Hemostasis is the arrest of bleeding, whether it be by normal vasoconstriction (the vessel walls closing temporarily), by an abnormal obstruction (such as a plaque) or by coagulation or surgical means (such as ligation)
Hemostasis is the arrest of bleeding, whether it be by normal vasoconstriction (the vessel walls closing temporarily), by an abnormal obstruction (such as a plaque) or by coagulation or surgical means (such as ligation)
Autologous Blood Transfusion (ABT) means reinfusion of blood or blood products taken from the same patient
ABT is not a new concept, fear of transfusion- transmitted diseases stimulated the growth of autologous programme
Coagulation: In medicine, the clotting of blood. The process by which the blood clots to form solid masses, or clots.
More than 30 types of cells and substances in blood affect clotting. The process is initiated by blood platelets. Platelets produce a substance that combines with calcium ions in the blood to form thromboplastin, which in turn converts the protein prothrombin into thrombin in a complex series of reactions. Thrombin, a proteolytic enzyme, converts fibrinogen, a protein substance, into fibrin, an insoluble protein that forms an intricate network of minute threadlike structures called fibrils and causes the blood plasma to gel. The blood cells and plasma are enmeshed in the network of fibrils to form the clot.
Thrombophilias are hypercoagulable conditions that can be acquired or inherited. Most important hypercoagulable conditions =, testing procedures, duration of anticoagulation will be discussed here. Useful for Internal Medicine Boards and Hematology boards. Some aspects on duration of anticoagulation, HIT are high-yield for USMLE exams.
In Fibrinolytic system the clots are broken down regularly to maintain the blood flow. I case of certain disease this system is altered and produce coagulation abnormalities and diseases like MI , stroke etc.
Autologous Blood Transfusion (ABT) means reinfusion of blood or blood products taken from the same patient
ABT is not a new concept, fear of transfusion- transmitted diseases stimulated the growth of autologous programme
Coagulation: In medicine, the clotting of blood. The process by which the blood clots to form solid masses, or clots.
More than 30 types of cells and substances in blood affect clotting. The process is initiated by blood platelets. Platelets produce a substance that combines with calcium ions in the blood to form thromboplastin, which in turn converts the protein prothrombin into thrombin in a complex series of reactions. Thrombin, a proteolytic enzyme, converts fibrinogen, a protein substance, into fibrin, an insoluble protein that forms an intricate network of minute threadlike structures called fibrils and causes the blood plasma to gel. The blood cells and plasma are enmeshed in the network of fibrils to form the clot.
Thrombophilias are hypercoagulable conditions that can be acquired or inherited. Most important hypercoagulable conditions =, testing procedures, duration of anticoagulation will be discussed here. Useful for Internal Medicine Boards and Hematology boards. Some aspects on duration of anticoagulation, HIT are high-yield for USMLE exams.
In Fibrinolytic system the clots are broken down regularly to maintain the blood flow. I case of certain disease this system is altered and produce coagulation abnormalities and diseases like MI , stroke etc.
This is the powerpoint for the students, faculties as well as any person who study medical and any life sciences subjects , the hemostasis portion is very comprehensively covered by diagrams and descriptions from standard books. Go through this, all the best.
HEMOSTASIS /stages of hemostasis / Formation of platelet plug/ Mechanism of b...Bharath S R
Vasoconstriction, the platelet cell membrane, the formation of a platelet plug, and the significance of the platelet mechanism for sealing vascular holes. PHARMACOLOGICAL AGENTS, INTERACTION BETWEEN THE INTRINSIC AND EXTRINSIC PATHWAYS, BLOOD CLOT, AND THE MECHANISM OF BLOOD COAGULATION
Hemostasis and coagulation of blood For M.Sc & Basic Medical Students by Pand...Pandian M
Blood coagulation
Mechanism of coagulation
STAGES OF HEMOSTASIS
Coagulation of blood
Factors involved in blood clotting
Enzyme cascade theory
Mechanisms for formation of prothrombin activator
Fibrinolysis
Anticlotting mechanism in the body
Applied physiology
This is the power point that explains about the blood and blood cells. Power point describes about the mechanism of coagulation and defense cells of our circulatory system.
Disseminated Intravascular coagulation is a very common and life endangering pathological condition due to consumptive coagulopathy.
