke Liver dysfunction
5 Albumin –
Globulin Ratio
Hypothyroidism Liver Dysfunction
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45. What is Plasmapheresis ?
• Experimental procedure done in animals to
demonstrate the importance of plasma
proteins.
• Clinical significance of Plasmapheresis = –
Therapeutic Plasma Exchange
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46. Plasmapheresis
• Used as a blood purification procedure for an
• Effective temporary treatment of many auto
immune diseases like ---
• Myasthenia gravis , Thrombocytopenic
purpura , GuillainBarré syndrome
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47. Prof.Dr.R.R.Deshpande
• Sharing of Knowledge
• FOR
• Propagating Ayurved
10/10/2017 47Prof.Dr.R.R.Deshpande