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.

1.

2.
3.

Veena

Veena

I, V, VIII, XIII
(
, )
( VIII:
, vWF

)
K
,
, ,

(250,000)

Veena

II, VII, IX, X


K
(
)



( ,
),
(55,000-70,000)

Veena

XI, XII, HMWK, PK



(
)

K

in vitro


(
)

()

VIII V

() XIII

a

Veena


1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

12.
13.
Veena

Factor I-
Factor II-
Factor III-
Factor IV-
Factor V-
Factor VI-Unidentified
Factor VII-
Factor VIII-

Factor IX-
Christmas
Factor X- Staurt
Power
Factor XI-

Factor XII-
Hageman
Factor XIII-

1.soluble plasma protein, MW 3,30,000; plasma level


250-400 mg%.
2. MW 69,000; plasma level 40 mg%.
3. Tissue factor or tissue extract.
4.Removal of Ca2+ by potassium oxalate, sodium
citrate or sodium edetate (EDTA, Versene)
prevents clotting in vitro.
5. Proaccelerin or accelerator globulin. It gets
consumed during clotting and is, therefore, absent
from serum.
7.Serum prothrombin convergen accelerator (SPCA)
or stable factor or Autoprothrombin I. Not
consumed during clotting and, therefore, is present
in serum as well as in plasma.
8.Antihemophilic globulin (AHG) or antihemophilic
factor-A (AHF-A). It is consumed during clotting,
therefore, absent from serum; half life 10-20 hours.
9. Plasma thromboplastin component (PTC) or
autoprothrombin II or AHF-B.
10. Autoprothrombin-C. Present in plasma and serum.
11.AHF-C. present in plasma and serum both.
12.Glass factor or contact factor, present in plasma and
serum both.
13.Fibrinrase or Laki-Lorand factor. It causes
polymerization of soluble fibrin to produce
insoluble fibrin.


(adhesion),


.
(aggregation),
.

(release reaction).

Veena



, Fn, FvW.

(GPIIb/IIIa)

.

RGD .
2,
.

2
ADP, , PAF(platelet-activating
factor), vWF 4 .
Veena

Veena

a)
b)

( )

( FXIII)
Veena


:

.

.


.


3 :
1.

2.

3.

Veena


( )
1.
2. .

.

,
&
.

,
.
.

Veena

,

Ca + +.

.

10-15 .
,

,
.

Veena


4 MB &
.

.
(FSF)



&
.
,
.

Veena



()


( )
Xa
Xa

Ca++

Veena



()


( )

Xa

X
(
)

Xa

Ca++, Va

Veena

Veena


,
.
1. :
& .
2. :

.

-
.

.

(TF)

VIIa

VII

Ca++

TF

Xa

Veena

Ca++

, Ca++


.
3 :
1. TF (Tissue Factor)
III :

: + .
2. X:
+ VII ( )
Ca + +, X
( Stuart-Prower ) Xa.
3. : Xa
( ) +
+ Va
( )
.
Veena

,
(in vivo), (in vitro)

XIIa

XII

(HMW-K
Prekallikrein)

XI

XIa
Ca++

IX

IXa
VIII

Ca++

VIIIa

Xa

Ca++

Veena

, Ca++

Veena




.

.
1. XII &

2.
3.
4. :
Ca + +, VIIIa,
5.



(TF)

TFPI
FXII

FXIIa

FX

FVIIa/TF

FVII

FXIa

FXI

PS, APC
FIX

FVIII

Ca++
(Pl) FVa

FIXa
Ca++

FVIIIa

FII

Ca++
Pl

FV
FXIII

FXa

TM

PC
FIIa

FXIIIa

F1+2

&

, (MacFarlane, Nature 1964)

(feedback) :

, VIII, V &
XIII.
. (
)
C (
).

Ca++

Veena

, Ca +
+
.
K,

.

i)
ii)

iii)

iv)

Veena


.


..


.

.

,

C S .
Va &
VIIIa.

Veena

III ( )

: &
III &
XII, XI, IX, X.


( )

FVIIIa FVa

FVIIIa FVa

FVIIIa FVa

(AT)

Xa

2- (a2-M)

1-

XIa

C1- (C1 inh)

XIIa -
-

2- (a2-AP)


(PAI)


t-PA

C (APC)

TFPI

TF +FVIIa

Fa

(+ FVIIIa)
(+ FVa)

FXIa
C

Fa

FIIa

FXa, APC
FVa FVIIIa, TFPI TF/FVIIa.

()

Fa
, , I, , t-PA,
,

1

C (PC)
B--

.
FVa FVIIIa

PS
.
2
.

S (PS)
B--

,
.

PC.
IXa-VIIIa & Xa-Va.
(40%) (60%)
C4bp.
3
.

Tissue factor
(TFPI)

TFPI +
2. TFPI +
3

Kunitz- type domain

.
1-TFPI+ VII a,
2-TFPI+VII a
3-.
1.

,

.

.
ecto-ADP ase CD39, ADP
.
2 -
(NO).
(
).
C,
(Va,VIIIa).

tPA, PAI-1.