This is a very serious disease and prompt diagnosis may help in early initiation of treatment.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. OUTLINE
• INTRODUCTION
• PATHOPHYSIOLOGY
• THROMBOSIS AND HEMORRHAGE
• TISSUE FACTOR PATHWAY INHIBITOR
• PLASMIN AND PROSTACYCLIN
• PROTEIN C
• PROTEIN S
• ANTITHROMBIN III
• HEPARIN AND HEPARIN COFACTOR II
• PROTEIN Z DEPENDENT PROTEASE INHIBITOR (PZI)
• CONCLUSION
• RECOMMENDATION
• REFERENCES
3. INTRODUCTION
• Coagulation is the process by which blood forms clots.
• It is an important part of haemostasis where in a damaged
blood vessel wall is covered by a platelet and fibrin-
containing clot to stop bleeding and begin repair of the
damaged vessel.
• After the activation of the blood clothing cascade, the
enzymes must be localized to the area of injury and they
must be turned off accordingly. The regulation of the
coagulation cascade is a complex process that involves
several key players.
4. EPIDEMIOLOGY
• Because most bleeding disorders are X-linked and recessive it
occurs predominantly in males. Females usually are
asymptomatic carriers.
• The world wide incidence of coagulation control defects is
approximately 1 case per 5000 male individuals, with
approximately one third of affected individuals not having a
family history.
• The prevalence rate is 20.6 cases per 100,000 male individuals
with 60% of those having severe disease.
5. PATHOPHYSIOLOGY
• Factor deficiency,
• Factor dysfunction or
• Factor inhibitors
lead to disruption of the normal coagulation cascade, resulting in
spontaneous hemorrhage and /or excessive hemorrhage in response
to trauma.
7. THROMBOSIS AND HEMORRHAGE
• The coordinated interplay of the molecules mentioned
above is crucial in preventing medical conditions such as
thrombosis and hemorrhage.
• Thrombosis is the excessive formation of blood clots that
ultimately blocks the normal flow of blood. The inability of
our body to inhibits the formation of blood clots will lead
to thrombosis.
• Hemorrhage is the process by which blood leaks out of the
blood vessels. The inability of our body to form clots lead
to hemorrhage.
8. FIBRINOLYSIS
• Fibrinolytic system is a parallel
system which is activated
along with activation of
coagulation cascade and
serves to limit the size of clot.
Fibrinolysis is an enzymatic
process that dissolves the
fibrin clot into fibrin
degradation products (FDPs)
by plasmin originating from
fibrin bound plasminogen in
liver.
• This reaction is catalysed by
tPA or urokinase plasminogen
activator (u-PA) released from
vascular endothelium.
9. TISSUE FACTOR PATHWAY INHIBITOR (TFPI)
• Tissue factor pathway inhibitor (TFPI) limits the action of tissue
factor(TF).
• This polypeptide inhibits the activity of tissue factor-factor VII
complex .
• It also inhibits excessive TF-mediated activation of factor VII and
factor X.
10. PROTEIN C
• Protein C is a major physiological anticoagulant.
• Protein C is a serine protease with potent anticoagulant, profibrinolytic
and anti-inflammatory properties
• A vitamin K-dependent serine protease enzyme that is activated by
thrombin to form activated protein C (APC).
• It is responsible for digesting activated factors V and VIII. It acts by
inhibiting activated factors V and VIII (with protein S and phospholipids
acting as cofactors).
• and Protein C is activated in a sequence that starts with Protein C and
thrombin binding to a cell surface protein thrombomodulin.
(Thrombomodulin is a transmembrane receptor on the endothelial
cells, it prevents the formation of the clot in the undamaged
endothelium by binding to the thrombin)Thrombomodulin binds these
proteins in such a way that it activates Protein C. The activated form,
along with protein S and a phospholipid as cofactors, degrades FVa and
FVIIIa.
Endothelial protein C receptor (EPCR) is another transmembrane
receptor that helps in the activation of protein C.
11. PROTEIN S
• Protein S is a vitamin K-dependent glycoprotein, synthesized by
endothelial cells and hepatocytes.
• It exists in plasma as both free (40%) and bound (60%) forms
(bound to C4b-binding protein)
• The anticoagulant activity is by virtue of free form while the
bound form acts as an inhibitor of the complete system and is up
regulated in the inflammatory states.
• It functions as a cofactor to APC in the inactivation of FVa and
FVIIIa.
• It also causes direct reversible inhibition of the prothrombinase
(Fva-FXa)
• Quantitative or qualitative deficiency of either (protein C or
protein S) may lead to thrombophilia (a tendency to develop
thrombosis).
12. ANTITHROMBIN III
• A glycoprotein synthesized in the liver that resembles the structure of 𝛼1-antitrypsin
• Antithrombin is a typical member of the serine protease inhibitor (serpin) superfamily that
degrades the serine proteases: thrombin, FIXa, FXa, FXIa, and FXIIa.
