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S
Akhmad Mustafa
Erwin Wijatmiko
Dedy Faroka
Farry
Department of Surgery - Hasan
Sadikin Hospital - Medical Faculty
Padjadjaran University
HEMOSTASIS
Mechanism to stop spontaneous
bleeding and maintain blood
circulation in vessels
Complex process
Hemostasis Pathofisiology
Bleeding
and
fibrinolysis
Coagulatio
n
Hemostasi
s
Interaction: Blood vessel thrombocyte
2. Thrombocyte
Qualitative or quantitative
3. Coagulation factors
Quantitative or inhibitor
Hemostasis Pathofisiology
Primary Hemostasis:
Vascular (blood vessel)
Thrombocyte
Secondary Hemostasis:
Blood coagulation factors
Exposure of
Subendothelial
Collagen
Vasoconstriction
Vascular Injury
Platelet adhesion
And
aggregation
Hemostasis
Fibrinolysis
Release of
tissue factor
Coagulation
Blood Vessel
Permeability, Fragility, Vasoconstriction
Release:
- Tissue Factor
- von Willebrand factor (vWf)
- Prostacyclin: Vasodilatation, Thrombocyte
Aggregation
inhibitor
- Anti thrombin
Coagulation inhibitor
- Thrombomodulin
Pro - coagulation
Balancing
Coagulation Inhibition
THROMBOCYTE
Perform and stabilized thrombocyte
plug
Adhesion - Aggregation - releasing
Protein S carrier
COAGULATION
Intrinsic Pathway: XII, XI, IX, VIII,
PF3, HMWK,
Calcium ion
HMWK
XIIa
Pre Kalikrein
Kalikrein
Plasminogen
VII
VIIa
Plasmin
Extrinsic Pathway:
- Tissue
Thromboplastin
- VII Factor
- VIIa
IX
X
Xa
Common Pathway:
Protrombin
Fibrinogen
Thrombin
Fibrin
IXa
Coagulation Cascade
RES
INHIBITOR
: AT III, Protein C,
Protein S,
2 Macroglobulin,
1 Antitrypsin
FIBRINOLYSIS
Fibrin destruction opening blood circulation
Fibrinolysis system : - Plasminogen
Vasoconstricti
Primary Hemostasis
Secondary Hemostasis
Fibrin
Thrombin
Fibrinogen
Anticoagulation counter-regulation
Fibrinolys
is
t-PA
Blocks coagulation
Thrombomodulin
Anticoagulation counter-regulation
Fibrinolys
is
t-PA
Blocks coagulation
Thrombomodulin
- Petechiae
- Hematom
- Echimosis
Rarely
Characteristic
Frequent, big,
soliter
Hemarthrosis
-Occult
bleeding
Characteristic
Thrombocyte/
vascular Disorder
Characteristic
Rarely
Characteristic,
small,
multiple
Rarely
Frequent
Rarely
Clinical
Presentation
Coagulation
Disorder
Coagulation
Disorder
- Bleeding from
Minimal
superficial
lesion
- Sex
- Family history
80-90% Male
Frequent
Thrombocyte/
vascular Disorder
Persistent, severe
bleeding is
frequent
Dominantly
female
Rarely
Echimosis
Petechiae
Thrombositopenia
Decreasing production: Hereditary,
Bone marrow
Hypoplasia
Increasing destruction:
Immune
: ITP, Secondary effect
diseases
Non immune : Microangiopathy, Vasculitis
Abnormal distribution: Splenomegali
LocalH em ostasis
Mechanical procedures
the oldest method is digital pressure, than develop to
hemostat
generally ligature or a hemoclip replaces hemostat as
permanent method on effecting hemostasis of a single
disrupt vessel
1st century Aulus Cornelius Celsus devise the use of
ligature
1552 Pare rediscovered the principle of ligature
1800 Philip Sying Phsick employ absorbable suture
1858 Simpson introduce fine wire suture, 1881 Lister used
catgut
1900 Halsted indicated the advantages of non absorbable
silk
1911 Cushing use silver clips to effect hemostasis in
LocalH em ostasis
Thermal Agents
Heat achieves hemostasis by denaturation of protein that
Chemical Agents
Epinephrine
1911 Cushing use skeletal muscle, shortly thereafter
Patients history
1. Prolonged bleeding or swelling after biting
the li or tongue
2. Bruises without apparent injury
3. Prolonged bleeding after dental extraction
4. Excessive menstrual bleeding
5. Bleeding problems associated with major or
minor operatives
6. Medical problems receiving a physicians
attention within the past 5 year
7. Medications including aspirin or remedies for
headache taken within past 10 days
8. A relative wit a bleeding problem
. Laboratory findings (PT, aPTT, INR, Platelet