Bleeding and Haemostasis. Saman W.Boskani HDD, FIBMS Maxillofacial Surgeon

Size: px
Start display at page:

Download "Bleeding and Haemostasis. Saman W.Boskani HDD, FIBMS Maxillofacial Surgeon"

Transcription

1 Bleeding and Haemostasis Saman W.Boskani HDD, FIBMS Maxillofacial Surgeon

2 1 Beeding

3 Its escaping or extravasation of blood contents from blood vessels

4 Types: - Arterial - Venous - Capillary

5 Differences between the types: Arterial Venous Capillary Bright red Eject out Synchronously Its control is difficult Darker blood Has steady flow Its control is sometimes easier Bright red Shows as generalized ooze Its rapid & controlled much easier Avoidable Common Most common than others

6 Classifications: According to time of haemorrhage: 1. Primary: immediately 2. Reactionary: commonly within first 24 hours 3. Secondary: usually occurs 7-14 days According to appearance: 1. Revealed (external) 2. Concealed (internal)

7 Classifications: (cont.) According to size of haemorrhage: 1. Small haemorrhages (petechiae,purpura,ecchymosis) 2. Large or massive haemorrhages (appear as running, clotting or hematomas) According to different organs or systems named: 1. Epistaxis, hemoptysis, 2. Hematamesis & melena, 3. Hematuria

8 Compensatory reactions activated by haemorrhage: Vasoconstriction Tachycardia Venoconstriction Tachypnea- increased thoracic pumping Restlessness Increased movement of intestinal fluid into capillaries

9 Increased secretion of norepinephrine &epinephrine Increased secretion of vasopressin Increased secretion of glucocorticoid Increased secretion of renin& aldosterone Increased secretion of erythropoietin Increased plasma protien synthesis

10 Clinical presentation: Pale,cold, wet skin Restlessness,anxiety,change in conscious level Tachycardia,with normal or even raised BP at first but later on Hypotension if bleeding cont. Deep sighing breathing( air hunger), tachypnea Thirst in late stages Empty veins Shock

11 Investigations 1. Hematological 1. Hb, pcv, blood group 2. Bleeding& clotting studies 2. Radiological studies (including US) 3. Electrolyte, acid- base analysis 4. Blood gas analysis & monitoring 5. Renal function studies after few days 6. Liver function studies

12 Management In general managing of a case of hemorrhage include: I. Primary assessment while resuscitating the patient I. IV line, fluid, sending blood for group& cross match II. Send for blood if necessary III. Assessing of the amount of blood lost if possible IV. Stopping of bleeding if possible( external) V. CVP measurement II. Secondary assessment Definitive treatment: including taking the patient to theatre if indicated

13 Management Local Haemostasis: 1. Mechanical: 1. Positioning 2. Pressure 1. Finger 2. Hemostat 3. Bandage,sterile gauze, tourniquet ( better to be avoided) 3. Packing 4. Ligation 2. Thermal 1. Electro cautery 2. Cryogenic surgery 3. Chemical 1. Epinephrine 2. Gel foam, oxycel, fibrin glue 3. Coagulation factors (regardingly ) 4. Follow up of the patient

14 2 hemostasis

15 Can be define as : The process of arresting bleeding by repair of vessel wall Maintaining a balance between Coagulation Fibrinolysis

16 Mature clot : is acombination of cross linked fibrin admixed with blood cells and plasma

17 Sub-endothelial matrix WBC Hemostatic plugendothelial cell Platelets Fibrin RBC WBC

18 CLOT Platelet Red Blood Cell Fibrin

19 COMPONENTS OF HEMOSTASIS Vascular system Platelet System Coagulation System

20 Hemostatic Mechanism 2 phases PRIMARY- blood vessel (vascular) and platelet response to injured vessel SECONDARYresponse of protein coagulation factors to the injury

21 Vascular phase It provide by vasoconstriction due to local contraction in smooth muscles of vessels by the effect of different stimuli (eg Thromboxane A2 which is a powerful vasoconstrctor) also (Serotonin, bradykinin ) By this process : 1-reduces blood loss 2-prevents clot from washing out

22 Platelet Phase Also platelet plays a great role as an injury to vascular walls ; expose endothelial collagen to which platelet adhere,& this required vwf which is producing in the Sub-endothelium, it binds to Glycoprotein in the surface of platelets

23 This phase pass through : 1- platelet adhesion 2-platelet activation 3-platelet aggregation

24 Coagulation It is a stepwise pathway, which is stimulated by platelet phase, The resultant system known as coagulation cascade which consist of two paralleling routes (Intrinsic & Extrinsic pathways )

25 Coagulation Intrinsic Pathway : all its components are found in blood so its activated by exposure to negatively charged foreign substance the Intrinsic Pathway include factors VIII, IX, XI, XII

26 Coagulation Extrinsic pathway: refer to extrinsic because the factors that activate it (tissue factor) is normally outside the vascular space and is exposed to vascular space only after damage to vascular endothelium Extrinsic Pathway include factor ( III, VII )

27 Coagulation Both intrinsic and extrinsic pathways connect to forming common pathway Common pathway include factors I,II, III,X

28 Contact XIIa XI XIa Intrinsic Pathway HKa IX IXa Coagulation Pathways TF Pathway TF-VIIa PL VIIIa PL (Tenase) Protein C, Protein S, Antithrombin III Tissue Factor + VII X Xa (Prothrombinase) Extrinsic Pathway Va Fibrinogen Common Pathway Prothrombin PL Thrombin Fibrin (weak) XIII XIIIa Fibrin (strong)

