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Hemostasis of blood:

1. Define coagulation.
Ans. When blood is shed it losses it’s mobility & converts into semisolid mass due to the
conversion of soluble fibrinogen into insoluble fibrin by the action of thrombin.
The process by which the soluble fibrinogen is converted into insoluble fibrin and
forms a clot is known as coagulation.

2. (a)Define hemostasis.
(b)What are the events of hemostasis?
(c)Discuss any one event.
(d)Discuss the events of hemostasis.
Ans.
(a)Hemostasis means prevention of blood loss or arrest of bleeding.
(b) The events of hemostasis are-
1). Vascular spasm.
2). Formation of platelet plug.
3). Blood coagulation.
4). Eventual growth of fibrous tissue into the blood clot to close the hole in the
vessel permanently.
(c) Formation of platelet plug: When platelet comes in contact with a damaged vascular
surface they immediately changes their characteristics drastically. They begin to swell &
assume irregular forms with numerous irradiating pseudopods protruding from their surface.
They become sticky so that they adhere to the collagen & to a protein (Von Willebrand
factor). They secrets large amount of ADP & their enzymes from thromboxane A 2 .The ADP
and thromboxane A2 inturn act on the nearby platelets to activate them as well. The stickiness
of these additional platelets causes them to adhere to the originally activated platelets.
Therefore at the site of any rent in a blood vessel wall, the damaged vascular wall or
extra vascular tissues elicit activation of successively increased number of platelets, thus
forming a platelet plug.

(d)
1). Vascular spasm: Immediately after a blood vessel is cut or ruptured, the stimulus of the
traumatized vessel causes the wall of the vessel to contract. The contraction results from both
nervous reflexes initiated by pain or other impulses and local myogenic contraction of
blood vessel initiated by direct damage to the vascular wall, local humoral factors from the
traumatized tissue & blood platelet.
Spasm means that a sharply cut blood vessel usually bleeds more than a ruptured blood
vessel. Vascular spasm lasts for many minute or even hours.

2) Formation of platelet plug: When platelet comes in contact with a damaged vascular
surface they immediately changes their characteristics drastically. They begin to swell &
assume irregular forms with numerous irradiating pseudopods protruding from their surface.
They become sticky so that they adhere to the collagen & to a protein (Von Willebrand
factor). They secrets large amount of ADP & their enzymes from thromboxane A 2 .The ADP
and thromboxane A2 inturn act on the nearby platelets to activate them as well. The stickiness
of these additional platelets causes them to adhere to the originally activated platelets.
Therefore at the site of any rent in a blood vessel wall, the damaged vascular wall or
extra vascular tissues elicit activation of successively increased number of platelets, thus
forming a platelet plug.

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3) Blood coagulation: When blood is shed it losses it’s mobility & converts into semisolid
mass due to the conversion of soluble fibrinogen into insoluble fibrin by the action of
thrombin.
The process by which the soluble fibrinogen is converted into insoluble fibrin and
forms a clot is known as coagulation.

Causes of Coagulation:
a. Trauma to the tissue
b. Trauma to the blood
c. Contact of blood with collagen.

Blood coagulation factor:

Clotting factor Synonyms


Factor Fibrinogen
Factor Prothrombin
Factor Tissue thromboplastin
Factor Calcium ion
Factor Labile factor
Factor Stable factor
Factor Antihemophillic factor A
Factor Antihemophillic factor B
Factor Stuart prower factor
Factor Antihemophillic factor C
Factor Hageman factor
Factor Fibrin stabilizing factor
Prekallikrein Fletcher factor
High molecular weight HMWK
kininogen
Platelets Platelets

4) Fibrous Organization of the blood clot: The usual course for a clot that forms in a small
hole of a vessel wall is invasion by fibrinoblast, beginning within a few hours after the clot is
formed. This continues to complete organization of the clot into fibrous tissue within about 1
to 2 weeks.

3.(a)Discuss the extrinsic path for blood clotting.


