 Thromboplastin is a plasma protein aiding blood

coagulation through catalyzing the conversion

of prothrombin to thrombin. It is a complex enzyme that
is found in brain, lung, and other tissues and especially
in blood platelets and that functions in the conversion of
prothrombin to thrombin in the clotting of blood—called
also thrombokinase.

 Although sometimes used as a synonym for the

protein tissue factor (with its official name "Coagulation
factor III [thromboplastin, tissue factor]"), this is a
misconception. Historically, thromboplastin was a
lab reagent, usually derived from placental sources,
used to assay prothrombin times (PT time).


 Thromboplastin, by itself, could activate the
extrinsic coagulation pathway. When
manipulated in the laboratory, a derivative could
be created called partial thromboplastin.
Partial thromboplastin was used to measure the
intrinsic pathway. This test is called the aPTT, or
activated Partial thromboplastin time.

 Partial thromboplastin is just phospholipids, and

not tissue factor.
 Used to test the concentration
of prothrombin in the blood

 Normally : 12 seconds

 Test for extrinsic pathway

 Citrated plasma
( from patient ) +
Calcium + Tissue
thromboplastin
( brain extract )

 Incubated at
temperature 37O c

 The time needed for

formation of fibrin
clot is recorded
 PT depend on concentration of prothrombin, factor
V, VII, X

 Normal in hemophilia (WHY??) (P.hemophilia) ?

 Prolonged in
1) vitamin K deficiency
2) patients are treated with dicumarol (blood thinners)

 Values above 30 sec. means tendency for bleeding

 PT must be done regularly in patients taking

dicumarol to determine the dose and its follow up
 Ratio of patient prothrombin time (PT) to
normal control sample raised to the power
of international sensitivity index (ISI)
ISI
PT test
INR =
PT normal

 Used to standardize measurement of PT

 Normal : 0.9 – 1.3

 If high >> bleeding tendency

 If low >> Coagulation tendency

 Patient taking warfarin >> 2-3

  Test intrinsic system

 Citrated plasma ( from

patients) +

1) Kaolin : it is surface activator

it activates factor XI, XII

2) Phospholipid : instead of
platelets phospholipid

3) Calcium

The time needed for formation of

fibrin clot = APTT
 30-40 seconds

 Prolonged when there is a

deficiency in factor V, VIII, IX,X,XII
1) Hemophilia
2) Vitamin K deficiency
 Fibrinogen Group ( I, V, VIII, XIII):
Consumed during clotting (not present in
serum)

 Prothrombin Group (II, VII, IX, X):

Not consumed during clotting so present in
serum.
 Used for diagnosis of hemophilia
A and B it is based on
a) Aluminum hydroxide treated
plasma : normally contain factor
V & VIII
b) Normal serum : contain factor II,
IX, X
 Mixingof ( a ) + ( b ) + platelets +
Calcium ( at 37 C )

 Themixture is then added to

prothrombin and fibrinogen solution
>> formation of fibrin clot
 If test done by using treated
plasma from patients suffering
from hemophilia and normal serum
>> No clotting occurs >>
lack of factor VIII (Hemophilia A)
 If test done by using normal treated

plasma and serum from patients

suffering from hemophilia

>> No clotting occurs >>

lack of factor IX (Hemophilia B )

 Blood of different individuals can be
grouped according to the presence
or absence of certain antigens
( Agglutinogens ) on the surface of
RBCs , These agglutinogens are
mucopolysaccharides (A, B)

2 Globulins (agglutinins) in plasma

( α= anti-A and β= anti B)
40 % 10 % 5% 45 %
 Additional agglutinogen A1 is identified.

 GroupA is subdivided into :

1- Group A1: have A and A1.
2- Group A2: have A only

 Blood groups are :

A1, A2 , B, A1B, A2B, O
 Discovered in 1940 after
work on Rhesus monkeys

 Subsequently discovered to
be in human beings (85 %).
 Rh refers to the presence or absence of
the D antigen on the red blood cell.

 +ve means presence of the D antigen

 -ve means absence of the D antigen

 NO anti D antibodies in both Rh +ve & -ve

 according to the presence or absence of
antigen ( Agglutinogen ) D on the surface of
RBCs

Rh +ve Rh –Ve

Percentage 85% 15%

Antigen on surface Presence of D Absence of D

of RBCs antigen on surface antigen
of RBCs

Genotype DD and Dd Only dd

1- BLOOD TRANSFUSION
Cross matching is important

2- Medico legal (-ve test) :

only exclude but not prove
paterinity.
 Mother Father
A B
??? Child
O

AO BB

A O B

AB BO
 AO BO

A O B O

AB AO BO O
What if the male is O ????
3- Susceptibility to diseases
O group people are more susceptible to
peptic ulcer

AB group people are more susceptible

to cancer stomach and DM
Universal Universal
recipient Donor
1) Normally No anti D in plasma

2) Blood group O is universal donor

3) Blood group AB is universal recipient

4) Cells containing antigen A are agglutinated

by anti A anti body of plasma of B group

5) Cells containing B antigen are agglutinated

by Anti B antibody of plasma of A blood
group
Agglutination of RBCs & Hemolysis

 If an individual is transfused with an

incompatible blood group destruction of
the red blood cells will occur.
 This may result in the death of the
recipient.