29 Important Note vwf which synthesized by vascular endothelial and attaches to both platelet receptors and collagen sp.

30 Important Note BT : primary hemostasis PT : Extrinsic pathway PTT : Intrinsic pathway TT : Common pathway

31 Important Note Some time case of vwf disease mistaken for hemophiliac case because the level of factor VIII are commonly low in vw disease because vwf acts as carrier protein for factor VIII but with normal PT,PTT

32 Important Note Bleeding time : reflects the time required to form the platelet plug (primary hemostasis ) so it reflects platelet function rather than coagulation cascade

33 Important Note Aspirin inhibits platelet function by irreversibly inhibiting the enzyme cyclo-oxygenase which is normally function to synthesize thromboxane A2, TXA2 normally acts to stimulate platelet aggregation and constriction of blood vessels so aspirin lead to prolonging Bleeding Time

34 Important Note Heparin activates anti-thrombin III (ATIII) which is a potent inhibitor of factor II thrombin as well as some other factor in intrinsic pathway, it prolong PTT, no PT except in high dose, it not affect BT because it not affect platelet function It can be antagonized by protamine

35 Important Note Warfarin inhibit the production of Vit. K dependant clotting factors X IX VII II so it affects common and extrinsic pathways and so it affects PT rather than PTT. Its effect can be antagonized by administering Vit K or fresh frozen plasma

36 Important Note Desmopressin acetate DDAVP is useful in many case of bleeding disorder because it induces the hepatic production of plasma clotting factors, and it stimulate the release the vwf from the endothelial cells

37 Fibrinolysis Plasminogen Extrinsic: t-pa, urokinase Activation Intrinsic: factor XIIa, HMWK, kallikrein Exogenous: streptokinase Fibrin, fibrinogen Plasmin Fibrin, fibrinogen degradation products

38 Fibrinolysis Mechanism of action of tissue palsmogen activator its enzyme that activate plasma enzyme plasmogen by converting it to active form plasmin and plasmin is an enzyme that protolytically cleave fibrin strands thereby degrading fibrin clots like streptokinase and urokinase

39 References Baily & Love Short practice of surgery Textbook of General & Oral Surgery Clinician s manual OMF surgery Internet articles

40 Thanks

Primary Exam Physiology lecture 5. Haemostasis

Primary Exam Physiology lecture 5. Haemostasis Primary Exam Physiology lecture 5 Haemostasis Haemostasis Body s response for the prevention and cessation of bleeding. Broadly consists of: Primary Haemostasis - vascular spasm and platlet plug formation

More information

Hemostasis. Learning objectives Dr. Mária Dux. Components: blood vessel wall thrombocytes (platelets) plasma proteins

Hemostasis. Learning objectives Dr. Mária Dux. Components: blood vessel wall thrombocytes (platelets) plasma proteins Hemostasis Learning objectives 14-16 Dr. Mária Dux Components: blood vessel wall thrombocytes (platelets) plasma proteins Hemostatic balance! procoagulating activity anticoagulating activity 1 Thrombocytes

More information

-Hashim ahmed is the one who wrote this sheet. I just edited it according to our record.

-Hashim ahmed is the one who wrote this sheet. I just edited it according to our record. * Subjects of this lecture : - Hemostasis - Platelets, general information, their ultrastructure and role in hemostasis. - Definitions: Thrombus, Embolus, Arteriosclerosis and Atherosclerosis. *NOTE: Prof

More information

This slide belongs to iron lecture and it is to clarify the iron cycle in the body and the effect of hypoxia on erythropoitein secretion

This slide belongs to iron lecture and it is to clarify the iron cycle in the body and the effect of hypoxia on erythropoitein secretion This slide belongs to iron lecture and it is to clarify the iron cycle in the body and the effect of hypoxia on erythropoitein secretion Topics of today lectures: Hemostasis Meaning of hemostasis Mechanisms

More information

Part IV Antithrombotics, Anticoagulants and Fibrinolytics

Part IV Antithrombotics, Anticoagulants and Fibrinolytics Part IV Antithrombotics, Anticoagulants and Fibrinolytics "The meaning of good and bad, of better and worse, is simply helping or hurting" Emerson Chapter 16: Blood Coagulation and Fibrinolytic System

More information

Blood coagulation and fibrinolysis. Blood clotting (HAP unit 5 th )

Blood coagulation and fibrinolysis. Blood clotting (HAP unit 5 th ) Blood coagulation and fibrinolysis Blood clotting (HAP unit 5 th ) Vessel injury Antithrombogenic (Favors fluid blood) Thrombogenic (Favors clotting) 3 Major systems involved Vessel wall Endothelium ECM

More information

Blood clotting. Subsequent covalent cross-linking of fibrin by a transglutaminase (factor XIII) further stabilizes the thrombus.

Blood clotting. Subsequent covalent cross-linking of fibrin by a transglutaminase (factor XIII) further stabilizes the thrombus. Blood clotting It is the conversion, catalyzed by thrombin, of the soluble plasma protein fibrinogen (factor I) into polymeric fibrin, which is deposited as a fibrous network in the primary thrombus. Thrombin

More information

WHITE PAPERS PRESENTATION VIDEO DOCUMENTATION EXPERIMENT WO NDCLOT. The WoundClot Principals for Effective Bleeding Control PRESENTATION

WHITE PAPERS PRESENTATION VIDEO DOCUMENTATION EXPERIMENT WO NDCLOT. The WoundClot Principals for Effective Bleeding Control PRESENTATION WHITE PAPERS PRESENTATION VIDEO DOCUMENTATION EXPERIMENT ARTICLES OUR STUDY BLEEDING CONTROL 5 POINT MODEL WO NDCLOT The WoundClot Principals for Effective Bleeding Control PRESENTATION Harnessing SCIENCE

