asilmi hemostasis ahmad shihada silmi faculty of sciences iug med. tech. dep. room # b326

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HEMOSTASISHEMOSTASIS

Ahmad Shihada SilmiAhmad Shihada SilmiFaculty of SciencesFaculty of Sciences

IUGIUGMed. Tech. DepMed. Tech. Dep..Room # B326Room # B326

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An overview of Haemostatic An overview of Haemostatic Mechanism, Platelet structure and Mechanism, Platelet structure and function, function, Define the term hemostasis, coagulation, Define the term hemostasis, coagulation, fibrinolysis, and hemorrhage.fibrinolysis, and hemorrhage.

List the major and minor systems involved List the major and minor systems involved in maintaining hemostasis.in maintaining hemostasis.

Describe the events that take place in Describe the events that take place in primary hemostasis.primary hemostasis.

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List the function of the vascular system.List the function of the vascular system.

Describe the major functions of the Describe the major functions of the endothelium.endothelium.

Name the three structural zones of Name the three structural zones of platelets.platelets.

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HEMOSTASIS OBJECTINESHEMOSTASIS OBJECTINES

Describe the composition and functions of Describe the composition and functions of the peripheral zone, the sol-gel zone, and the peripheral zone, the sol-gel zone, and the organelle zone.the organelle zone.

Explain the role of platelets in the Explain the role of platelets in the haemostatic process.haemostatic process.

List steps in platelet plug formationList steps in platelet plug formation

Name essential elements for the process Name essential elements for the process of platelet adhesion.of platelet adhesion.

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Describe the process of platelet Describe the process of platelet aggregation.aggregation.

Describe the events take place in Describe the events take place in secondary hemostasis.secondary hemostasis.

Name the product responsible for Name the product responsible for stabilization of the haemostatic plug.stabilization of the haemostatic plug.

List characteristics for the contact List characteristics for the contact coagulation proteins.coagulation proteins.

List characteristics for the prothrombin List characteristics for the prothrombin proteins.proteins.

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Interaction of the Fibrinolytic, Interaction of the Fibrinolytic, Coagulation Systems and Related Coagulation Systems and Related Pathology.Pathology.

Name the component of the coagulation Name the component of the coagulation and fibrinolytic system.and fibrinolytic system.

List plasminogen activators and negative List plasminogen activators and negative feedback clotting mechanisms.feedback clotting mechanisms.

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Describe plasmin’s action in forming the Describe plasmin’s action in forming the intermediate degradation product, D intermediate degradation product, D dimer.dimer.

Name the primary inhibitor of the Name the primary inhibitor of the fibrinolytic system.fibrinolytic system.

Describe the physiologic interactions of Describe the physiologic interactions of the proteolytic system.the proteolytic system.

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HEMOSTASIS OBJECTIVESHEMOSTASIS OBJECTIVES

Acquired coagulation disordersAcquired coagulation disordersObjectivesObjectives

Following this conference, the student will be able Following this conference, the student will be able totoExplain the classification of acquired disorder of Explain the classification of acquired disorder of haemostasis such as:haemostasis such as:

Hepatic diseaseHepatic disease, , vitamin K deficiencyvitamin K deficiency , , renal renal diseasedisease, , haeorrhagic disease of the newbornhaeorrhagic disease of the newborn, , overdosage with anticoagulantoverdosage with anticoagulant, , massive massive transfusion syndrometransfusion syndrome..

Explain the action of oral anticoagulantsExplain the action of oral anticoagulants

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Acquired coagulation disordersAcquired coagulation disordersObjectivesObjectives

Name the most common laboratory test used to Name the most common laboratory test used to monitor oral anticoagulant therapymonitor oral anticoagulant therapyList mechanisms and clinical conditions List mechanisms and clinical conditions associated with DIC.associated with DIC.Define the three generalized clinical states of Define the three generalized clinical states of DIC with regard to the typicalDIC with regard to the typicalLaboratory abnormalities associated with each Laboratory abnormalities associated with each state.state.Describe the use of laboratory tests to Describe the use of laboratory tests to distinguish primary fibrnolysis from DIC.distinguish primary fibrnolysis from DIC.Identify therapies for treatment of DICIdentify therapies for treatment of DIC

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HEMOSTASIS OBJECTIVESHEMOSTASIS OBJECTIVES

Quantitative and Qualitative Vascular and Quantitative and Qualitative Vascular and Platelet Disorders.Platelet Disorders.