,
,
.

+
(FDPs)

()

(PG),

To PG ,

(PL)
: t-PA, u-PA
.

Graphics accessed URL http://www.acta-ortho.gr/v55t4_4/Figure1.jpg, http://depts.washington.edu/labweb/dept/staff/bios/hemostas/images/introfibsys_figure_1.jpg, &

: &



(TPA)

-

(PAI-1)
a2-
TAFI

FDPs
D-Dimer

Graphic accessed at URL http://www.setma.com/images/FibrinolyticDysfunction.gif, 2008.

:
. :

C (APC)

(t-PA)

t-PA, u-PA


( , FDP)
Veena

Veena

FXII, HMWK

Pro-UK

t-PA-I

PAI-I

C1

t-PA-II

HMW-UK

PAI-I

PAI-I

HRC

A2-AP
a2-M

Graphic accessed at URL http://coursewareobjects.elsevier.com/objects/elr/Rodak3e/IC/jpg/Chapter40/040006.jpg, 2008.

Veena

Graphic accessed at URL http://www.sigmaaldrich.com/img/assets/27040/fibrinogen-

a & b


D domain


In vitro
Graphic accessed at URL http://coursewareobjects.elsevier.com/objects/elr/Rodak3e/IC/jpg/Chapter40/040006.jpg, 2008.

5 M



-
XIIa


-

Pyrogens

XI a
XII a

Urokinase plasminogen
activator


.

.
,

, tPA


, .


.


()
5 loops

KRINGLES









a2

&
a2-
- 1

Graphic accessed at URL http://www.sigmaaldrich.com/img/assets/24600/Plasminogen_Image.gif, 2008.




V
VIII

Graphics accessed URL http://www.sigmaaldrich.com/etc/medialib/life-science/biochemicals/migrationbiochemicals1/Plasmin_Image.Par.0001.Image.559.gif &


http://www.cs.stedwards.edu/chem/Chemistry/CHEM43/CHEM43/Plasmin/FUNCTION.HTML, 2009.

()
PG
O t-PA PG,
( )
(95%) PAI-I.
u-PA
( ).

.
( ,
, , WK)
O t-PA
, u-PA
, ..

()
(PL), ,


.
2-
2-, 2 ..
PG
PL t-PA
.
D-Dimers
FDPs.

1 TPA. 2 TPA
3 - TPA
PAI-1 .

&
. P
.

.


-2-
-2-

(PAIs)

.
tPA

.

a2-.
BioMedica Diagnostics Inc. / March 2002 / Rev.
1.0

FDPs vs D-Dimer

FDPs , ,

(fibrin split products),


:


X, Y, D,
E



D-dimers FDP

Veena



.

(DIC),

,


.


2-

,
2-
. 2-
,

(DIC).

-1 (PAI_1)

.
,
,
.

Veena

K: K
, VII, IX
, X & C.

: .
"" ()
. .:
A: VIII
B: IX

: &

:
.
: 1.
,
.
2.

t- PA
.

Veena

:
: (.. )
K


:-

Veena



&
XII.
in vitro & in vivo.
/ :
( ), Na, K, &
( )

: (screening tests)

Veena



(PT)
aPTT



D-Dimers FDP

()
()

Veena



( )
.

.

,
vW.

.
& vW.

(TF)

VIIa

VII

Ca++

TF

Xa

Veena

Ca++

, Ca++

()

Veena

(FII, FV, FVII F),



>100 mg/dl.
PT
()
per os

, APTT
FVII,

&
, V, VII, , , DIC,
, &
.

Veena

PT
37 oC.
100 L .
200 L PT .
.

.
INR.

INR (International Normalized Ratio)

Veena



.

.

(ISI),

. ISI,
.
INR = (PT / MNP)ISI
MNP = Mean Normal Plasma.

INR (International Normalized Ratio)

Veena

INR 1.0 PT
, INR 1.0 ,
.
Mean Normal Plasma = 10 14 .
=
INR 2.0 3.0.
INR 5 5.5 =
.

,
(in vivo), (in vitro)

XIIa

XII

(HMW-K
Prekallikrein)

XI

XIa
Ca++

IX

IXa
VIII

Ca++

VIIIa

Xa

Ca++

Veena

, Ca++


()

Veena

FVIII,
FIX, FXI, FXII
>100 mg/dl , V,
.

(Ellagic Acid, Micronized Silica).
Calcium Chloride.
.

. FVIII
( ), FIX ( )
.
,

(PK HMWKg)

Veena

37 oC.
100 L .
100 L
3 .
100 L Calcium Chloride
.

.
APTT
: 26 40 .
: 45 65 .
= > 70 .

(TT)

Veena

.
..
+ -->

.
.
15 .

()

Veena

Clauss,

.

, .
DIC
.
, ,
& (
)

Veena

D-Dimers FDPs

Veena

D-Dimers
. DIC,
, ,
, , , .
FDPs /
.

latex ( )
ELISA ( )

Veena


(I)

Veena