More information

Anatomy and Physiology

Anatomy and Physiology Anatomy and Physiology For The First Class 2 nd Semester Thrombocytes = Platelets Thrombocytes = Platelets Blood platelets are non-nucleated disc like cell fragments 2-4 µm in diameter. Platelets are not

More information

Hemostasis. Clo)ng factors and Coagula4on NORMAL COAGULATION. Overview of blood coagula4on. The Cascade Theory 5/1/12. Clot

Hemostasis. Clo)ng factors and Coagula4on NORMAL COAGULATION. Overview of blood coagula4on. The Cascade Theory 5/1/12. Clot Hemostasis Clo)ng factors and Coagula4on Dr Badri Paudel www.badripaudel.com Hemostasis is defined as a property of circula4on whereby blood is maintained within a vessel and the ability of the system

More information

Topics of today lectures: Hemostasis

Topics of today lectures: Hemostasis Topics of today lectures: Hemostasis Meaning of hemostasis Mechanisms of hemostasis - Vascular contraction - Platelets plug - Blood coagulation (clotting) - Structure and functions of platelets - Blood

More information

Ch. 45 Blood Plasma proteins, Coagulation and Fibrinolysis Student Learning Outcomes: Describe basic components of plasma

Ch. 45 Blood Plasma proteins, Coagulation and Fibrinolysis Student Learning Outcomes: Describe basic components of plasma Chapt. 45 Ch. 45 Blood Plasma proteins, Coagulation and Fibrinolysis Student Learning Outcomes: Describe basic components of plasma Inheritance of X-linked gene for Factor VIII hemophilia A Explain the

More information

UNIT VI. Chapter 37: Platelets Hemostasis and Blood Coagulation Presented by Dr. Diksha Yadav. Copyright 2011 by Saunders, an imprint of Elsevier Inc.

UNIT VI. Chapter 37: Platelets Hemostasis and Blood Coagulation Presented by Dr. Diksha Yadav. Copyright 2011 by Saunders, an imprint of Elsevier Inc. UNIT VI Chapter 37: Platelets Hemostasis and Blood Coagulation Presented by Dr. Diksha Yadav Hemostasis: Prevention of Blood Loss Vascular constriction Formation of a platelet plug Formation of a blood

More information

Moath Darweesh. Omar Sami. Saleem Khreisha. 1 P a g e

Moath Darweesh. Omar Sami. Saleem Khreisha. 1 P a g e 7 Moath Darweesh Omar Sami Saleem Khreisha 1 P a g e -First of all, I want to give a quick revision to simplify the whole hemostasis mechanism, it will be much easier here with me. Enjoy (you can skip

More information

PHASES OF HAEMOSTASIS

PHASES OF HAEMOSTASIS HAEMOSTASIS Maintains the integrity of a closed, highpressure circulatory system after vascular damage Vessel Wall Injury events in the vessel wall and in the blood which seal breach Delicate balance exists

More information

Chapter 19. Hemostasis

Chapter 19. Hemostasis Chapter 19 Hemostasis Hemostasis Hemostasis is the cessation of bleeding stopping potentially fatal leaks important in small blood vessels not effective in hemorrhage excessive bleeding from large blood

More information

Introduction to coagulation and laboratory tests

Introduction to coagulation and laboratory tests Introduction to coagulation and laboratory tests Marc Jacquemin Special Haemostasis Laboratory Center for Molecular and Vascular Biology University of Leuven Coagulation in a blood vessel: fibrin stabilises

More information

Hemostasis and. Blood Coagulation

Hemostasis and. Blood Coagulation Hemostasis and Blood Coagulation Events in Hemostasis The term hemostasis means prevention of blood loss. Whenever a vessel is severed or ruptured, hemostasis is achieved by several mechanisms: (1) vascular

More information

Coagulation Disorders. Dr. Muhammad Shamim Assistant Professor, BMU

Coagulation Disorders. Dr. Muhammad Shamim Assistant Professor, BMU Coagulation Disorders Dr. Muhammad Shamim Assistant Professor, BMU 1 Introduction Local Vs. General Hematoma & Joint bleed Coagulation Skin/Mucosal Petechiae & Purpura PLT wound / surgical bleeding Immediate

More information

Dr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH Assistant Professor FACULTY OF MEDICINE -JAZAN

Dr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH Assistant Professor FACULTY OF MEDICINE -JAZAN Dr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH Assistant Professor FACULTY OF MEDICINE -JAZAN The student should be able:» To identify the mechanism of homeostasis and the role of vessels, platelets

More information

Hemostasis Haemostasis means prevention of blood loss from blood vessels.

Hemostasis Haemostasis means prevention of blood loss from blood vessels. ١ Hemostasis Haemostasis means prevention of blood loss from blood vessels. Bleeding is stopped by several mechanisms, which are: 1. Local vasoconstriction 2. Formation of platelet plug 3. Blood coagulation

More information

Hemostasis and Thrombosis

Hemostasis and Thrombosis Hemostasis Hemostasis and Thrombosis Normal hemostasis is a consequence of tightly regulated processes that maintain blood in a fluid state in normal vessels, yet also permit the rapid formation of a hemostatic

More information

Bleeding Disorders. Dr. Mazen Fawzi Done by Saja M. Al-Neaumy Noor A Mohammad Noor A Joseph Joseph

Bleeding Disorders. Dr. Mazen Fawzi Done by Saja M. Al-Neaumy Noor A Mohammad Noor A Joseph Joseph Bleeding Disorders Dr. Mazen Fawzi Done by Saja M. Al-Neaumy Noor A Mohammad Noor A Joseph Joseph Normal hemostasis The normal hemostatic response involves interactions among: The blood vessel wall (endothelium)

More information

4/23/2009. September 15, 2008

4/23/2009. September 15, 2008 The Current Treatment of Deep Venous Thrombosis: Are We Doing Enough? George H. Meier, MD Professor and Chief Division of Vascular Surgery University of Cincinnati College of Medicine Cincinnati, Ohio

More information

Disseminated Intravascular Coagulation. M.Bahmanpour MD Assistant professor IUMS

Disseminated Intravascular Coagulation. M.Bahmanpour MD Assistant professor IUMS به نام خدا Disseminated Intravascular Coagulation M.Bahmanpour MD Assistant professor IUMS Algorithm for Diagnosis of DIC DIC Score factor score Presence of known underlying disorder No= 0 yes=2 Coagolation

More information

Hemostasis Haemostasis means prevention of blood loss from blood vessels.

