STEP 1

1. Maternal line : garis keturunan dari ibu

STEP 2

1. What factor that influence blood clotting ?

2. How the mechanism of blood clotting ?

3. What kind of hemophilia ?

4. What is the risk factors of the hemostatic problem ?

5. Explain the hemostatic process !

6. What is the definition of hemostatic ?

7. How can the bleeding difficult to stop ?

8. Explain the pathofisilogy of hemostatic disorders ?

9. Why the blood still bleeding within in half an hour ? is it in a normal condition ?

STEP 3

1. How can the bleeding difficult to stop ?

Answer : Bleeding stop mechanism is hemostatic. Blood stop bleeding
influenced by 13 factors. That makes the mechanism distrurb.
2. Why the blood still bleeding within in half an hour ? is it in a normal
condition ?
Answer : There are exist of the different normal value of blood bleeding time
for each system :
a. Blood vessel system : 2-3 minutes
b. Platelets system : ganguan jumlah platelets -> disorder (?)
c. Coagulation system > 30 minutes (abnormal)
d. Fibrinous system : 2-3 minutes
e. Inhibitors coagulation (ex:heparin)
How is the coagulation system can influence the hemophylia ?
- Bleeding time : Duke (normal value : 1-3 minutes & max value : 3-6
minutes) and Ivy (normal value : 1-6 minutes & max value : 7-11 minutes)
method
- Clotting time : Gelas arloji and lee&white (normal value : 9-15 minutes)
method

3. What factor that influence blood clotting ?

Answer :
F. I :Fibrinogen -> precursor fibrin
F.II : Protombin -> precursor trombine
F.III :Tromboplastin -> protombin activation
 F.IV :Calcium -> active protombin + make fibrin
F.V :Proacelery -> help acceleration of changing from protombin to trombin
F.VI :-
F.VII : Stability factor -> change protombin
F.VIII : Anti hemolytic -> activated protombin
F. IX : factor chasmast -> activated protombin
F.X : factor stuart power -> accelerate the connection of protombin
F.XI : PTA -> accelerate the form of thrombin
F.XII : factor hagenan -> to active PTA
F.XIII : laki lorand -> to make string of fibrin
4. How the mechanism of blood clotting ?
5. What is the definition of hemostatic ?
Answer :
6. Explain the hemostatic process !
Answer : Mechanism of hemostatic -> u/ menjaga agar tidak kehilangan
blood stream
a. Blood vessel system
b. Platelets system
c. Coagulation system
d. Fibrinous system
The relation between collagen and fibrinous ?
Collagen : F. XII (inactive) -> F.XII(active)

XI (inactive) -> XI (active)

Ca2+ (factor IV), PF 3, F.VIII
X(inactive)->X (active)
Ca 2+,F.V,PF3
Thrombin

7. What is the risk factors and ethiology of the hemostatic problem ?

Answer : - depend of VWF factor
8. Explain the pathofisilogy of hemostatic disorders depend of each system?
9. Explain the physiology of hemostatic ?
10.Explain pathogenesis of hemophylia ?
11.Kenapa factor ke IV tidak ada pengaruhnya ?
12.Fibrinolisis?

Learning Issue
1. What is the risk factors and ethiology of the hemostatic problem ?
Answer :
- Von Willebrand factor deficiency
- Vitamin K deficiency : liver deliver F.II,VII,IX,X, and protein C&S depend on
vitamin K
 - thrombosis divided into 2 white thrombus (artery) fibrin &
thrombocyte

Red thrombus (vena) fibrin & RBC

a. Arterial thrombosis
Risk factor : - incomplete blood vessel endothel
enzyme,smoking,cholesterol
- activated thrombocyte anti-thrombin III,protein C & S
- reduce active coagulation
- lacking of antibody
2. Explain the pathofisilogy of hemostatic disorders depend of each system?
Answer :
1. Vaskuler :
a. Non allergic purpura (happen in mucose membrane because disruption of
B cell and T cell)
ex : lupus erythrorus systemic
- Purpura senilus
- Telangektasia hemoragic herediter
- Ehler Danlos Syndrome : happens because the disfunction of collagen ->
make the thrombocyte aggregation disorder -> characterize : hipo allergic
skin
b. Allergic
- Imunologic disorder in blood vessel (indicated by petechie found)
- Purpura Henoch Schonlein -> manifestation : mucose bleeding, digestive
system, arthritis
2. Thrombosit plug -> VWF
3. Coagulation -> hemophylia A (factor VIII deficiency) & hemophylia B (factor
IX deficiency)
4. Fibrinolysis ->
3. Explain the physiology of hemostatic ?
Answer :
Intrinsic pathway (from blood cell) Extrinsic pathway
(from endothelium)
Thrombosit -> XII -> XIIa VIIa <- VII (Tissue
thromboplastin)

XI -> XIa
Ca2+ Ca2+
IX -> IXa
VIII Ca2+
X -> Xa
Ca2+ V
Prothrombin -> Thrombin

Fibrinogen -> Fibrin

Fibrin Stabil

4. Explain pathogenesis of hemophylia ?

 Answer :
5. Why the VI factor didnt influence the coagulation system?
Answer :

6. Explain the process of fibrinolysis?

Answer :
Proactivator plasminogen
-> Thrombin

Plasminogen activator

Urokinase
Plasminogen ---------------- plasmin

Fibrinogen ------ Solubl e fibrin

Fibrin