Step 1

 Bleeding : nama yang umum digunakan untuk menggambarkan kehilangan

darah. Hal ini dapat merujuk pada kehilangan darah dalam tubuh
(perdarahan internal) atau kehilangan darah di luar tubuh (perdarahan eksternal).
 Transfusion : Transfusi darah adalah proses menyalurkan darah atau produk
berbasis darah dari satu orang ke sistem peredaran orang lainnya. Transfusi darah
berhubungan dengan kondisi medis seperti kehilangan darah dalam jumlah besar
disebabkan trauma, operasi, syok dan tidak berfungsinya organ pembentuk sel darah
merah.
 Circumcised : adalah tindakan memotong atau menghilangkan sebagian atau
seluruh kulit penutup depan dari penis
Step 2
1. What is hemostasist ?
2. What is the factor can influence hemostatis ?
3. What are the function of hemostasis ?
4. What is mechanism of hemostasis ?
5. Mention the abnormalities of hemostasis ?
6. What is the meaning of fibrinolisis ?
7. What is the factor of blood clotting ?
8. What kind of transfusion ?
9. In what condition a person should receive blood transfusion ?
10.What is relationship between genetic and unstoppable bleeding ?

Step 3
1. What is hemostasist ?
 Hemostasis is a process to maintain the viscovity of blood that make
blood can circulate in blood vessel.
 Is a contain to keyword hemo and stasis .Hemo (blood) ,stasis (stop).
Hemostasis is complex process that continue to prevent to occur
blood loss spontaniously and to stop bleeding cause damage the
blood vesel system

The function of organ systems is to maintain a stable internal

Environment
Vander's Human Physiology The Mechanism of Body Function 13
edition

Homeostasis (ho¯ me¯-o¯-STA¯ -sis; homeo-

sameness; -stasis
 standing still) is the condition of equilibrium (balance) in the
body’s internal environment due to the constant interaction of
the body’s many regulatory processes.

Hemostasis is traditionally defined as a physiological response to

blood vessel injury and bleeding, which entails a co-ordinated
process involving the blood vessel, platelets, and blood clotting
proteins (i.e. coagulation factors).
Dr Mustapha Alfallah – Pediatric Hematologist-
Oncologist

2. What is the factor can influence hemostatis ? + peranan masing2

- Any damage in blood vesel or tissues
- Trombosit adhesion agregation and activation
- Factor coagulation
- Inhibitor coagulation
- fibrinolisist
3. What are the function of hemostasis ?
- To prevent unstoppale bleeding from blood vesel
- To controlling the blood loss from blood vesel
- To maintain viscovity of blood that make blood can circulate in blood
vesel
- Homeostasis is essential for health and survival. The ability to
maintain physiological variables such as body temperature and blood
sugar concentrations within normal ranges is the underlying principle
upon which all physiology is based.
Vander's Human Physiology The Mechanism of Body Function 13
edition
4. What is mechanism of hemostasis ? Skema
- There are primary step there are 3 step
- Spasme vascular : its begining from blood vesel torn, because of
factor that release from subendotel, start constriction that can inhibit
the circulation of blood and reduce the loss of blood
- Making a platelts plug
- Blood coagulation

- Vit K can help the FVII,iX,X

 During Hemostasis three steps occur in a rapid sequence.
1. Vascular spasm - Vascular spasm is the blood vessels first response to
injury.
2. Platelet plug formation - Platelets adhere to damaged endothelium to
form platelet
plug and then degranulate.
As platelets adhere to the collagen fibers of a wound they become
spiked and much
stickier. They then release chemical messengers such as adenosine
diphosphate , serotonin and thromboxane A2. These chemicals are
released to
cause more platelets to stick to the area and release their contents and
enhance
vascular spasms.
The platelet plug formation is activated by the Von Willebrand factor
(VWF),
3. Coagulation or blood clotting. Coagulation reinforces the platelet plug
with fibrin
threads that act as a “molecular glue”. Once the platelet plug has been
formed by
the platelets, the clotting factors begin to form a collagen fiber called
fibrin. Once
this begins, red and white blood cells become caught up in the fibrin
mesh which
causes the clot to become even stronger
sumber :Hemostasis and Bleeding disorders. Dr Mustapha Alfallah
Pediatric Hematologist-Oncologist
5. Mention the abnormalities of hemostasis ? abnormalities from blood
coagulation ?
- Trombopati : anomali trombosit function
- Trombopati herediter ; platelets store disease
- Trombositopenia : abnormalities in platelets, the platelets > 100.000
- Tromboastenia glanzemen
- Von Willebrand disease : it make dissable adhesion trombosit, reduce
activities factor in plasma
- Hemofilia A & B : A: deficiency factor 8
 B : deficiency factor 9
- Deficiency Vit K

- Trombositopenia : abnormal sign of spontan skin and bleeding in

mukose, and long bleeding after trauma, that cause failed production
in trombosit, disfunction of bone marrow