Hemostasis Haemostasis means prevention of blood loss from blood vessels. 1 Hemostasis Haemostasis means prevention of blood loss from blood vessels. Bleeding is stopped by several mechanisms, which are: 1. Local vasoconstriction 2. Formation of platelet plug 3. Blood coagulation

More information

Anticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT

Anticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Haemostasis Thrombosis Phases Endogenous anticoagulants Stopping blood loss Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Vascular Platelet

More information

Physiology of. The Blood hemostasis. By prof. Israa f. jaafar

Physiology of. The Blood hemostasis. By prof. Israa f. jaafar Physiology of The Blood hemostasis By prof. Israa f. jaafar Learning objectives Understand the Platelet structure and function Explane the Platelet production Understand the phases of hemostasis: vascular

More information

THROMBOTIC DISORDERS: The Final Frontier

THROMBOTIC DISORDERS: The Final Frontier THROMBOTIC DISORDERS: The Final Frontier Jeffrey I. Weitz, MD, FRCP(C), FACP Professor of Medicine and Biochemistry McMaster University Canada Research Chair in Thrombosis Heart & Stroke Foundation/ J.F.

More information

Outline Anti-coagulant and anti-thrombotic drugs Haemostasis and Thrombosis Year 3 Dentistry

Outline Anti-coagulant and anti-thrombotic drugs Haemostasis and Thrombosis Year 3 Dentistry Outline Anti-coagulant and anti-thrombotic drugs Year 3 Dentistry Professor Yotis Senis Cellular Haemostasis y.senis@bham.ac.uk I. Haemostasis and II. Coagulation and anti-coagulants III. Platelets and

More information

Thrombosis. Jeffrey Jhang, M.D.

Thrombosis. Jeffrey Jhang, M.D. Thrombosis Jeffrey Jhang, M.D. Introduction The human hemostatic system has evolved to maintain blood flow under normal physiologic conditions while remaining primed to rapidly respond to vascular injury

More information

PHM142 Lecture 4: Platelets + Endothelial Cells

PHM142 Lecture 4: Platelets + Endothelial Cells PHM142 Lecture 4: Platelets + Endothelial Cells 1 Hematopoiesis 2 Platelets Critical in clotting - activated by subendothelial matrix proteins (e.g. collagen, fibronectin, von Willebrand factor) and thrombin

More information

Oral Anticoagulant Drugs

Oral Anticoagulant Drugs Oral Anticoagulant Drugs Spoiled sweet clover caused hemorrhage in cattle(1930s). Substance identified as bishydroxycoumarin. Initially used as rodenticides, still very effective, more than strychnine.

More information

What are blood clots?

What are blood clots? What are blood clots? Dr Matthew Fay GP Principal The Willows Medical Practice- Queensbury GPwSI and Co-Founder Westcliffe Cardiology Service GP Partner Westcliffe Medical Group Created 5/31/18 Dr. Matthew

More information

Page 1 of 6 THROMBOCYTES

Page 1 of 6 THROMBOCYTES Page 1 of 6 THROMBOCYTES Platelets are not cells in the strict sense. About one-fourth the diameter of a lymphocyte, they are cytoplasmic fragments of extraordinarily large cells (up to 60 µm in diameter)

More information

Chapter 1 Introduction

Chapter 1 Introduction Chapter 1 Introduction There are several disorders which carry an increased risk of thrombosis, clots that interfere with normal circulation, including: venous thromboembolism (VTE), comprising both deep

More information

BLEEDING DISORDERS Simple complement:

BLEEDING DISORDERS Simple complement: BLEEDING DISORDERS Simple complement: 1. Select the statement that describe the thrombocytopenia definition: A. Marked decrease of the Von Willebrandt factor B. Absence of antihemophilic factor A C. Disorder

More information

Review of the TICH-2 Trial

Review of the TICH-2 Trial Review of the TICH-2 Trial Mikaela Hofer, PharmD PGY-1 Pharmacy Resident Pharmacy Grand Rounds September 18, 2018 2018 MFMER slide-1 Objectives Review the pharmacologic options to limit hematoma expansion

More information

Coagulation an Overview Dr.Abdolreza Abdolr Afrasiabi Thal assem a & Heamophili hilia G ene i tic R esearc C en er Shiraz Medical Medic University

Coagulation an Overview Dr.Abdolreza Abdolr Afrasiabi Thal assem a & Heamophili hilia G ene i tic R esearc C en er Shiraz Medical Medic University In The Name God Coagulation an Overview Dr.Abdolreza Afrasiabi Thalassemia & Heamophilia Genetic Research hcenter Shiraz Medical University Bleeding Clotting Hemostasis Review of platelet function Platelets

More information

BIOH122 Human Biological Science 2

BIOH122 Human Biological Science 2 BIOH122 Human Biological Science 2 Session 2 Haematological System Haemostasis and Blood Groups Bioscience Department Endeavour College of Natural Health endeavour.edu.au Session Plan o Platelets Properties

More information

ACQUIRED COAGULATION ABNORMALITIES

ACQUIRED COAGULATION ABNORMALITIES ACQUIRED COAGULATION ABNORMALITIES ACQUIRED COAGULATION ABNORMALITIES - causes 1. Liver disease 2. Vitamin K deficiency 3. Increased consumption of the clotting factors (disseminated intravascular coagulation

More information

Blood platelets play important role in coagulation.