Ans.

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3.(b)Discuss the intrinsic path for blood clotting.
Ans.

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4.Name the investigations you will suggest in a case of bleeding disorder.

Ans.

Bleeding disorder Example Lab investigation


1.Vascular disorder Non-thrombocytopenic Bleeding time-Normal
purpura Clotting time- Normal
Prothrombin time- Normal
Clot retraction-impaired
2.Platelet disorder Thrombocytopenic purpura Bleeding time-Prolonged
Clotting time- Normal
Prothrombin time- Normal
Clot retraction-impaired
Platelet count-decreased
PBF -RBC(Normocytic
Normochromic)
-Platelet(abnormal)
3.Coagulation disorder a.Haemophillia(A&B)
Bleeding time-Normal
Clotting time- Prolonged
Prothrombin time- Normal
Platelet count-Normal

b.Von-willebrand disease Bleeding time-Prolonged


Von-wille brand factor-
Decreased
APTT - Increased
c.Vit-K deficiency
d.Liver disease Prothrombin time-increased

5.How Prothrombin activator is formed by intrinsic pathway?


Ans. See Ans.no.3.(b)

6.Why blood doesn’t clot inside the blood vessels?


Ans.Blood does not clot inside the blood vessels due to-

(1) Endothelial surface factor:


a. Smoothness of the endothelium prevents contact activation of intrinsic clotting system.
b. Presents of monomolecular layer of protein absorbed to the inner surface of the
endothelium that repels the platelets & clotting factor. Thus, prevent clotting.

(2) Speed of the blood flow:


It prevents the intravascular coagulation.
(3) Presence of natural anti-coagulant:
a. Heparin: It is secreted by mast cells or basophil.
b. Fibrin: Fibrin thread itself absorbs thrombin.
c. Antithrombin: It removes the thrombin from the blood and as a result fibrinogen can not
be converted into fibrin.
d. Absence of coagulation factor or thromboplastin.

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7.Discuss the role of platelets in hemostasis.

Ans.

8.Describe the basic steps involve in coagulation.

Ans.

9) Name two anticoagulants which you have used in lab.


Ans.1.Na-citrate solution (3.8%)
2.NH4-Oxalate & k-Oxalate (6mg+4mg)

10)Name the essential clotting factor.


Ans.
Clotting factor Synonyms
Factor Fibrinogen
Factor Prothrombin
Factor Tissue thromboplastin
Factor Calcium ion

11) Short note of-a) Hemostasis


b) Hemophilia
c) Bleeding time
d) Clotting time

Ans.a) Write yourself.

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b) Hemophilia:
It is a sex linked disease transmitted by females who themselves show no
symptom, to male who manifests signs of the disease. It is characterized by prolonged
coagulation time but bleeding time & prothrombin time is normal (Platelet count is normal). It
has two types -
1. Hemophilia A: Due to deficiency of factor (85%)
2. Hemophilia B: Due to deficiency of factor (15%)
Effects:
1.Anaemia
2.Weakness
3.Bleeding in tissue & joint space

Mother Father
(Carrier) (Normal)
XX XY

XX XX
Normal Carrier

XY XY
Normal Sufferer

At least one of her two X-chromosomes will have the appropriate genes.

c) Bleeding time: Bleeding time is the time required for the stoppage of bleeding.
Normal bleeding time is 2-6 min. However the time depends largely on the depth of the
wound & other degree of hyperemia. Bleeding time is prolonged due to the Purpura.
There are two methods-
1.Duke’s method
2.Ivy’s method

Normal value:
1.In Duke’s method-upto 8 min
2.In Ivy’s method-upto 11 min

d) Clotting time: Clotting time is the time required for Coagulation of blood.
Normal clotting time is about 5-11 min. Clotting time prolonged due to the hemophilia.
There are two methods-
1.Lee and White method
2.Capillary tube method

Normal value:
1.5 to 11 min in Lee and White method
2.2 to 4 min in Capillary tube method

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