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BLOODCOUAGULATION1. Very, very short definition of hemostasis
2. Not so short, but still short description of the general mechanism
3. The cascade - initation, proceeding, control
5. Diseases,deficiencies – and (shortly) about treatments
HEMOSTASIS = PREVENTION OF BLOODLOSS
Achieved by four phases/mechanismsVascular phase – damaged vessel contractsPlatelet phase – formation of the platelet Coagulation phase – formation of the blood clotTissue repair
GENERAL MECHANISM OF BLOODCOAGULATION
• Balance between anticouagulants/procoagulants
• Damage on vessel – cascacade – prothrombinactivator
• Prothrombin – thrombin
• Fibrinogen – fibrin
Platelets:
- adheres to broken vesselwall - prothrombin attach to prothtrombinreceptors on platalets
- release fibrin stabilizing factor (FXIII)- covalent crosslinks between the fibrin molecules
- activate own contractile elemen = broken wall of vessel is pulled together
THE CASCADE
• formation of prothrombin activator
• extrinsic pathway• intrinsic pathway• common pathway = epw and ipw ending the same way...
EXTRINSIC PW1. Initiated by traumatized tissue – releases complex of tissue factors
2. TFs = phospholipids from membranes of tissue + lipoproteincomplex
3. TF + FVII = complex
4. Complex + Ca2+ act on FX = FXa (activated)
5. FXa + phospholipids + FV – act on prothrombrin in presense of Ca2+ - prothrombin split – thrombin
Thrombin convert fibrinogen to fibrin
INTRINSIC PW1 Damaged vessels wall expose collagenfibers – FXII – FXIIa. Platelets - attach to collagen – release platelet factor 3 (lipoprotein)
2 FXIIa – FXI – FXIa.* HMWkininogen * Prekallikrein (Fletcher factor)
3 FXIa – FIX – FIXa
4 FIXa + FVIII + phospholipids (from platelets) + platelet factor 3 (from platelets) – FX – FXa
5 FXa + FV + phopspholipids (from platelets or tissue) = prothrombin activator – prothrombin – thrombin – fibrinogen – fibrin
COMMON PW=5
• EXTRINSIC PW • explosive • initiated by tissue factors• clotting within 15 sec if severe trauma
• INTRINSIC PW • slower• initiated when FXII + platelets contact with
collagen • 1 – 6 minutes to cause clotting • CA2+
• promotes/ accelerates the bloodclotting reactions
WHEN CLOT IS FORMED – it contracts
• contractile elements of platelets
• serum (fluid without fibrinogen and clotting factors) is expressed from clot – within 20 – 60 minutes
CONTROL OF CASCADE
• To prevent excessive clotting (which might lead to thromobosis – more about that later): Fibrinolysis
• Plasminogen is activated = converted into plasmin by:
• plasma kallikrein• t-PA = tissue plasminogen activator • urikinase
• Plasmin: re-dissolves the soluble fibrins – fibrinopeptides
• inhibits thrombinformation = polymerization of fibrin is halted
DISEASES, DEFICIENSIESVitamin K: needed for synthesis of • prothrombin• FVII• FIX• FX• protein c HEMOPHILIA• HA = FVIII (85%)• HB = FIX (15 %)• von Willebrand´s THROMBOEMBOLIC CONDITIONSTHROMBOEMBOLIC CONDITIONS• Thrombus – an abnormal clot in vessel• Emboli – thrombus sailing with blood stream - NOT GOOD.