第四节血栓与止血检测 ppt课件.ppt

NORMAL HEMOSTASIS GENERAL COMPONENTS VASCULAR WALL PLATELETS COAGULATION CASCADE Hemostasis: Platelet Activation Pathways (1) I - Fibrinogen II - Prothrombin III - Thromboplastin IV - Calcium V - Labile f. VI - Suture deficiency VII - Stable f. VIII - AHF-A IX - AHF-B X - Stuart-Prower f. XI - AHF-C XII - Hageman f. XIII - Fibrin Stabilizing f. Control of coagulation Antithrombin III and Heparin Proteins C and S TFPI Tests of Hemostasis Screening tests BT (Bleeding Time) - Platelet BV function CRT (Capillary Resistance Test) PC (Platelet Count) CRT (Clot Retraction Test) CT (Clotting Time) PT (Prothrombin Time) – Extrinsic APTT – Instrinsic TT (Thrombin Time) – Both paths APTT PF3-like material calcium heat/agitate end product - clot Abnormal: hemophilias, heparin, depletion states, severe hepatic dz Prothrombin Time (PT) calcium platelets tissue phospholipid heat clot Abnormal: factor depletion, coumadin, severe liver disease, (heparin) Thrombin Time (TT) Hemostasis and Thrombosis Vic Vernenkar, D.O. St. Barnabas Hospital Dept. of Surgery Normal Hemostasis A well regulated process Maintains blood in a fluid, clot free state in normal vessels Induces the rapid formation of a localized hemostatic plug at the site of vascular injury Thrombosis Pathological state Inappropriate activation of the normal hemostatic process within the non-interrupted vascular system. Thrombus (blood clots) formation Blocks blood flow to vital areas Normal sequence of Hemostasis (4 steps) 1. Arteriolar vasoconstriction (transient) Reflex neurogenic mechanisms Bleeding would resume after vasoconstriction if it weren’t for the activation of platelets or coagulation systems 2. Exposure of subendothelial ECM when there is endothelial injury ECM, especially collagen, is highly thrombogenic Platelets adhere and become activated Change in shape Release of secretory products Aggregation of platelets forms hemostatic plug This is primary hemostasis First two steps of norm