BLOOD COAGULATION

Dr.Sreedhar Dept. of Physiology

Hemostasis
Prevention of blood loss Vascular spasm Platelet plug formation Clot formation

Platelet Plug Formation

Injury to vessel exposes collagen & -ve charged surface of endothelium

Platelet adhesion and aggregation Release of ADP, Platelet factor 3 Temporary plug

Clotting Factors
Factors I to XIII I Fibrinogen II- Prothrombin IV Calcium etc

Clotting Mechanism
Formation of Prothrombin Activator Intrinsic mechanism contact with collagen ( ref book for steps ) Extrinsic mechanism Tissue injury ( ref book for steps ) Conversion of Prothrombin to Thrombin

Conversion of Fibrinogen to Fibrin ( Fibrin Stabilizing Factor )

Fibrinolysis
Plaminogen in Plasma is converted to Plasmin by Tissue Plasminogen Activators ( streptokinase) Clinically to dissolve clots in Coronory artery

Plasmin causes Fibrinolysis

Blood in fluid state

Antithrombin III inhibits thrombin Protien C inhibits factor V and VIII ( activated by Thrombomodulin present in endothelial surface ) Heparin Mast cells and Basophil cells binds to antithrombin III Smooth Vascular endothelium Plasmin

Intravascular Thrombosis
Injury to vascular wall Slow rate of blood flow Deficiency of antithrombin III, protien C, heparin Thrombus clot in blood vessel Emboli clot in circulation which can block coronory, pulmonary, cerebral

Anticoagulants
Citrate, Oxalates, EDTA- bind to Calcium Heparin in vitro , in vivo activates antithrombin III inhibits thrombin Dicoumarol Vit K antagonist Vit K important for synthesis of Prothrombin (liver ), VII,IX, X

Tests for clotting

Clotting time time of prick to clot formation- capillary tube method-3-8 minprolonged in Haemophilia Bleeding time - time of prick to stoppage of bleeding- filter paper method-2-5 minprolonged in thrombocytopenic purpura( deficiency of platelets ) Prothrombin time Thromboplastin generation test

Clotting disorders
Haemophilia - tendency to bleed genetic disorder, transmitted as X- linked recessive, females carriers, males suffer Haemophilia A or Classical Haemophiliadeficiency of factor VIII Von Willebrand disease- deficiency of vWF,a sub constituent of factor VIII-inherited as dominant in both sexes. Haemophilia B or Christmas disease-X-linkeddeficiency of factor IX- Vit K dependent