Physiology (GRPS-101) Practical notes

Freshmen 2011 - 2012

HEMOSTS!S
Hemostasis" (Sto##age o$ %loo& $lo' a$ter &amage)
A break in a blood vessel stimulates hemostasis, a fast, localized response to
reduce blood loss through clotting.
1( )asc*lar s#asms are the immediate vasoconstriction response to blood vessel
injury slows the flow of blood and thus helps to limit blood loss.
2( Platelet Pl*g Formation" When a blood vessel is damaged, the blood is
exposed to collagen fibers in the basement membrane of the vessel and the
platelets become sticky and spiky, adhering to each other and the damaged vessel
wall. Once attached, other platelets are attracted to the site of injury, activating a
positive feedback loop for clot formation.
+( ,oag*lation- or %loo& clotting, is a multistep process !clotting cascade" in
which blood is transformed from a li#uid to a gel. $actors that promote clotting are
called clotting $actors (%hese factors are proteins that exist in the blood in an
inactive state", those that inhibit clot formation are called anticoag*lants.
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Physiology (GRPS-101) Practical notes
Freshmen 2011 - 2012
,lotting o$ .loo&
&lood clotting is the transformation of li#uid blood into a semisolid gel. 'lots are
made from fibers !polymers" of a protein called fibrin !see the diagram below".
Fi%rin monomers come from an inactive precursor called $i%rinogen. %his
process re#uires throm%in, the enzyme that converts fibrinogen to fibrin. %his
process also re#uires calci*m, which acts as a kind of glue to hold the fibrin
monomers to each other to form the polymeric fiber. %he fibrin fibers form a
loose meshwork that is stabilized by clotting $actor /!!!. %he stabilized
meshwork of fibrin fibers traps erythrocytes, thus forming a clot that stops the
flow of blood.
'
l
o
tt ing
is
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n
it
ia ted
b y
t wo
pathways i.e intrinsic pathway and extrinsic pathway .
!ntrinsic Path'ay" which is triggered by elements that lie within the blood
inself !intrinsic to the blood".
E0trinsic Path'ay is triggered by tissue damage outside of the blood vessel.
,lot Remo1al
%he clot itself stimulates the secretion of
tiss*e #lasminogen acti1ator !%(A" from
the surrounding vascular epithelium. %(A
is an enzyme that catalyzes the conversion
of #lasminogen to #lasmin.
!ntro&*ction
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Physiology (GRPS-101) Practical notes
Freshmen 2011 - 2012
)emostasis is the stopping of bleeding or blood flow through a blood vessel or
organ.
%he termination of bleeding by mechanical or chemical means or by the
complex coagulation process of the body, which consists of vasoconstriction,
platelet aggregation, and thrombin and fibrin synthesis.
Ste#s
Physiological
stat*s
*ed blood cells!*&'s"
White blood cells !W&'s"
(latelets
'lotting factors !tiny proteins"
All float in a li#uid called
plasma
.lee&ing When vessel wall torn open
blood begin to escape
+essel contract as reaction to
damage to reduce flow of blood
! for few minutes "
Platelets
a&hesion
(latelets stick to the damaged
surfaces
(latelets change shape
!become activated" , release
chemicals !cytokines" to draw
more platelets and keep vessels
contracted
Platelets
aggregation $orm plug !loose platelets plug"
,oag*lation
,xposed collagen and tissue
factors !protein- phospholipids
mixture " imitate a series of
reaction !coagulation cascade "
%he cascade is a series of
enzymatic reactions that ends in
the formation of a fbrin
protein fiber mesh that
stabilizes the platelet plug ! clot
"
,ventually, as the damaged vessel repairs itself, the clot retracts and is slowly
dissolved by the enzyme plasmin.
.lee&ing time
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Physiology (GRPS-101) Practical notes
Freshmen 2011 - 2012
.t is time interval between skin puncture !coming out of blood from vessel" and
cessation of flow of blood !the time taken from blood vessels construction and
platelets plug formation to occur"
To &etermine %lee&ing time
E2*i#ments"
/.0isposable gloves
1.2terile disposable lancet.
3.$ilter paper
4.2top watch
5.'otton 2wab
6.Alcohol 2wab.
Proce&*re"
/. 7eep ready filter paper. !With patient data
8name, Age, 2ex, date of test, 9ame of test,
:ethod;" in corner of it. 9eatly bordered.
3. 0isinfect the ball of finger !or ear lobe" to be
pricked. Allow to dry.
4. %ake a lancet, have deep skin puncture about 35
mm depth and immediately start the stop watch.
5. touch the blood with filter paper , repeat every
3< seconds.
6. %ill there is no stain on filter paper stop the stop
watches.
=. 'ount and number the spots of blood on filter
paper.
>. 'alculate and record bleeding time.
Res*lt"
&leeding time is min sec.
3ormal %lee&ing time"
/ to 3 min
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Physiology (GRPS-101) Practical notes
Freshmen 2011 - 2012
,lotting time
.t is the time interval in between onset of bleeding and appearance of jelly like
semisolid mass i.e. blood clot.
To &etermine clotting time
E2*i#ments"
/.0isposable gloves
1.2terile disposable lancet.
3.'apillary tube or glass slide
4.2top watch
5.'otton 2wab
6.Alcohol 2wab.
Proce&*re"
*sing glass sli&e"
/. Wear gloves
1. 0isinfect the ball of finger to be pricked. Allow to dry.
3. %ake a lancet, have deep skin puncture
about 35 mm depth and immediately
start the stop watch.
4. (ut three full drops on the glass slide
5. After 3< seconds, using stopwatch, try
to pull fibrin thread from a blood drop on
the slide using new lancet or syringe
needle
6 ?se new drop every 3 minutes
=. *epeat trying at regular time intervals 3< seconds", till fibrin thread appears
between the needle and slide.
>. *ecord time interval between pricking finger and first appearance of fibrin
thread. %hat is clotting time of blood.
Res*lt"
'lotting time is min sec.
3ormal clotting time"
4 to @ mins
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