Blood platelets play important role in coagulation. B.N. Bandodkar College of Science, Thane T.Y. B.Sc Paper II Haematology Blood Coagulation / Blood clotting By Dr N.N. Patil Introduction: When blood is shed, it looses its fluidity within few minutes and

More information

Chapter 1. General introduction

Chapter 1. General introduction Chapter 1 General introduction 8 Haemostasis All organs and tissues of higher organisms are provided with nutrients and oxygen through the bloodstream. The bloodstream is an extensive vascular system that

More information

Agent Dose MoA/PK/Admin Adverse events Disadvantages Protamine Heparin: 1mg neutralizes ~ 100 units Heparin neutralization in ~ 5 min

Agent Dose MoA/PK/Admin Adverse events Disadvantages Protamine Heparin: 1mg neutralizes ~ 100 units Heparin neutralization in ~ 5 min Nanik (Nayri) Hatsakorzian Pharm.D/MPH candidate 2014 Touro University College of Pharmacy CA Bleeding Reversal Agents Agent Dose MoA/PK/Admin Adverse events Disadvantages Protamine Heparin: 1mg neutralizes

More information

Haemostasis & Coagulation disorders Objectives:

Haemostasis & Coagulation disorders Objectives: Haematology Lec. 1 د.ميسم مؤيد علوش Haemostasis & Coagulation disorders Objectives: - Define haemostasis and what are the major components involved in haemostasis? - How to assess the coagulation status?

More information

Bleeding, Coagulopathy, and Thrombosis in the Injured Patient

Bleeding, Coagulopathy, and Thrombosis in the Injured Patient Bleeding, Coagulopathy, and Thrombosis in the Injured Patient June 7, 2008 Kristan Staudenmayer, MD Trauma Fellow UCSF/SFGH Trauma deaths Sauaia A, et al. J Trauma. Feb 1995;38(2):185 Coagulopathy is Multi-factorial

More information

Biochemical Reaction Networks and Blood Clotting

Biochemical Reaction Networks and Blood Clotting Biochemical Reaction Networks and Blood Clotting Yasmeen Hussain, Aaron Fogelson Abstract Following an injury to the walls of a blood vessel, platelet aggregation and blood coagulation are induced. Through

More information

Diagnosis of hypercoagulability is by. Molecular markers

Diagnosis of hypercoagulability is by. Molecular markers Agenda limitations of clinical laboratories to evaluate hypercoagulability and the underlying cause for thrombosis what is the INR the lupus anticoagulant and the antiphospholipid antibody syndrome hassouna

More information

Chapter 19 Blood Lecture Outline

Chapter 19 Blood Lecture Outline Chapter 19 Blood Lecture Outline Cardiovascular system Circulatory system Blood 1. distribution 2. regulation 3. protection Characteristics: ph 7.4 38 C 4-6 L Composition: Plasma Formed elements Erythrocytes

More information

Emergency Blood and Massive Transfusion: The Surgeon s Perspective. Transfusion Medicine Update September 16 17, 2009

Emergency Blood and Massive Transfusion: The Surgeon s Perspective. Transfusion Medicine Update September 16 17, 2009 Transfusion Medicine Update September 16 17, 2009 Mandip S. Atwal, D.O. FACOS Carl M. Pesta, D.O. FACOS Agenda History Hemorrhagic shock Transfusion is Bad Transfusion Prevention Transfusion The Red Chest

More information

Review Article Sri Lanka Dental Journal 2016; 46(01) 05-13

Review Article Sri Lanka Dental Journal 2016; 46(01) 05-13 Review Article Sri Lanka Dental Journal 2016; 46(01) 05-13 The Importance of Knowing the Patient s Clotting Profile before Dental Treatment N.A. Alles, N.S. Soysa Introduction Patients having bleeding

More information

Hemodynamic Disorders, Thrombosis, and Shock. Richard A. McPherson, M.D.

Hemodynamic Disorders, Thrombosis, and Shock. Richard A. McPherson, M.D. Hemodynamic Disorders, Thrombosis, and Shock Richard A. McPherson, M.D. Edema The accumulation of abnormal amounts of fluid in intercellular spaces of body cavities. Inflammation and release of mediators

More information

Pathology note 8 BLEEDING DISORDER

Pathology note 8 BLEEDING DISORDER Pathology note 8 BLEEDING DISORDER Slide75 ( Types of clotting factors deficiency): Today we will talk about public public factor deficiency it could be acquired or inherited, acquired diseases are more

More information

Blood (II) Huawei Liang, PhD

Blood (II) Huawei Liang, PhD Blood (II) Huawei Liang, PhD E-mail: hwliang@zju.edu.cn Physiological hemostasis 生理止血 The arrest of bleeding from a broken blood vessel -- that is, the stoppage of hemorrhage ( 出血 ) Three major events:

More information

Cover Page. The handle holds various files of this Leiden University dissertation.

