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Hemostasis
Is the complex process by which the body spontaneously stop bleeding and maintains blood in the fluid state within the vascular compartment. Normal hemostasis: rapid & localized.
The major role of the hemostasis system is to maintain a complete balance of the bodys tendency toward clotting and bleeding.
Secondary Hemostasis :
Enzymatic activation of the coagulation proteins to produce fibrin from fibrinogen stabilizing fragile clot formed during primary hemostasis.
Microcirculation bleeding
Platelet plug
Hemostasis plug
Hemostasis is achieved by highly integrated and regulated interaction of major and minor systems.
Major system
Blood vessel Platelet Coagulation proteins Fibrinolysis system Inhibitor protease serine
Minorsystem
Vein
arteriole
Venule
capillary
1. Sympathetic ganglion nerve cell bodies and nerve fibers 2. Nerves 3. Arteriole 4. Venule 5. Lymph node hilus and lympathetic tissue 6. Lymphatic vessels
10. Nerves
11. Lymph node : medulla 12. Lymph node : cortex 13. Marginal sinus 14. Capsule 15. Tunica Adventitia 16. Tunica Media 17. Internal elastic membrane 18. Lumen of large (elastic) artery 19. Endothelium and subendothelial connective tissue 20. Adipose tissue 21. Capillaries 22. Medium-sized vein (l.s) filled with blood 23. Tunica media 24. Tunica adventitia 25. Nerve 26. Arteriole
7. Veins
9. Arterioles
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Trigger Coagulation other hemostasis Intrinsic (XII XIIa) process Extrinsic (tissue factor/F III release)
Blood Vessel
Endothelial Cells Basement Membrane
Platelets
White Cells
Bone Marrow
Trombopoiesis
Megakaryocyte
Spleen
Platelet Structure
Platelet Function
Adhesion
Shape Change Release A
ADP Release
3 seconds B
Aggregation
10 seconds
Coagulation
Fibrin Formation
5 minutes
Platelet adhesion
The principle mechanism of platelet adhesion involves :
Plasma Collagen fibres Platelet membrane glycoprotein GPIb (the receptor for von Willebrands factor/vWF)
vWF
Glycoprotein Ib (GPIb)
Collagen fibers
Shape change
Secretion
Cytoskeletal reassembly
Platelet aggregation
Platelet aggregation (platelet-toplatelet interaction) is an energy dependent process requires ATP (primarily derived from glycolysis)
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PDGF
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Coagulation Factors
Factor I Factor II Factor III Factor IV Factor V Factor VII Factor VIII Factor IX Factor X Factor XI Factor XII Factor XIII Fibrinogen Prothrombin Tissue Thromboplastin Calcium Ions Labile Factor, Proaccelerin Stable Factor, Proconvertin Antihemophilic Factor Christmas Factor Stuart-Prower Factor Plasma Thromboplastin Antecedent Hageman Factor Fibrin Stabilizing Factor
Coagulation Factors
Fibrinogen Group
Factors I, V, VIII and XIII
Prothrombin Group
Factors II, VII, IX and X
Contact Group
Factors XI, XII Prekallikrein (Fletcher Factor) High Molecular Weight Kininogen (Fitzgerald Factor)
On the basis of physical properties, coagulation proteins may be devided into three groups :
Contact proteins Prothrombin proteins Fibrinogen or thrombin-sensitive proteins.
Blood coagulation leading to fibrin formation can be separated into three pathways :
Extrinsic pathway Intrinsic pathway Common pathway
Coagulation Process
Fibrinolysis
Physiologic process of removing unwanted fibrin deposits.
Kinin System
Important in:
inflammation. Vascular permeability. Chemotaxis
Complement System
Composed of + 22 serum proteins. Working together with antibodies & clotting factors. Important as mediators of immune & allergic reaction.
Hemostasis Tests
Screening assays in hemostasis Monitoring of anticoagulant therapy Disseminated Intravascular Coagulation Thrombophilia Inhibitor (Lupus Anticoagulant, Anti Phospholipid Antibody)