Agglutinogen Agglutinin
 Difference between the agglutination and
coagulation
Agglutination Coagulation

Part of the immune system Part of hemostatic system

Antigen anti body reaction Formation of insoluble fibrin

threads

Occurs at the site of Occurs at the site of blood

inflammation vessels injury

Anti bodies include Coagulation include

( M , A , G , E , D) Intrinsic and Extrinsic)
 The recipient RBCs not affected by
agglutinins in donor’s plasma….. WHY??

 Blood transfusion can be safely made only

when blood groups are compatible
1- Transfusion of large vol. of group O blood >>
agglutination of recipient RBCs as the agglutinins not
diluted enough.

2- Transfusion of large vol. of any blood group >>

agglutination of RBCs of group AB recipient due to
large amounts of agglutinins in donor’s plasma

3- Rh incompatibility
4- Subgroup incompatibility (M, N, S antigens)
especially in group O.
1- Repeated Blood
transfusion.
2- Erythroblastosis Fetalis
( hemolytic disease of the new born
)
 Normally there are no anti Rh anti bodies
( anti D ) in plasma of both Rh +ve and Rh –ve
blood , only Rh –ve person can be sensitized to
form anti D anti bodies if :

a) Rh –ve person is transfused with Rh +ve

blood

b) during fetal maternal hemorrhage ( as in

abortion )
 c)Rh –ve mother delivers Rh +ve
baby
( at time of delivery Rh +ve fetal
RBCs enter general circulation of
the mother leading to
sensitization of immune system to
produce anti D anti bodies )
• The most common problem with Rh
incompatibility is during pregnancy(Rh +ve male
& Rh –ve female)
• A small amount of blood from the fetus may
contact the blood of the mother during Delivery.

 If the fetus has Rh+ blood and the

mother has Rh- blood, then the
mother will make anti-Rh
antibodies
 the first born baby is usually not
affected
 However, if the woman gets pregnant again,
to another Rh+ baby, then the mother’s anti-
Rh antibodies can leak across the placenta
(Ig G ) and attack the foetal blood and can
lead to agglutination and hemolysis>>
anemia, jaundice, kernicterus, born dead.

 When the 1st baby is affected ??

• To prevent Hemolytic disease of
the newborn, all Rh-ve women
should receive an injection of anti-
Rh antibodies or ‘anti-Rh gamma
globulin’ after every delivery ,
miscarriage, or abortion (within 48
hs)

•Abs bind and inactivate fetal Rh Ags

before the mother’s immune system
can produce anti-Rh Abs.

• Rh –ve females should never be

transfused with Rh +ve blood
Treatment :
: jaundiced baby is treated by
exchange transfusion with

Rh –ve group O blood

immediately after birth
 IgG
which one of
them can cross
the placenta ?

IgM

Anti D antibodies are of G type

( The ABO system is M type )
 Human RBCs carry on their surface specific
antigens ( Agglutinogens ) and in plasma
specific antibodies ( Agglutinin )
 Based upon the presence or absence of some
of these antigens and antibodies human
blood has been classified into groups ( 4
groups A , B , AB , O )
 Each group may be Rh +ve or Rh -Ve
according to the presence or absence of
antigen ( Agglutinogen )
D on the surface of RBCs
 Anti D Anti B Anti A

Rh +ve
A

B
Rh -Ve

AB
O
1 drop of recipient's plasma is
added to 1 drop of donor’s RBCs
and 1 drop of recipient's RBCs is
added to 1 drop of donor’s
plasma.

 If
no agglutination >> safe
blood transfusion
 To restore whole blood as in hemorrhage
(>20% lost)

 To restore one deficient element

e.g. RBCs (Hb %< 40%) , WBCs , platelets ,
plasma proteins and clotting factors
(haemophilias)

 In erythroplastosis fetalis
1) Blood should be compatible and cross matching
test should be done
2) Rh negative person should be transfused with
Rh negative blood
3) Blood must be free from diseases
e.g. AIDS , Virus c ,Virus B and syphilis
4) Hb of transfused blood should be normal.
5) The transfused blood must be fresh, not stored
for more than 21 days at 4o C , Na citrate added
(anticoagulant) and dextrose (nutrient)
1) Intracellular K+ leaves RBC to plasma >>
hyperkalemia >> stop heart in diastole
2) Decreased coagulation factors (VII, VIII, IX)
3) Decreased platelet count
4) Decreased Hb conc. (RBCs hemolysis)
5) Decreased dextrose and increased lactic
acid (glycolysis)
 Agglutination of donors RBCs (clumping) by the
anti bodies of recipient , then hemolysis which
lead to
a) Blockage of blood capillaries : by clumped RBCs
leading to
# joint pain ( blockage of capillaries of joints )
# Anginal pain ( blockage of coronary vessels )
# paralysis (blockage of brain vessels)
b) Hazards of intravascular hemolysis :
 Shock : due to release of histamine and other
vasodilators resulting in drop of ABP
 Hyper kalemia : K is released from RBCs
resulting in cardiac arrhythmia
 Hemolytic jaundice : bilirubine is produced
from hemolysed RBCs leading to yellow
coloration of skin and mucous membrane
( jaundice )
 Blockage of renal tubules : Hemoglobin is
filtered by renal glomeruli forming acid
hematine , which blocks the renal tubules
which may lead to renal failure
 Transmission of diseases (hepatitis , AIDS)

 Allergic reaction >> rigors and fever

 Excessive amount of blood >> circulatory

overload and HF.

 Tetany: decreased Ca++ level in plasma >>

neuromuscular excitability (excessive citrate)
 www.mostafayehia.net
www.facebook.com/Dr.MostafaYehia