Cover Page. The handle   holds various files of this Leiden University dissertation. Cover Page The handle http://hdl.handle.net/1887/28736 holds various files of this Leiden University dissertation. Author: Debeij, Jan Title: The effect of thyroid hormone on haemostasis and thrombosis

More information

Prothrombin Complex Concentrate- Octaplex. Octaplex

Prothrombin Complex Concentrate- Octaplex. Octaplex Prothrombin Complex Concentrate- Concentrated Factors Prothrombin Complex Concentrate (PCC) 3- factor (factor II, IX, X) 4-factor (factors II, VII, IX, X) Activated 4-factor (factors II, VIIa, IX, X) Coagulation

More information

Chapter 4: Haemodynamic disorders, shock

Chapter 4: Haemodynamic disorders, shock Chapter 4: Haemodynamic disorders, shock 1. Regarding platelets (2006) (a) They are the main source of thrombin (b) they number 150-300 x10 3 per microlitre (c) They contain a nucleus (d) They are biconcave

More information

Approach to bleeding disorders &treatment. by RAJESH.N General medicine post graduate

Approach to bleeding disorders &treatment. by RAJESH.N General medicine post graduate Approach to bleeding disorders &treatment by RAJESH.N General medicine post graduate 2 Approach to a patient of bleeding diathesis 1. Clinical evaluation: History, Clinical features 2. Laboratory approach:

More information

Hemostasis. Coagulation vs anticoagulation

Hemostasis. Coagulation vs anticoagulation Hemostasis is a process of forming clots in the wall of damaged blood vessels and preventing blood loss while maintaining blood in fluid state within the vascular system. Coagulation vs anticoagulation

More information

Chapter 3. Haemostatic abnormalities in patients with liver disease

Chapter 3. Haemostatic abnormalities in patients with liver disease Chapter 3 Haemostatic abnormalities in patients with liver disease Ton Lisman, Frank W.G. Leebeek 1, and Philip G. de Groot Thrombosis and Haemostasis Laboratory, Department of Haematology, University

More information

Hemodynamics. Objectives. Filtration across the endothelium 1/17/2017. K[(P cap - P int )-σ(π cap π int )]

Hemodynamics. Objectives. Filtration across the endothelium 1/17/2017. K[(P cap - P int )-σ(π cap π int )] Hemodynamics Amir Kol DVM, Ph.D, Dip ACVP (Clinical Pathology) UC Davis, School of Veterinary Medicine akol@ucdavis.edu Objectives Understand the mechanisms that promote extravascular fluid accumulation

More information

Hemostasis and fibrinolysis the hemostatic balance

Hemostasis and fibrinolysis the hemostatic balance Hemostasis and fibrinolysis the hemostatic balance Bleeding Clotting The hemostatic balance Reference: Boron & Boulpaep Medical Physiology, 3 rd Ed, Chapter 18 Dr. Ana-Maria Zagrean Carol Davila University

More information

Chapter 19 Cardiovascular System Blood: Functions. Plasma

Chapter 19 Cardiovascular System Blood: Functions. Plasma Chapter 19 Cardiovascular System Blood: Functions 19-1 Plasma Liquid part of blood. Colloid: liquid containing suspended substances that don t settle out of solution 91% water. Remainder proteins, ions,

More information

Effective Date: Approved by: Laboratory Director, Jerry Barker (electronic signature)

Effective Date: Approved by: Laboratory Director, Jerry Barker (electronic signature) 1 of 5 Policy #: 702 (PHL-702-05) Effective Date: 9/30/2004 Reviewed Date: 8/1/2016 Subject: TRANSFUSION GUIDELINES Approved by: Laboratory Director, Jerry Barker (electronic signature) Approved by: Laboratory

More information

True/False: Idarucizumab can be utilized for the management of bleeding associated with dabigatran.

True/False: Idarucizumab can be utilized for the management of bleeding associated with dabigatran. Discuss the role of idarucizumab for the management of bleeding associated with dabigatran Understand dosing, preparation and administration of idarucizumab I have no financial interest/arrangement or

More information

10. Which of the following immune cell is unable to phagocytose (a) neutrophils (b) eosinophils (c) macrophages (d) T-cells (e) monocytes

10. Which of the following immune cell is unable to phagocytose (a) neutrophils (b) eosinophils (c) macrophages (d) T-cells (e) monocytes Chapter 2. Acute and chronic inflammation(6): 1. In acute inflammation, which events occur in the correct chronological order? (Remembered from 2000, 2004 exam.) p50 (a) transient vasoconstriction, stasis

More information

Platelet-fibrin clot. 50Kd STEMI. Abciximab. Video of a IIb/IIIa inhibitor in action. Unstable Angina and non-stsegment

Platelet-fibrin clot. 50Kd STEMI. Abciximab. Video of a IIb/IIIa inhibitor in action. Unstable Angina and non-stsegment Objectives IIb/IIIa, Vitamin K, and Direct Thrombin Inhibition in Cardiology Michael Gulseth, Pharm. D., BCPS Assistant Professor, Duluth Pharmacy 6122 February 14, 2005 Describe the pharmacology, kinetics,

More information

Thursday, February 26, :00 am. Regulation of Coagulation/Disseminated Intravascular Coagulation HEMOSTASIS/THROMBOSIS III

Thursday, February 26, :00 am. Regulation of Coagulation/Disseminated Intravascular Coagulation HEMOSTASIS/THROMBOSIS III REGULATION OF COAGULATION Introduction HEMOSTASIS/THROMBOSIS III Regulation of Coagulation/Disseminated Coagulation necessary for maintenance of vascular integrity Enough fibrinogen to clot all vessels

More information

Hematology Review. CCRN exam. The Coagulation Cascade. The Coagulation Cascade. Components include: Intrinsic pathway Extrinsic pathway Common pathway

Hematology Review. CCRN exam. The Coagulation Cascade. The Coagulation Cascade. Components include: Intrinsic pathway Extrinsic pathway Common pathway CCRN exam Hematology Review CCRN Review October 2013 Department of Critical Care Nursing Hematology is 2% of the exam Focus on coagulation cascade, DIC, and HIT Anatomy of the hematologic system Bone marrow

More information

Branch of medicine that deals with blood, its formation and disorders is called. Three main functions of cardiovascular system are,, and.