• It binds with a high affinity to thrombin and inhibits its irreversibility
• It is constantly active, but its adhension to these factors is increased by the presence of
heparan sulfate (a glycosaminoglycan) or the administration of heparins (different
heparinoids increase affinity to Fxa, thrombin, or both).
• It also blocks the enzymes of the intrinsic pathway, such as factor IX, factor X, factor XI, and
factor XII.
• Antithrombin is Heparin and endogenous endothelial heparan sulfates, which are
heterogeneous but structurally similar to heparin, accelerate antithrombin’s inhibitory
actions.
• The neutralization of proteases by antithrombin is due to a stable enzyme: antithrombin
complex that is formed by a molecular mechanism characteristic of inhibitory serpins
13. HEPARIN
• A negatively-charged glycosaminoglycan that is released by most
cells, which are immune cells found in the tissue surrounding
blood vessels.
• It acts as an anticoagulant(a substance that prevents
coagulation; that is it stops blood from clotting) by stimulating
the binding of antithrombin III to thrombin and other serine
proteases.
HEPARIN COFACTOR II
• A plasma protein that works with heparin to inhibit the activity
of thrombin.
14. PLASMIN
• Plasmin (a serine protease) is generated by proteolytic cleavage of plasminogen
(a zymogen that has a high affinity for fibrin), a plasma protein synthesized in
the liver. This cleavage is catalyzed (transformed into the active form) by
tissue-type plasminogen activator (t-PA), which is synthesized and secreted by
endothelium. Plasmin proteolytically cleaves fibrin into fibrin degradation
products that inhibit excessive fibrin formation.
• Plasmin activity is tightly regulated by its inhibitors ( 𝛼2-antiplasmin) thus
preventing widespread fibrinolysis
• Once t-PA is activated, plasmin can locate fibrin clots at injury sites and
hydrolyze the peptide bonds.
PROSTACYCLIN
• Prostacyclin (PGI2) is released by endothelium and activates platelet Gs protein-
linked receptors. This, in turn, activates adenylyl cyclase, which synthesizes
cAMP. cAMP inhibits platelet activation by decreasing cytosolic levels of calcium
and, by doing so, inhibits the release of granules that would lead to activation of
additional platelets and the coagulation cascade.
15. Protein Z dependent protease inhibitor/ protein Z (PZI)
• It is a recently described component of the anticoagulant
system that is produced in the liver.
• It inhibits factor Xa in reaction requiring PZ and calcium.
16. CONCLUSION
• Coagulation system is kept in balance by activators
and inhibitors of the cascade which serve to bring
the system back into balance.
17. Coagulation system is kept in balance by activators and inhibitors of
clotting and fibrinolysis. Clotting occurs when blood vessels are
damaged and activators of coagulation factors are released. Clotting is
controlled by fibrinolysis. Inhibitors serve to bring the system back into
balance.
18. Fig. 1.3 Coagulation with arrows for negative and positive
feedback. (Pallister and Watson, 2010).
19. RECOMMENDATION
• Further studies are needed to explore major hereditary defects
involving molecules that control coagulation and new lines of
management especially for gene therapy which is the last hope for
millions of patients for complete eradication of these disorders.
20. REFERENCES
Alan D. Michelson (26 October 2006). Platelets. Academic Press. pp. 3–5. ISBN 978-0-
12-369367-9. Retrieved 18 October 2012.
David Lillicrap; Nigel Key; Michael Makris; Denise O'Shaughnessy (2009). Practical
Hemostasis and Thrombosis. Wiley-Blackwell. pp. 7–16. ISBN 1-4051-8460-4.
Davie EW, Ratnoff OD (1964). "Waterfall sequence for intrinsic blood
clotting".Science. 145 (3638): 1310–2. Bibcode:1964Sci...145.1310D.
doi:10.1126/science.145.3638.1310. PMID 14173416.
Furie B, Furie BC (2005). "Thrombus formation in vivo". J. Clin. Invest. 115 (12):
3355–62. doi:10.1172/JCI26987. PMC 1297262 . PMID 16322780.
Hoffbrand, A. V. (2002). Essential haematology. Oxford: Blackwell Science. pp. 241–
243, 243-245, ISBN 0-632-05153-1.
Pallister CJ, Watson MS (2010). Haematology. Scion Publishing. pp. 336–347. ISBN 1-
904842-39-9.
Schmaier, Alvin H.; Lazarus, Hillard M. (2011). Concise guide to hematology. Chichester,
West Sussex, UK: Wiley-Blackwell. p. 91. ISBN 978-1-4051-9666-6.