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Bleeding time, clotting time,
PT, and PTT
Presented By
HUSSAIN AKHTAR
WHAT IS COAGULATION?
Coagulation is a complex process by which blood forms clots. Blood
must be remain fluid with in the vasculature and yet clot quickly when
expose to non endothelial surface at a site of vascular injury.
It is an important part of haemostasis (the cessation of blood loss from
a damaged vessel), where in a damaged blood vessel wall is covered
by a platelet and fibrin-containing clot to stop bleeding and begin
repair of the damaged vessel.
Disorders of coagulation can lead to an increased risk of bleeding
(hemorrhage) or clotting (thrombosis).
constrict
Platelet plug formation - Platelats adhere
to damaged endothelium to form platelet
plug (primary hemostasis) and then
degranulate.
Blood Coagulation - Clots form upon the
conversion of fibrinogen to Fibrin, and its
addition to the platelet plug (secondary
hemostasis).
Factor I
Fibrinogen
Factor VIII
Antihemophilic
globulin
Factor II
Prothrombin
Factor IX
Partial
thromboplastin
component
Factor III
Thromboplastin Factor X
Stuart-Prower
factor
Factor IV
Calcium
Factor XI
Plasma
thromboplastin
antecedent
Factor V
Labile or
proaccelerin
Factor XII
Hageman factor
Factor VII
Stable factor or
proconvertin
Factor XIII
Fibrinstabilizing factor
EXTRINSC
Tisue Thromboplastin
XII
XI
IX
VIII
VII
X
FIBRINOGEN
(I)
V
PROTHROMBIN
(II)
THROMBIN
(III)
FIBRIN
FIBRINOLYTIC PHASE
ANTICLOTTING MECHANISMS ARE
HEMOSTASIS
DEPENDENT UPON:
VESSEL DEFECTS
VITAMIN C DEFICIENCY
BACTERIAL & VIRAL INFECTIONS
ACQUIRED
PLATELET DISORDERS
THROMBOCYTOPENIA
(INADEQUATE NUMBER OF PLATELETS)
Causes
DRUG INDUCED
BONE MARROW FAILURE
HYPERSPLENISM
OTHER CAUSES
THROMBOCYTOPATHY
) ADEQUATE NUMBER BUT ABNORMAL FUNCTION
)
causes
UREMIA
INHERITED DISORDERS
MYELOPROLIFERATIVE DISORDERS
DRUG INDUCED(ASPIRIN,
NSAIDS)
FACTOR
DEFICIENCIES
Acquired:
Inherited:
1.
HEMHHHHOPHILIA A
1. Anticoagulant
therapy
2.
HEMOPHILIA B
2. Liver diseases
3.
VON WILLEBRANDS
DISEASE
3. DIC
LABORATORY EVALUATION
PLATELET COUNT
BLEEDING TIME (BT)
Clotting time (CT)
PROTHROMBIN TIME (PT)
Activated PARTIAL THROMBOPLASTIN TIME
(APTT)
< 100,000
Thrombocytopenia
50,000 - 100,000
Mild Thrombocytopenia
BLEEDING TIME
PROVIDES ASSESSMENT OF PLATELET COUNT
AND FUNCTION
NORMAL VALUE
2-8 MINUTES
PROTHROMBIN TIME
Measures Effectiveness of the Extrinsic
Pathway
NORMAL VALUE
10-15 SECS
PT
The prothrombin time: is therefore the time required for the plasma
EXTRINSC
Tisue Thromboplastin
XII
XI
IX
VIII
VII
X
FIBRINOGEN
(I)
V
PROTHROMBIN
(II)
THROMBIN
(III)
FIBRIN
When is it ordered?
Used to monitor oral anticoagulant therapy (Warfarin /
Coumadin).
When a patient who is not taking anti-coagulant drugs
An elevated prothrombin
time may indicate the
Vitamin K deficiency
presence
of:
DIC
liver disease
a deficiency in one or more of the following factors:
I, II, V, VII, X.
Anticoagulant (warfarin)
INR
A PT test may also be called an INR test.
INR (international normalized ratio) stands for a way of
elevated.
INR of greater than 5 or 5.5 = unacceptable high risk of
bleeding,whereas if the INR=0.5 then there is a high
chance of having a clot.
Normal range for a healthy person is 0.91.3, and for
people on warfarin therapy, 2.03.0, although the target
INR may be higher in particular situations, such as for
those with a mechanical heart valve.
NORMAL VALUE
25-40 SECS
PTT
The partial thromboplastin time (PTT) or activated partial
EXTRINSC
Tisue Thromboplastin
XII
XI
IX
VIII
VII
X
FIBRINOGEN
(I)
V
PROTHROMBIN
(II)
THROMBIN
(III)
FIBRIN
When is it ordered?
When a patient presents with unexplained bleeding or
bruising,
It may be ordered as part of a pre-surgical evaluation for
bleeding tendencies,
When a patient is on intravenous (IV) or injection heparin
e.g hemophilia
DIC
Liver disease
FACTOR DEFICIENCIES
Inherited:
1.
HEMOPHILIA A
Acquired:
1. Anticoagulant
therapy
2. HEMOPHILIA B
2. Liver
3. VON
WILLEBRANDS
DISEASE
diseases
3. DIC
HEMOPHILIA B (Christmas
Disease)
ANTICOAGULANTS
ANTICOAGULANTS
1. Coumadins (Vitamin K antagonists)
2. Heparin
Coumadin's
These oral anticoagulants that antagonize the
effects of vitamin K.
Examples include warfarin. It takes at least 48 to
72 hours for the anticoagulant effect to develop.
Where an immediate effect is required, heparin
must be given concomitantly.
Monitored by PT times
These anticoagulants are used to treat patients
with deep-vein thrombosis (DVT), pulmonary
embolism (PE), atrial fibrillation (AF), and
mechanical prosthetic heart valves.
Heparin
Heparin is a biological substance.
It works by activating antithrombin III, which
Liver Disease
Liver Disease can Result in Reduced
Production of Coagulation
Factors
(I,II,V,VII,IX,X).
DIC
Disseminated intravascular coagulation (DIC is a
Pre-analytic
errors
Problems with blue-top tube
Partial fill tubes
Vacuum leak and citrate
evaporation
Biological effects
Hct 55 or 15
Lipemia, hyperbilirubinemia,
hemolysis
Laboratory errors
Delay in testing
Prolonged incubation at 37C
Freeze/thaw deterioration