Branch of medicine that deals with blood, its formation and disorders is called. Three main functions of cardiovascular system are,, and. Chapter 19 The Blood Human body must maintain a balance called. Body fluid inside the cells is called fluid; that outside is called or fluid. Two major fluid networks that help in connecting cells are

More information

Continuing Medical Education

Continuing Medical Education Continuing Medical Education WHY DO HEMOPHILIACS BLEED? B.R. Agarwal Z.E. Currimbhoy Deficiency of coagulation factor VIII (antihemophilic factor) and coagulation factor IX (Christmas factor) result in

More information

Hemodynamic Disorders, Thromboembolic Disease, and Shock

Hemodynamic Disorders, Thromboembolic Disease, and Shock Hemodynamic Disorders, Thromboembolic Disease, and Shock Kumar et al: Robbins & Cotran Pathologic Basis of Disease 7E Figure 4-1 Factors affecting fluid balance across capillary walls. Capillary hydrostatic

More information

Chapter 11. Lecture and Animation Outline

Chapter 11. Lecture and Animation Outline Chapter 11 Lecture and Animation Outline To run the animations you must be in Slideshow View. Use the buttons on the animation to play, pause, and turn audio/text on or off. Please Note: Once you have

More information

VENOUS THROMBOEMBOLISM PHARMACOLOGY. University of Hawai i Hilo DNP Program NURS 603 Advanced Clinical Pharmacology Danita Narciso Pharm D

VENOUS THROMBOEMBOLISM PHARMACOLOGY. University of Hawai i Hilo DNP Program NURS 603 Advanced Clinical Pharmacology Danita Narciso Pharm D VENOUS THROMBOEMBOLISM PHARMACOLOGY University of Hawai i Hilo DNP Program NURS 603 Advanced Clinical Pharmacology Danita Narciso Pharm D LEARNING OBJECTIVES Know what factors anticoagulant medications

More information

Discuss the role of idarucizumab for the management of bleeding associated with dabigatran

Discuss the role of idarucizumab for the management of bleeding associated with dabigatran Discuss the role of idarucizumab for the management of bleeding associated with dabigatran Understand dosing, preparation and administration of idarucizumab I have no financial interest/arrangement or

More information

Important Considera/ons for Coagula/on Tests on Children and Neonates

Important Considera/ons for Coagula/on Tests on Children and Neonates Important Considera/ons for Coagula/on Tests on Children and Neonates Cindy Neunert, MD MSCS Associate Professor Pediatric Hematology/Oncology/Bone Marrow Transplant Columbia University Medical Center

More information

L iter diagnostico di laboratorio nelle coagulopatie congenite emorragiche

L iter diagnostico di laboratorio nelle coagulopatie congenite emorragiche L iter diagnostico di laboratorio nelle coagulopatie congenite emorragiche Armando Tripodi Angelo Bianchi Bonomi Hemophilia and Thrombosis Center Dept. of Clinical Sciences and Community Health University

More information

COAGULATIONS. Dr. Hasan Fahmawi, MRCP(UK), FRCP(Edin)

COAGULATIONS. Dr. Hasan Fahmawi, MRCP(UK), FRCP(Edin) COAGULATIONS Dr. Hasan Fahmawi, MRCP(UK), FRCP(Edin) Haemostasis-blood must be maintained in a fluid state in order to function as a transport system, but must be able to solidify to form a clot following

More information

Haemorrhagic Disorders. Dr. Bashar Department of Pathology Mosul Medical College

Haemorrhagic Disorders. Dr. Bashar Department of Pathology Mosul Medical College Haemorrhagic Disorders Dr. Bashar Department of Pathology Mosul Medical College Hemorrhagic Disorders These include Disorders of platelets. Disorders of blood vessels. Disorders of coagulation & fibrinolysis.

More information

General approach to the investigation of haemostasis. Jan Gert Nel Dept. of Haematology University of Pretoria 2013

General approach to the investigation of haemostasis. Jan Gert Nel Dept. of Haematology University of Pretoria 2013 General approach to the investigation of haemostasis Jan Gert Nel Dept. of Haematology University of Pretoria 2013 Clinical reasons to investigate haemostasis Investigating a clinically suspected bleeding

More information

INFLAMMATION & REPAIR

INFLAMMATION & REPAIR INFLAMMATION & REPAIR Lecture 7 Chemical Mediators of Inflammation Winter 2013 Chelsea Martin Special thanks to Drs. Hanna and Forzan Course Outline i. Inflammation: Introduction and generalities (lecture

More information

Bleeding and Thrombotic Disorders. Kristine Krafts, M.D.

