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The process of blood clotting and then the subsequent dissolving of the clot, following repair of the injured tissue, is termed Haemostasis. A problem with the coagulation system is called a Coagulopathy.
John Santangelo
John Santangelo
Bone Marrow
Platelets
Small, granulated bodies that aggregate at the site of injury
Thrombopoiesis
Pluripotent stem cell Committed stem cell Megakaryoblast Megakaryocyte Platelets
Megakaryocytes
Giant cells- 35-160m in diameter Multinucleated
Platelet morphology
Non-nucleated, Colorless disc, 2-4 m in diameter
Cell membrane: 6 nm in thickness Phospholipids important in initiation of Coagulation Receptors for ADP, vWF, collagen, fibrinogen, thrombin
Functions of platelets 1.Hemostasis 2. Coagulation of blood 3. Clot retraction 4. Phagocytosis 5. Storage and transport- serotonin & histamine
Primary Haemostasis
Dependent on Platelets and Von Willebrand Factor (vWF)
Platelets gather and attach to vWF
Secondary Hemostasis
Platelet aggregation initiates secondary haemostasis through the coagulation cascade Coagulation cascade is initiated by the intrinsic or extrinsic pathway The final cascade results in fibrin deposition cross-linking platelets and clot formation
Thrombocytopaenia:
A reduction in platelets below the Normal Reference Range (NRR)
Hypersplenism
Unknown cause
Viral infections
Epinephrine administration
Composition of Blood Cellular part: 1. Red Cells (erythrocytes) 2. White cells (leukocytes) 3. Platelets (thrombocytes) Liquid part: Proteins, enzymes, chemicals, coagulation factors, antibodies, and many more. The cells float in this liquid part. If blood is anticoagulated, it is called Plasma.
Vivo:
Inside the body Vitro: Outside the body
Petechiae
Purpura
Liver
Femur
To insure stability of the initially loose platelet plug, a fibrin mesh (also called the clot) forms and entraps the plug.
If the plug contains only platelets it is termed a white thrombus. If red blood cells are present it is called a red thrombus.
Finally, the clot must be dissolved in order for normal blood flow to resume following tissue repair.
The dissolution of the clot occurs through the action of the conversion of plasminogen to plasmin.
Two pathways lead to the formation of a fibrin clot: The intrinsic pathway and The extrinsic pathway.
These two pathways converge on a common pathway that leads to clot formation.
Both pathways are complex and involve numerous different proteins termed clotting factors.
Hemostasis
Injury to vessel Constriction of injured vessel (vasospasm) Platelet adhesion Platelet activation and aggregation Temporary platelet plug formation Activation of clotting factors Fibrin network True clot
Factor III - tissue thromboplastin (tissue factor) Factor IV - ionized calcium ( Ca++ ) Factor V - labile factor or proaccelerin Factor VI - unassigned Factor VII - stable factor or proconvertin Factor VIII - antihemophilic factor
When blood is collected into a tube it clots. It clots faster in a glass tube because of the rough surface of the glass. When collected into a plastic tube it takes much longer because the plastic is has a smooth surface.
The easiest way to stop blood clotting in the tube is to remove one of the clotting factors.
In the laboratory, calcium is added to this blood and the time it takes to form a clot in the plasma is measured.
Note that plasma is used to perform the test not whole blood or Serum.
All the coagulation factors are produced in the Liver except the following:
The Intrinsic pathway can be initiated by events that take place within the lumen of blood vessels.
The Intrinsic pathway requires only elements (clotting factors, Ca++, platelet surface etc.) found within, or intrinsic to the vascular system. The Extrinsic pathway is the other route to coagulation. It requires Tissue Factor (tissue thromboplastin), a substance which is "extrinsic to", or not normally circulating in the vessel. Tissue Factor is released when the vessel wall is ruptured.
Old Tests
Bleeding time Tests vascular integrity and platelet function Incision on volar aspect of the forearm 1mm deep and 1 cm long BP cuff inflated to 40 mmHg Normal < 8 minutes Borderline 8-10 minutes Abnormal 10 + minutes Affected by ASA (acetylsalicylic acid, Aspirin ) (permanent) and NSAIDs
Thromboasthenia
Platelet function disorder Tests:
Old Tests:
Bleeding & Clotting time
New Test:
PFA 100 Plate Function Analysis 100
Normal Reference Range: The Normal Reference Range for a particular test or measurement is usually defined as the prediction interval between which 95% of values of the healthy population fall into, whatever the distribution of these values. In case of normal distribution, it can alternatively be defined as the interval limited by 2 standard deviations from either side of the mean.
It is sometimes referred as "reference interval", normal range or normal values (and sometimes "usual" range/values). All these terms should be discouraged as not everyone outside the interval is abnormal, and people who have a particular condition may still fall within this interval. Therapeutic range: The range of concentrations at which a drug or other therapeutic agent is effective with minimal toxicity to most patients.
Total = 95.4%
Within 2 Standard Deviations