Blood coagulation cascade. Brief outline of blood clotting cascade with information on tests. Over view for medical laboratory scientist program and for ASCP certification test
Here's important & condensed ppt slides about hemostasis and its orchestrated steps and cogulation cascade, roles of endothelium,platelets and Coagulation protiens....!
Here's important & condensed ppt slides about hemostasis and its orchestrated steps and cogulation cascade, roles of endothelium,platelets and Coagulation protiens....!
This slide briefly imparts the knowledge of Amylase and Lipase enzymes. The clinical importance, calculation, concentration, sources and principle of amylase estimation are the major components of uploaded slide.
This slide briefly imparts the knowledge of Amylase and Lipase enzymes. The clinical importance, calculation, concentration, sources and principle of amylase estimation are the major components of uploaded slide.
A power point presentation on "Drugs affecting coagulation and anticoagulants" suitable for undergraduate medical students. Also suitable for Post Graduate students of Pharmacology and Pharmaceutical Sciences.
Defensive programming in Javascript and Node.jsRuben Tan
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This lecture was the opening lecture on the ‘Physiology of Coagulation’ at the Continuing Medical Education (CME) Grand Rounds, 2011. Organised by Kuwait Anesthesia Council, Kuwait
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Coagulation of blood right from haematopoiesis, platelets, endothelial injuries, development of clotting factors, coagulation cascade, applied aspect of coagulation related disorders and much more.
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http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
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Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
2. Medical Laboratory
Scientist
Hematology
Part 4 of 4: Blood coagulation
Brief overview
2Protégé Education Center, LLC
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Presented by
Nithianandan Selliah, PhD
Scientist
Founder and CEO
of Protégé Education Center, LLC
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Hemostasis
Normal hemostasis is the responsibility of a complex system of three
individual components:
Platelets - in the circulation
Endothelial cells – line the wall of the blood vessel
Blood-clotting proteins – circulate in the blood
The process of hemostasis occurs in three phases:
1. Vascular platelet phase: primary hemostasis
2. Activation of the coagulation cascade: formation of the clot
3. Activation of a series of control mechanisms: stop the
propagation of the clot and limit activation of the coagulation
cascade to the region of endothelial rupture
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Mechanisms of Blood Coagulation
Primary hemostasis:
1. Vasoconstriction: When injury occurs, vessel walls constrict,
causing reduced blood flow to the site of injury.
2. Platelet plug: Platelets aggregate to the site of the injury. They
stick together acting as a "plug."
Secondary hemostasis
3. Platelets activate the process which causes a fibrin clot to form.
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Clotting Cascade
Extrinsic Pathway
The extrinsic pathway is activated by external trauma that
causes blood to escape from the vascular system. This
pathway is quicker than the intrinsic pathway. It involves factor
VII.
Intrinsic Pathway
The intrinsic pathway is activated by trauma inside the vascular
system, and is activated by platelets, exposed endothelium,
chemicals, or collagen. This pathway is slower than the extrinsic
pathway, but more important. It involves factors XII, XI, IX, VIII.
Common Pathway
Both pathways meet and finish the pathway of clot production in
what is known as the common pathway. The common pathway
involves factors I, II, V, and X.
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Coagulation Cascade
6
Damaged vessel
Intrinsic system
Activated by chemicals, collagen,
exposed endothelium, platelets
Extrinsic system
Blood escapes from
vascular system
Contact damaged tissues
Release phospholipoproteins
and organelle membrane
Derives tissue thromboplastin
or
Tissue Factor
Factor XII Factor XIIa
XI XIa
X
IXa
VIIIa
PL
Ca++
VIIa
VIIIX
Xa
Prothrombin Thrombin
XIII
Fibrinogen
Soluble fibrin
monomer
Ca++
VIIIa
PL
Ca++
Va
PL
Ca++
XIIIa
Fibrin clot
PL = Platelet Phospholipids
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Activated Partial Thromboplastin
Time (aPTT)
aPTT measures the time necessary to generate
fibrin from initiation of the intrinsic pathway.
Activation of factor XII is accomplished with an
external agent (e.g., kaolin) capable of activating
factor XII without activating factor VII.
The normal time is usually reported as less than
30 to 35 seconds (25 to 35 seconds), and
decreased values ("short") may be abnormal.
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Prothrombin Time (PT)
PT measures the time necessary to generate
fibrin after activation of factor VII.
