Coagulation

COAGULATION www.freelivedoctor.com

HEMOSTASIS ,[object Object],[object Object],clot RESOLUTION FORMATION www.freelivedoctor.com

COAGULATION ,[object Object],[object Object],[object Object],www.freelivedoctor.com

COAGULATION FIRST STEP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

PRIMARY HEMOSTASIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

C O L L A G E N von Willebrand Factor fibrinogen endothelial cells Platelet Adhesion mediated by GP-Ib on platelet surface and vWF C O L L A G E N GP-Ib www.freelivedoctor.com

von Willebrand Factor ,[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

[object Object],[object Object],[object Object],[object Object],C O L L A G E N Platelet Activation GP-IIb, IIIa release of  and electron dense granules www.freelivedoctor.com

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],C O L L A G E N Platelet Aggregation GP IIb-IIIa - fibrinogen interaction Aspirin inhibits TXA 2 and ADP www.freelivedoctor.com

Coagulation Factors XII XI IX VIII VII X V I extrinsic pathway intrinsic pathway PT aPTT XIII Stable clot www.freelivedoctor.com II

Coagulation Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],II XII XI IX VIII VII X V I extrinsic pathway intrinsic pathway PT aPTT XIII Stable clot negative charged surface tissue factor www.freelivedoctor.com

Coagulation Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],II XII XI IX VIII VII X V I extrinsic pathway intrinsic pathway PT aPTT XIII Stable clot negative charged surface tissue factor www.freelivedoctor.com

Secondary Hemostasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

A A B B fibrinopeptide A & B D domain E domain Spontaneous aggregation fibrinogen fibrin monomer soluble fibrin polymer www.freelivedoctor.com E D D E D D E D D E D D E D D E D D E D D E D D B A A B E D D E thrombin Factor XIIIa

Stabilization of Fibrin Clot Thrombin Factor XII I Factor XIIIa soluble fibrin clot stabilized fibrin clot www.freelivedoctor.com E D D E D D E D D E D D E D D E D D E D E D E D D E D D E D D E D D E D D E D D E D E D

Other Proteins in Blood Coagulation ,[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

ANTICOAGULATION & FIBRINOLYSIS ,[object Object],[object Object],[object Object],www.freelivedoctor.com

ANTICOAGULATION & FIBRINOLYSIS Vascular Wall ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

ANTICOAGULATION & FIBRINOLYSIS Anti-Coagulation Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],II XII XI IX VIII VII X V I XIII Stable clot www.freelivedoctor.com

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],II XII XI IX VIII VII X V I XIII Stable clot www.freelivedoctor.com

Anticoagulation Heparin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],II XII XI IX VIII VII X V I XIII Stable clot aPTT www.freelivedoctor.com

Anticoagulation Heparin AT AT www.freelivedoctor.com

Coumadin (Warfarin) Anticoagulants ,[object Object],[object Object],[object Object],[object Object],[object Object],II XII XI IX VIII VII X V I PT XIII Stable clot www.freelivedoctor.com

Thrombolytic (Fibrinolytic) Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Plasmin Degradation of Fibrin Clot plasmin plasmin plasmin D-dimer E-fragment DED complex Fibrin Degradation Products www.freelivedoctor.com E D D E D D E D D E D D E D D E D D E D E D E D E D E D D D D E D D D D E

Bleeding Disorders www.freelivedoctor.com

Procoagulant Platelets Factors Fibrinogen von Willebrand Factor Anticoagulant Antithrombin III Protein C Protein S Profibrinolytic Plasminogen tPA Fibrin Fragment D-dimer Antifibrinolytic PAI-1 Alpha-2 Antiplasmin clot RESOLUTION FORMATION www.freelivedoctor.com

Vessel Abnormalities increased vascular fragility ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Henoch-Schonlein purpura ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Coagulation Factor Abnormality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Hemophilia A (Factor VIII deficiency) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],II XII XI IX VIII VII X V I XIII Stable clot aPTT www.freelivedoctor.com

hemophilia A www.freelivedoctor.com

Hemophilia B (Christmas disease, Factor IX def.) ,[object Object],[object Object],II XII XI IX VIII VII X V I XIII Stable clot www.freelivedoctor.com

von Willebrand’s disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Vitamin K Deficiency vitamin K dependent factors : II, VII, IX, X ,[object Object],[object Object],[object Object],[object Object],[object Object],II XII XI IX VIII VII X V I PT XIII Stable clot www.freelivedoctor.com

Severe Liver Disease factors synthesized in liver : II, V, VII, IX, X, fibrinogen ,[object Object],[object Object],II XII XI IX VIII VII X V I PT XIII Stable clot aPTT www.freelivedoctor.com

PLATELET ABNORMALITIES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Thrombocytopenia ,[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Thrombocytopenia increased destruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Thrombocytopenia increased destruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Thrombocytopenia increased destruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com HUS

Disseminated Intravascular Coagulation (DIC) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

DIC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

DIC ,[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

DIC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Platelet Functional Abnormalities congenital ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1 2 www.freelivedoctor.com

Platelet Functional Abnormalities acquired ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Coagulation Tests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Coagulation Tests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

History & Physical Exam are most important most sensitive most specific Tests of Hemostasis www.freelivedoctor.com

Coagulation

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