- Hemofili A : because X linked recessive, in women : carrier, factor Von

Willebrand because autosomal willebrand. In bleeding at joint and
muscle ,von willebrand bleeding in mukosa after trauma

- Dissable in vascular : purpura henoch, scurvy

- Dissable of abnormalities count trombosit : purpura
trombosithopenic (petechiae)
- Disease Von Willebrand
- Disease of coagulation : hemofilia A & B, dissaminate intravascular
coagulation, deficiency vit K

Lecture 3 phatofisiology
6. What is the meaning of fibrinolisis ?
Fibrinolisis is process broken fibrin after reparation process in blood
vesel by system fibrinolitic. system fibrinolitic is system enzym
multicomponent that produce enzym active plasmid
Fibrinolisis : proses penghancuran fibrin setelah proses reparasi oleh
dinding pembuluh, karena dinding pembuluh telah rusak

fibrinolysis principally exist to ensure that fibrin deposition in excess of

that which is required to prevent blood loss from damaged vessels is
either prevented or degreded and removed
hemostasis and thrombosis protocols, david j perry 1999
7. What is the factor of blood clotting / coagulation ? (13 factor)
mechanism of factor
Factor fibrinogen, protombin, tissues factor, calsium, proacelarin,
acyglubulin, FVII, accelerator convertion protombin serum
FVIII : antihemofili factor, glubolin antihemofili
FIX : comtromboplastin plasma, Factor chrismast
FX : stuart factor
FXI : PTA
 FXII : hagemann factor
FXIII : stabillitation fibrin factor

- thrombin is the cornerstone of hemostasis. prothrombin, its percusor,

is a vitamin K dependent plasma. thrombin is crucial to the conversion of
fibrinogen to fibrin. it is the most potent physiological activator of
platelets causing shape change, the generation of thrombooxane A2,
ADP release, and ultimately platelt agregation.
- tissue factor is an integral transmembrane protein coded for by a short
gene of 12,4 kb on chromosome 1. it is found on the surface of vascular
tissues. tissue factor (thromboplastin) binds and promotes activation of
factor VII, and is required for the initiation of blood coagulation
- factor V is a plasma glycoprotein of mol wt 330 kDa coded for by
complex 25 exon 80-kb gene on chromosome 1. it is a critical cofactor in
coagulation, which in its activated form facilities the conversation of
prothrombin to thrombin
- Factor VII this is a vitamin K depent plasma glycoprotein and serine
protease of mol wt 50 kDa coded for by a 13-kb gene on chromosome
13. Factor Vii is involved in the initiation of blood coagulation, forming a
complex with tissue factor to generate an enzyme complex that
activates factor IX
- factor VIII is a plasma glycoprotein of approx mol wt 360 kDa coded for
by a complex 26 exon 186-kb gene on the X chromosome. factor VIII is
one of the largest and least stable coagulation factors with a complex
polypeptide composition, circulatin in plasma in a noncovalent complex
with vWF
hemostasis and thrombosis protocols by David J Perry 1999 Totowa,
New Jersey
8. What kind of transfusion ? spesific in unit of blood component ?
Transfusion of trombosit : it is for accute bleeding
HANDBOOK EN WHO
9. In what condition a person should receive blood transfusion ?
<30 – 40 % from blood total in body
Abnormalities of blood : thalasemia B mayor
10.What is relationship between genetic and unstoppable bleeding ?
(Diagram) ??
 Hemofili is genetic disease that infection to son from mother. Mother
with carrier have a son hemofili.
11. What is coagulation study ?
12. Mention coagulation cascade ?