It measures the integrity of the "extrinsic"
and "common" pathways (factors VII, V, X,
prothrombin, and fibrinogen).
A prolonged PT may reflect either factor
deficiency or a circulating inhibitor of
coagulation.
The test is more sensitive than the aPTT for
deficient levels of factors, and a relatively
small drop in factor VII levels may prolong
the PT.
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Thrombin Time (TT)
TT is the time to drive the reaction of fibrinogen to
fibrin in the presence of thrombin
It measures the integrity of this reaction and
isolates an abnormality to either a decrease in
normal fibrinogen or an inhibitor to its activation.
Abnormalities can be: deficient fibrinogen (< 100
mg/dl), abnormal fibrinogen, or an inhibitor to the
reaction.
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Coagulation Cascade
10
Damaged vessel
Intrinsic system
Activated by chemicals, collagen,
exposed endothelium, platelets
Extrinsic system
Blood escapes from
vascular system
Contact damaged tissues
Release phospholipoproteins
and organelle membrane
Derives tissue thromboplastin
or
Tissue Factor
Factor XII Factor XIIa
XI XIa
X
IXa
VIIIa
PL
Ca++
VIIa
VIIIX
Xa
Prothrombin Thrombin
XIII
Fibrinogen
Soluble fibrin
monomer
Ca++
VIIIa
PL
Ca++
Va
PL
Ca++
XIIIa
Fibrin clot
PL = Platelet Phospholipids
aPTT
PT
TT
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Antithrombin III Test
This test is done if repeated blood clots oocur or if blood
thinning medicine does not work.
Lower-than-normal AT III can have an increased risk of clotting.
Lower than normal AT III may be due to:
Bone marrow transplant
DIC (disseminated intravascular coagulation)
AT III deficiency, an inherited condition causing lower blood
clotting protein levels
Liver cirrhosis
Nephrotic syndrome
Higher than normal AT III may be due to:
Use of anabolic steroids
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Factor VIII assay
12
This test is used to find the cause of too much bleeding (decreased
blood clotting), or if a family member is known to have hemophilia A
A normal value is 50 - 200% of the laboratory control or reference value.
Decreased levels may be due to:
Disseminated intravascular coagulation (DIC)
Hemophilia A
Presence of a Factor VIII inhibitor (antibody)
Von Willebrand's disease
Increased levels may be due to:
Advanced age
Diabetes
Liver disease
Inflammation
Pregnancy
Obesity
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Editor's Notes
The aPTT measures the time necessary to generate fibrin from initiation of the intrinsic pathway. Activation of factor XII is accomplished with an external agent (e.g., kaolin) capable of activating factor XII without activating factor VII.
Citrated plasma, an activating agent, and phospholipid are added together and incubated at 37°C. Calcium is added, and the time necessary for the clumping of kaolin is measured.
The normal time is usually reported as less than 30 to 35 seconds (25 to 35 seconds), and decreased values ("short") may be abnormal.
This test is abnormal in the presence of reduced quantities of factors XII, IX, XI, VIII, X, V, prothrombin, and fibrinogen (all integral parts of the "intrinsic" and "common" pathway.
It is usually prolonged if a patient has less than approximately 30% normal activity. It can also be abnormal in the presence of a circulating inhibitor to any of the intrinsic pathway factors.
The differentiation of inhibitors from factor depletion is important and can best be accomplished by a mixing study in which patient and normal plasma are combined in a 1:1 ratio and the test is repeated on the mixed sample. If the abnormal value is corrected completely, the problem is factor deficiency. If the result does not change or the abnormality is corrected only partially, an inhibitor is present. This difference stems from the above mentioned fact that the aPTT will be normal in the presence of 50% normal activity
Since platelet factors are necessary for the cascade to function normally, the test is performed in the presence of a phospholipid emulsion that takes the place of these factors. The classic partial thromboplastin time depends on contact with a glass tube for activation. Since this is considered a difficult variable to control, the "activated" test uses an external source of activation.
Inherited deficiency of factor VII is a rare bleeding disorder - a prolonged PT and a normal aPTT. The PT completely corrects when mixed with normal plasma.
Acquired deficiencies are usually related to liver disease, warfarin therapy, or depletion secondary to consumptive coagulopathy, severe bleeding, or massive transfusion.
Circulating inhibitors are most often directed at factor X or thrombin. Most common are heparin or products of fibrinolysis. In their presence the prolonged PT cannot be completely corrected to normal in a 1:1 mixing study.