Bleeding and Thrombotic Disorders. Kristine Krafts, M.D. Bleeding and Thrombotic Disorders Kristine Krafts, M.D. Bleeding and Thrombotic Disorders Bleeding disorders von Willebrand disease Hemophilia A and B DIC TTP/HUS ITP Thrombotic disorders Factor V Leiden

More information

Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban

Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban Purpose The aim of this guidance is to outline the management of patients presenting

More information

Blood Thinner Agent. Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy

Blood Thinner Agent. Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy Blood Thinner Agent Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy Outline: Blood thinner agent definition. anticoagulants drugs. Thrombolytics. Blood thinner agent Therapeutic interference

More information

Bleeding Disorders HOPE Maram Al-anbar

Bleeding Disorders HOPE Maram Al-anbar Bleeding Disorders HOPE Maram Al-anbar 9-9 - 2014 ^^ Attention Please ^^ We ( correction team of pediatric package^hope/2010^ ) had decided to make one lecture of bleeding disorders in place of the two

More information

Chapter 19: Cardiovascular System: Blood

Chapter 19: Cardiovascular System: Blood Chapter 19: Cardiovascular System: Blood I. Functions of Blood A. List and describe the seven major homeostatic functions of blood: 1. 2. 3. 4. 5. 6. 7. II. Plasma A. Composition 1. It is a fluid consisting

More information

BLOOD. Dr. Vedat Evren

BLOOD. Dr. Vedat Evren BLOOD Dr. Vedat Evren Blood Liquid suspension of formed elements Blood = Blood cells + plasma Plasma = Coagulation factors + serum Cells = Erythrocytes + Leukocytes + Thrombocytes 8 % of the total body

More information

Recombinant Activated Factor VII: Useful. Department of Surgery Grand Rounds 11/8/10 David Mauchley MD

Recombinant Activated Factor VII: Useful. Department of Surgery Grand Rounds 11/8/10 David Mauchley MD Recombinant Activated Factor VII: Useful Department of Surgery Grand Rounds 11/8/10 David Mauchley MD Hemostasis and Coagulation Traditional cascade model Two convergent pathways Series of proteolytic

More information

Inflammation. (4 of 5)

Inflammation. (4 of 5) Inflammation (4 of 5) What will we discuss today? Plasma protein derived mediators Anti-inflammatory mediators Morphologic patterns of acute inflammation Plasma protein derived mediators 3 systems: -Complement

More information

TRAUMA RESUSCITATION. Dr. Carlos Palisi Dr. Nicholas Smith Liverpool Hospital

TRAUMA RESUSCITATION. Dr. Carlos Palisi Dr. Nicholas Smith Liverpool Hospital TRAUMA RESUSCITATION Dr. Carlos Palisi Dr. Nicholas Smith Liverpool Hospital First Principles.ATLS/EMST A- Airway and C-spine B- Breathing C- Circulation and Access D- Neurological deficit E- adequate

More information

The changing face of massive transfusion

The changing face of massive transfusion The changing face of massive transfusion HAABB, Kansas City, 18 April 2018 John R. Hess, MD, MPH, FACP, FAAAS Professor of Laboratory Medicine Medical Director, Transfusion Service, Harborview MC U of

More information

Coagulation, Haemostasis and interpretation of Coagulation tests

Coagulation, Haemostasis and interpretation of Coagulation tests Coagulation, Haemostasis and interpretation of Coagulation tests Learning Outcomes Indicate the normal ranges for routine clotting screen and explain what each measurement means Recognise how to detect

More information

HEME 10 Bleeding Disorders

HEME 10 Bleeding Disorders HEME 10 Bleeding Disorders When injury occurs, three mechanisms occur Blood vessels Primary hemostasis Secondary hemostasis Diseases of the blood vessels Platelet disorders Thrombocytopenia Functional

More information

Recombinant factor VIIa: Hype or hope? Jed Gorlin MD, MBA

Recombinant factor VIIa: Hype or hope? Jed Gorlin MD, MBA Recombinant factor VIIa: Hype or hope? Jed Gorlin MD, MBA Goals of presentation Challenge current use of rviia using data Review how rviia works Approved indications Review results of randomized trials

More information

Hemorrhage http://www.docstoc.com/docs/106382628/hematocrit-plasma-andserum http://www.cdha.nshealth.ca/system/files/hemolysis.jpg http://www.pxbiovision.com/science/science/science/preanalyticalphase_files/

More information

Blood (5600 ml "8%" of B.W.) RBCs (Erythrocytes)

Blood (5600 ml 8% of B.W.) RBCs (Erythrocytes) Blood (5600 ml "8%" of B.W.) Plasma (55%) Cells (45%) Water Inorganic S. Organic S. RBCs WBCs platelets (ions) (plasma proteins + others) (erythrocytes) (leucocytes) (thrombocytes) Plasma proteins (conc.

More information

Chapter 19 Blood. Functions of blood:

Chapter 19 Blood. Functions of blood: Chapter 19 Blood Functions of blood: 1. transportation functions 1. oxygen delivery 2. nutrient delivery 3. transportation of metabolic wastes (urine formation) 4. transportation of hormones (part of the

More information

Bleeding Disorders.1 MS4.24.Feb.19. Abdallah Awidi Abbadi.MD. FRCP.FRCPath Professor

Bleeding Disorders.1 MS4.24.Feb.19. Abdallah Awidi Abbadi.MD. FRCP.FRCPath Professor Bleeding Disorders.1 MS4.24.Feb.19 Abdallah Awidi Abbadi.MD. FRCP.FRCPath Professor Email: abdalla.awidi@gmail.com Hemostasis BV Injury Neural Contact Damage/contact. Blood Vessel Constriction Reduced

More information

The Cardiovascular System: Blood

The Cardiovascular System: Blood C h a p t e r 11 The Cardiovascular System: Blood PowerPoint Lecture Slides prepared by Jason LaPres Lone Star College - North Harris Introduction to the Cardiovascular System A circulating transport system

More information

Bleeding disorders. Hemostatic failure: Inappropriate and excessive bleeding either spontaneous or in response to injury.

Bleeding disorders. Hemostatic failure: Inappropriate and excessive bleeding either spontaneous or in response to injury. 1 Bleeding disorders Objectives: 1. Discuss briefly the physiology of hemostasis. 2. Define the mechanisms of thrombocytopenia and the relative bleeding risk at any given platelet count. 3. Be able to

More information