Both Congenital and Acquired.Both Congenital and Acquired.

Congenital Disorder of platelet FunctionCongenital Disorder of platelet Function

1- Bernard Soulier Syndrome (BSs).1- Bernard Soulier Syndrome (BSs).

2- Glanzmann’s thrombasthenia2- Glanzmann’s thrombasthenia

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ObjectivesObjectives..Definition of HemostasisDefinition of Hemostasis

Haemostatic componentsHaemostatic components

Concepts of Normal HemostasisConcepts of Normal Hemostasis

Role of Coagulation in HemostasisRole of Coagulation in Hemostasis

Primary and SecondaryPrimary and Secondary Role of Blood Vessels in HemostasisRole of Blood Vessels in Hemostasis Coagulation ProteinsCoagulation Proteins Factor NomenclatureFactor Nomenclature Coagulation GroupsCoagulation Groups Phospholipids Contribution to Coagulation.Phospholipids Contribution to Coagulation.

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Vessel wall, Blood flow & Coagulation Vessel wall, Blood flow & Coagulation SubstancesSubstances

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In Case if there is an Endothelial In Case if there is an Endothelial InjuryInjury((BleedingBleeding must be prevented at site of injury) must be prevented at site of injury)

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Flow must be MaintainedFlow must be Maintained

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DefinitionDefinition

Hemostasis: drives from the Greek meaning Hemostasis: drives from the Greek meaning “The stoppage of blood flow”.“The stoppage of blood flow”.

There are There are threethree haemostatic componentshaemostatic components::

1- The 1- The extra-vascularextra-vascular (The tissues surrounding (The tissues surrounding blood vessels) involved in Hemostasis when local blood vessels) involved in Hemostasis when local vessel is injured.vessel is injured.

It plays a part in Hemostasis by It plays a part in Hemostasis by providing back-providing back-pressurepressure on the injured vessel through on the injured vessel through swelling swelling and trappingand trapping of escaped blood. of escaped blood.

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The threeThe three haemostatic components haemostatic components

2- The2- The vascularvascular (The blood vessels through (The blood vessels through which blood flow) it depends on the size, amount, which blood flow) it depends on the size, amount, of smooth muscle within their walls and integrity of smooth muscle within their walls and integrity of the endothelial cell lining.of the endothelial cell lining.

3- The 3- The intra-vascularintra-vascular (The (The platelets and plasma platelets and plasma proteinsproteins that circulate within the blood vessels). that circulate within the blood vessels).

These components are involved in These components are involved in CoagulationCoagulation (clot or thrombus formation) or (clot or thrombus formation) or FibrinolysisFibrinolysis (clot (clot or thrombus dissolution).or thrombus dissolution).

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Concepts of Normal HemostasisConcepts of Normal Hemostasis

Under normal conditions, the formation and Under normal conditions, the formation and dissolution of thrombi is maintained in a delicate dissolution of thrombi is maintained in a delicate balance. (fig ).balance. (fig ).

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Without this balance, the individual may experience either Without this balance, the individual may experience either excessive bleedingexcessive bleeding (poor clot formation or excessive Fibrinolysis) (poor clot formation or excessive Fibrinolysis)

Vaso-occlusion (uncontrolled formation of thrombin in vascular Vaso-occlusion (uncontrolled formation of thrombin in vascular system, occluding vessels and depriving organs of blood).system, occluding vessels and depriving organs of blood).

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There are certain conditions associated with There are certain conditions associated with excessive bleeding are referred to as: excessive bleeding are referred to as: Hypo-Hypo-coagulablecoagulable states. states.

Such as, Such as, HemophiliaHemophilia or deficiency in one of the or deficiency in one of the plasma coagulation proteins such as factors plasma coagulation proteins such as factors VIIIVIII. .

Acquired conditions such as Acquired conditions such as DIC, Liver and KidneyDIC, Liver and Kidney diseases.diseases.

In addition to Coagulation promotion, In addition to Coagulation promotion, vessel injuryvessel injury initiates initiates FibrinolysisFibrinolysis through endothelial cell through endothelial cell release of release of tissuetissue Plasminogen activatorsPlasminogen activators ( (tPAStPAS).).

This is to ensure that excessive coagulation does This is to ensure that excessive coagulation does not occur.not occur.

