Documente Academic
Documente Profesional
Documente Cultură
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Prof. Dr. Ana Maria Vldreanu
mm
H EM O STAZA
Definitie: ansamblu de fenomene fiziologice care
Hemostaza fiziologica:
anumita viteza de desfasurare
mecanisme de reglare ce functioneaza strict la
Factori participanti:
H EM O STAZA
subendoteliala
2. Trombocitele timpul vasculo-plachetar;
activitate in procesul coagularii
3. Proteinele plasmatice:
Factorii coagularii
Inhibitorii fiziologici ai coagularii
Factorii fibrinolizei
Inhibitorii fiziologici ai fibrinolizei
4. Fluxul celulelor sangvine: leucocite,
monocite, eritrocite
( ! Hemofilicii sever anemici sangereaza mai
mult decat cei cu Hb normala); Interactiunea L
endoteliu E (importanta in inflamatie)
trombocitelor prin:
incarcarea electrica negativa prin care respinge
elementele figurate
Secretia de GAG (heparansulfat) rol anticoagulant
(activare antitrombina III leaga trombina)
Trombomodulina
Endoteliu activat:
Sub actiunea CK proinflamatorii
Status protrombotic marker p-selectina:
Endoperoxizi
(PGG2, PGH2)
Tromboxan sintetaza
Tromboxan A2
Tromboxan B2
(plachete)
Prostaciclin sintetaza
Prostaciclin
(PGI2)
6-Ceto-PGF1
(Celule endoteliale)
1 (b).Subentoteliulvascular
Subendoteliul este format din :
Fibronectina
Elastina
Factor von Willebrand
Sistemul proteinei C
2.Trom bocitul
Structura foarte complexa; suprafata trombocitului contine
Epinefrina
ADP
Trombina
Tromboxan A2
2.Trom bocitul
In interiorul trombocitului:
Granule
Corpi densi contin o serie de factori
vasoactivi, CK
Ca++ insoteste activarea trombocitelor
CASCAD A CO AG U LARII
(proenzime, zimogeni):
-
F
F
F
F
II a (trombina)
VII
IX
X
- PC
- F XI
- F XII
Cascada coagulrii
CASCAD A CO AG U LARII
2. Cofactori coenzime (acceleratori accelereaza viteza
reactiei):
F V (proaccelerina creste activitatea enzimatica a F X)
F VIII (factorul antihemofilic A; este cofactor al F IX)
3. Factori de contact:
F XI
F XII (Hageman)
PK (prekalicreina)
F XIII (factor stabilizator al fibrinei)
HMWK (High Molecular Weight Kininogen)
ajutata de un cofactor
Pentru tenaza intrinseca serinproteaza e IXa
cofactor e VIIIa
extrinseca serinproteaza e
VIIa
cofactor e FT IIIFactorul tisular
Pentru complexul protrombinazic serinproteaza
Xia
Calea extrinsec
Factor XII
HMW kininogen
Pre-kalicrein
Factor XI
Factor VIIa
Factor tisular
PL, Ca 2+
Factor XIa
Factor IXa
Factor VIIIa
PL, Ca 2+
Factor IX
Factor Xa
Factor Va
PL, Ca 2+
Factor X
Protrombin
PL = fosfolipide
Factor X
Trombin
Fibrinogen
Fibrin
CASCAD A CO AG U LARII
Faza de contact a coagularii, ce presupunea formarea F
Celula purtatoare de FT
1.
FT
activeaza F X F Xa
VIIa
2.
3.
Generarea trombinei
CASCAD A CO AG ULARII
al coagularii
CE (secunde) : are loc prin fixarea F VII de portiunea
CASCAD A CO AG ULARII
Calea Intrinseca:
Activarea factorilor de contact se face de catre
CASCAD A CO AG ULARII
Calea Comuna
CC : F Xa in prezenta F V si a ionilor de Calciu,
PT cat si a APTT.