13. Factor ex and in and process of coagulation ?

14. Basic principle management of the coagulation problems ?
15. Peranan faktor plasma dalam koagulasi ?

STEP 7
1. What is hemostasist ?
Hemostasis Is a contain to keyword hemo and stasis .Hemo (blood) ,stasis (stop).
Hemostasis is complex process that continue to prevent to occur blood loss
spontaniously and to stop bleeding cause damage the blood vesel system
Source : IPD 6 edition
2. What is the factor can influence hemostatis ? + peranan masing2
 Vessel walls : important in hemostasis 1, because in endhotelian produce
protein then can make hemostasis begining. Have a characteristic :
permeability, vasoconstriction
 Platelets : the part that very important to stop to close injury.
 Coagulation factor : factor that make activated and accelerate hemostasis
process
 Coagulation inhibitory factor : factor when stop produce too many fibrin.
 Fribrinolitic system : system for to lysis fibrin. Untuk menghilangkan fibrin
yang berlebihan.
Source : Hematology by At Glance & IPD Jilid 2
3. What are the function of hemostasis ?
- To process of clott formation in the vessel walls damage and prevent blood loss
while maintain blood in the liquid state in the vascular system
Sources : Physiology Guyton and Hall 2007 Prince SA
- To pprevent blood exit from blood vessel
- To prevent unstopable bleeding
Sources : dr Sampurna .Hemostasis
4. What is mechanism of hemostasis ? Skema
Intrinsic : trombosit akan mengaktivkan faktor 12, akan terkativasi menjadi faktor
12A, akan dibantu plasma enzim akan menjadi faktor 11 kemudian menjadi faktor
11A, dengan dibantu Ca2+ menjadi faktor 9, dibantu dengan ion kalsium, Ca2+,PF3
menjadi F8 menjadi F10. Tromboplastin aktif karena damage plasenta, emboli, luka
bakar, hemolitik, cancer. Fibrinogen to fibrin dibantu F13, Ca membatu fibrin
menjadi stabil
Extrinsic : mengaktifkan F3, dibantu ion Ca2+ menjadi F7 -> menjadi F10 dibantu oleh
F5A.
5. Mention the abnormalities of hemostasis ? abnormalities from blood coagulation ?
Contain some abnormalities :
Thrombositopenia : the count of platelts under 150.000/mmk
Thrombopati : platelets function abnormalities
vWD : thrombosit adhesion
Hemofili A&B : deficiency factor 8 (A) ,deficiency F.9 (B)
Defiiency Vit K : disturb in cascade coagulation
Source : Hematologi Klinik Ringkas

DIC : syndrome yang terjadi karena diposition fibrin sistemik dan sewaktu waktu
menyebabkan perdarahan sistemik.
vWd dissease classification :
- Type 1 : adanya penurunan sintesis vWF
- Type 2 : kerusakan sintesis vWF sedang dan besar
- Type 3 : tidak ada sintesis vWF

- Karena kerusakan hemostasis :

Trombosis : increase the number of platelts each more than 400.000/mmk
- Karena abnormal genetis :
vWd , DIC (karena infeksi, jamur, cancer), ITP (karena abnormal autoimun
menyebabkan trombositopenia)
Souce : Patofisiologi Sylvia
6. What is the meaning of fibrinolisis ?
Fibrinolisis is body mechanism to control fibrin deposition in the vascular system.
Untuk menghambat proliferasi fibrin

7. What is the factor of blood clotting / coagulation ? (13 factor) + mechanism of factor
- F1 (fibrinogen) : is plasma protein synthesis in the liver is convert to fibrin
 - F2 (prothrombin) : plasma protein synthesis in liver is convert in to thrombin
- F3 (thromboplastin) : lipoprotein are remove damage tissue to activate F12 the
formation thrombin
- F4 (Calcium ion in organis ions in the plasma obtain from food and bonds are
need in all stage of blood cotting
- F5 (Proaccelerin) : a plasma protein synthesis in the liver is required is intrinsic
mechanism
- F6
- F7
8. What kind of transfusion ? spesific in unit of blood component ?
- Whole blood : volume 300ml darah donor ,Hb 12gr/dl, tidak terdapat faktor
koagulasi labil. Indikasi : perdarahan akut, transfusi tukar. Penyimpanan : +2 -
+6. Maks 3 minggu ,harus segera ditrnasfusi sebelum 30 menit setelah keluar
dari penyimpanan
- Darah Endap (PRC) packed red cell : volume 150 – 250 ml dengan jumlah plasma
minimal, Hb 20 gr/100dl, Hct 55-75%. Indikasi ; pengganti sel darah ,erah pada
anemi, perdarahan akut
- Darah Merah Cuci (washed Eritrosit) : volume 260ml, Hct 0,57 l/l, leukosit <
100000000 ,plasma < 0,2 ml
- Trombosit Concentrate : mengandung trombosit minimal 55000000000 .eritrosit
< 12 0000000.indikasi perdarahan akibat trombositopenia, gangguan fungsi
trombosit,
- FFP (fresh Frozen Plasma ) : plasma dipisahkan dari 1 kantong whole blood
maksimal 6 jam atau dibekukan .terdiri dari faktor pembekuan stabil albumin
dan immunoglobin, volum 60 – 180 ml
- Cryoprecipitate : presipitasi dari FFP, saat thawing 4 C dan dicampur dengan 10-
20 ml plasma ,setengah dari F8 dan fibrinogen darah utuh
9. In what condition a person should receive blood transfusion ?
10. What is relationship between genetic and unstoppable bleeding ? (Diagram) ??
Hemofili is heredite dissease in X linked reccessive, just X chromosome bring itr
11. What is coagulation study ?
Coagulation : is a process complex a begining clotting blood, mempunyai banyak
faktor
12. Mention coagulation cascade ?

13. Factor ex and in and process of coagulation ?

14. Basic principle management of the coagulation problems ?

Penanganan dasar perdarahan ? prinsipnya ?
15. Peranan faktor plasma dalam koagulasi ?
Plasma coagulation factor : interact to produce thrombin, which convert
fibrinogen to fibrin. By radiating from and anchuring the hemostatic
plug.