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ARREST BLEEDING
MAINTAIN BLOOD IN FLUID STATE
HOMEOSTATIC HEMOSTASIS
Fisiologic funtion Maintain blood in fluid state
Hemostatic Balance
Hemostasis an equilibrium of physiological activators and
inhibitors of coagulation
Theequilibrium
The equilibriumisisfragile
fragileand
andseveral
several
causes put
causes putpatient
patientatatrisk
risk
PAI-1 Prot. S
Antiplasmin Prot. C
Procoagulant Anticoagulant
HEMOSTASIS
Primary Hemostasis
Blood vessel contraction
Platelet Plug Formation
Secondary Hemostasis
Activation of Clotting Cascade
Deposition & Stabilization of Fibrin
Tertiary Hemostasis
Dissolution of Fibrin Clot
Dependent on Plasminogen Activation
Hemostasis Lab Tests
CBC-Plt
BV Injury BT,(CT)
PT
Tissue PTT
Neural Platelet Factor
Adhesion
and
Activation
Reduced
Fibrin
Blood flow formation
Plt Study
Morphology
Stable Hemostatic Plug
Function
Antibody
The primary haemostatic system:
haemostasis and platelet plug formation
Primary haemostasis
Platelet aggregation
trombosit
Adhesion
endothelial cells
Activation
sub endothelial tissue
Vascular Aggregation
injury
White clot
Formation of
platelet plug
exposed sub
endothelial tissue
The haemostatic system:
secondary haemostasis and clot
formation
Prothrombin Thrombin Activation of the
Factor coagulation cascade
Intrinsic
Xa
Extrinsic Fibrinogen Fibrin
leads to generation of
pathway pathway thrombin and, in turn,
fibrin
Coagulation cascade
leads to clot formation
Clot
growth
Fibrin threads
The haemostatic system:
Tertiary haemostasis and clot formation
Clinical Manifestation of Hemostatic
defect
Ptechia
Purpura
Echymosis
Haematoma
Haematemesis
Melena
Haemathrosis
Haematophysis
Hematuria
Epistaxis
Gum bleedeing
Petechia : a minute, rounded spot of haemorrhage on a
surface, such as skin, mucous membrane, serious
membrane
Purpura : a condition in which haemorrhage occur in the
skin
Ecchymosis: extravasasion of blood into the
subcutaneous tissue. It is marked by purple discoloration
of the skin, the color gradually changing to brown green
and yellow
Hematemesis : the vomiting blood
Hemoptysis : the spitting of blood from larynx ,pharynx,
trachea, bronchi or lung
Hematoma : a focalized extravasation of blood which
soon clot to form a solid mass and readily became
encapsulated by connective tissue
Melena : the discharge of stool colored black by altered
blood
Hemathrosis : extravasation of blood into a joint
Hematuria : the discharge of urine containing blood
Epistaxis : bleeding from nose
Hematoschezia : the discharge of stool colored red or
brown
Disorders of Hemostasis
Vascular disorders
Scurvy, easy bruising, Henoch-Schonlein purpura.
Platelet disorders
Quantitative - Thrombocytopenia
Qualitative - Platelet function disorders Glanzmans
Coagulation disorders
Congenital - Haemophilia (A, B), Von-Willebrands
Acquired - Vitamin-K deficiency, Liver disease
Mixed/Consumption: DIC
VASCULAR
Vascular
Purpura, echymosis
Connective tissue Ehler-Danlos Syndrome
Aging process senile purpura (Batemans disease)
Infectious
Meningococcus Rocky Mountains syndrome
typhoid fever Roseola spot
Vit C deficiency scurvy
Immunologic Henoch-Schonlein purpura
fragility capillary infectious, vasculitis
Senile Purpura
Henoch-Schonlein purpura
20y Male, fever, painful symmetric polyarthritis for a day. During the next two days,
edema and palpable purpura developed.
Henoch-Schonlein purpura
Immune disorder
Children
Follows infection
Petechiae with
edema and
itching.
9 Maret 2004
9 Maret 2004
9 Maret 2004
9 Maret 2004
Vascular
Non palpable purpura
senile purpura
scurvy
use corticosteroid
Palpable purpura Henoch-Schonlein
syndrome
THE ROLE OF PLATELET IN
HEMOSTASIS
THE ROLE OF PLATELET IN HEMOSTASIS
Platelet dysfunction:
Inherited Disorders:
Bernard-Soulier disease
large platelets, failure of adhesion
Glanzmanns thrombasthenia
normal size, failure of aggregation
Acquired Disorders:
Drugs : Aspirin
Alcohol
Uremia,
Platelet dysfunction
Quantitatif : - thrombocytemia
- ITP
- aplastic anemia
- DHF
- acute leukemia
- hypersplenism
Platelet Disorders - Features:
Mucocutaneous bleeding
Petechiae, Purpura, Ecchymosis.
Spontaneous bleeding after trauma
CNS bleeding (severe, plt)
Prolonged bleeding time (BT)
Dengue Hemorrhagic fever
Platelet deficiency..
Petechiae
(typical of platelet disorders)
(typical of
coagulation factor
disorders)
Coagulation Disorders
Laboratory findings:
Normal bleeding time & Platelet count
Prolonged prothrombin time (PT)
deficiencies of II, V, VII, X
Prolonged time (aPTT)
all factors except VII, XIII
Mixing studies - normal plasma corrects PT or
aPTT
Factor VIII Deficiency
Classic hemophilia (hemophilia A):
Congenital disorder
Deficiency of vWF molecule
Part of FVIII,
Mediates platelet adhesion
Prolonged Bleeding time
Low Factor VIII & long aPTT
Mucocutaneous bleeding
Von-Willebrand Disease:
Vitamin K deficiency
- neonates - decreased intestinal
flora and dietary intake
- oral anticoagulants (coumadin)
- fat malabsorption syndromes
thrombocytopenia ( BT)
Secondary - decrease in all coagulation factors
IX, X
Clinical Features of Bleeding Disorders
Platelet Coagulation
disorders factor disorders