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Role of Coagulation in HemostasisRole of Coagulation in Hemostasis

CoagulationCoagulation: Is the process where by on vessel : Is the process where by on vessel injury, injury, Plasma proteinPlasma protein, , Tissue factorsTissue factors and and Calcium Calcium interact on the surface of the platelets interact on the surface of the platelets to form a to form a Fibrin clotFibrin clot..

PlateletsPlatelets provide a surface for the coagulation provide a surface for the coagulation reaction, and reaction, and interact with fibrininteract with fibrin to form a stable to form a stable platelet fibrin clot.platelet fibrin clot.

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Tissue factorsTissue factors (except (except CaCa and and Tissue Tissue ThromboplastinThromboplastin) normally circulate in the plasma ) normally circulate in the plasma as as inactive proteins.inactive proteins.On activation some factors form enzymatic On activation some factors form enzymatic proteins known as proteins known as Seiren ProteasesSeiren Proteases that that activateactivate other specific factors in the coagulation other specific factors in the coagulation sequence.sequence.

Other conditions are related to uncontrolled Other conditions are related to uncontrolled tthrombosis hrombosis are called are called Hyper-coagulable stateHyper-coagulable state. . This is related to an appropriate formation of This is related to an appropriate formation of thrombithrombi in the vascular vessels that in the vascular vessels that occludeocclude normal blood flow.normal blood flow.

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Hemostasis can be divided into Hemostasis can be divided into two stagestwo stages: : PrimaryPrimary and and SecondarySecondary..

PrimaryPrimary hemostasis includes the hemostasis includes the platelet and platelet and vascularvascular response to vessel injury. response to vessel injury.

Secondary Secondary hemostasis includes the hemostasis includes the coagulation coagulation factorsfactors response to such injury. response to such injury.

Together, platelets, vessels, and coagulation Together, platelets, vessels, and coagulation factors combine to factors combine to stop bleedingstop bleeding and allow for and allow for vessel repair through formation of vessel repair through formation of a stable fibrin-a stable fibrin-plateletplatelet plug at the site of injury. plug at the site of injury.

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Role of Blood Vessels in HemostasisRole of Blood Vessels in Hemostasis

Blood flows through the vascular system to and Blood flows through the vascular system to and from all parts of the body. The vascular system from all parts of the body. The vascular system consists of consists of capillaries, arteries, and veinscapillaries, arteries, and veins..

Blood normally carried within vessels whose Blood normally carried within vessels whose physical capabilities include physical capabilities include Contraction Contraction (narrowing)(narrowing) and and DilationDilation, which are controlled by , which are controlled by the smooth muscle of the vessel media.the smooth muscle of the vessel media.

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VasoconstrictionVasoconstriction and and VasodilatationVasodilatation provide the provide the means for means for control blood flow rate and blood control blood flow rate and blood pressurepressure..

Substances Substances released from the endothelial cells released from the endothelial cells and sub- endothelial smooth muscles also and sub- endothelial smooth muscles also contribute to normal blood flow and prevent contribute to normal blood flow and prevent abnormal formation of clotabnormal formation of clot..

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Summary of Important Vascular Summary of Important Vascular FunctionFunction

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Vascular Endothelium Function

Prostacyclin

Thromboxane A2

ELAMs, ICAMs

von Willebrand factor

Vasodilation, inhibition of platelet aggregation

From platelets, constrictmuscular arteries

Cytokines induce synthesis to promote leukocyte adhesion

Promote platelet-collagen adhesion to exposed sub-endothelium

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Vascular Endothelium Function

Tissue factor pathway inhibitor

Thrombomodulin

Tissue plasminogen activator

Heparan sulfate proteoglycans

Tissue factor

Anticoagulant- Inhibits coagulation extrinsic pathway

Anticoagulant- Inhibits coagulation by activating protein C system

Anticoagulant- Inhibits coagulation by activating fibrinolysis

Anticoagulant- Inhibits coagulation by activating antithrombin

Procoagulant- Inflammatory cytokines (IL-1, TNF) induce expression

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asilmi hemostasis ahmad shihada silmi faculty of sciences iug med. tech. dep. room # b326

Documents

asilmi hemostasis list

primary hemostasis

secondary hemostasis

term hemostasis

list characteristics

b326 slide

treatment of dic slide

platelet disorders