CASCAD A CO AG ULARII
Factorul II
actor principal in coagulare
el activvat de tenaza
isi induce propria sinteza explozie
trombinica
intervine in faza de amplificare a
coagularii
Activeaza trombocitele
Declanseaza mecanismele
anticoagulante
International
Journal of
Hemostasis
and
Thrombosis
Research,
Martie
2001,
30/S2/2
IIa)
Fibrinoformarea
Fibrinopeptide A
Fibrinopeptide B
Inhibition of Excessive
C lotting
Dangerous to expand beyond the boundaries of the injury.
FIBRIN O LIZA
Definitie: proces fiziologic care are ca scop
FIBRIN O LIZA
Plasminogenul: GP sintetizata in ficat
c% plasmatica = 20 mg/dl
Timp de injumatatire 2 zile
Prin scindarea plasminogenului rezulta PLASMINA
Clot Removal
Blood clots are designed to be temporary. After the clot has formed, the process of vessel repair begins. Epithelial
cells at the margin on the injury undergo cell division. These new cells eventually fill the gap in the vessel created by
the injury. Also, cells called fibroblasts are recruited to the area. Fibroblasts form connective tissue that repairs the
basement membrane of the vessel (fibroblasts also form scar tissue that may or may not be removed over time). At
this point the vessel is healed and the blood clot is no longer needed. The clot is removed in the following way:
The clot itself stimulates the secretion of tissue plasminogen activator (TPA) from the surrounding vascular
epithelium. TPA is an enzyme that catalyzes the conversion of plasminogen to plasmin. Plasminogen is an inactive
precursor molecule found in the blood, but plasmin is an enzyme that dissolves clots. Plasmin levels are not very
high so clot removal is a slow process. By the time the clot has been completely dissolved by plasmin, the vessel has
had a chance to heal itself. In summary, the clot, which forms rapidly, calls for its own destruction by initiating the
activation of plasmin.
Clot Removal
Blood clots are designed to be temporary. After the clot has formed, the process of vessel repair begins. Epithelial
cells at the margin on the injury undergo cell division. These new cells eventually fill the gap in the vessel created by
the injury. Also, cells called fibroblasts are recruited to the area. Fibroblasts form connective tissue that repairs the
basement membrane of the vessel (fibroblasts also form scar tissue that may or may not be removed over time). At
this point the vessel is healed and the blood clot is no longer needed. The clot is removed in the following way:
The clot itself stimulates the secretion of tissue plasminogen activator (TPA) from the surrounding vascular
epithelium. TPA is an enzyme that catalyzes the conversion of plasminogen to plasmin. Plasminogen is an inactive
precursor molecule found in the blood, but plasmin is an enzyme that dissolves clots. Plasmin levels are not very
high so clot removal is a slow process. By the time the clot has been completely dissolved by plasmin, the vessel has
had a chance to heal itself. In summary, the clot, which forms rapidly, calls for its own destruction by initiating the
activation of plasmin.
Fibrinoliza
Plasminogen
Extrinsec: t-PA, urokinaza
Activare
PAI-I
Fibrin, fibrinogen
Plasmin
TAFI
2-antiplasmin
produi de degradare
Activatorii plaminogenului:
FIBRIN O LIZA
Fibrinogenoliza
+ A fragment
+ B 1-42 fragment
Fibrinoliza
I. Inhibitori fiziologici
Inhibitoriifi
brinolizei
1. Antiplasminele:
2.
Inhibitoriifi
ziologiciaicoagularii
Antitrombina III - cel mai important inhibitor
(*trombomodulina)
Sistemul proteina C, proteina S: inhiba F Va, F
VIIIa
TAFI: - inhibitori ai caii extrinseci
Sistemul proteinei C
Trombina
calitative: trombopatii
cantitative: trombocitopenii
de cauza plasmatica
2. Tulburari de coagulare
Congenitale:
Hemofilii
Boala von Willebrand
Dobandite
3. Tulburari ale fibrinolizei: fibrinoliza primara din bolile
hepatice
4. Anomalii complexe ale hemostazei si coagularii CID
PTT