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HAEMOSTASIS

(VIRCHOW’S TRIAD)

Blood vessel (vasoconstriction)


Platelets (adhesion and aggregation)
Coagulation and Fibrinolysis

Prof. Dr. Herman Hariman, Ph.D (U.K), SpPK (KH)


Prof. Dr. Adi Koesoema Aman, SpPK (KH)
HAEMORRHAGIC
SCREENING TEST
A Global test that may predict what
happened with the

Blood vessel (vasoconstriction)


Platelets (adhesion and aggregation)
Coagulation and Fibrinolysis
BLOOD VESSEL
BLOOD VESSELS
MEASUREMENT
TORNIQUET TEST
BLEEDING TIME
Tourniquet Test
Capillary-fragility-test
• Hess test (commonly used): pressure is
put midway between systole and diastole
for 5 minutes. Reading is done 5 minutes
after the release of the cuff
• Rumple Leed (X): the same pressure as
above but for 15 minutes and reading is
done straight away after the release of the
cuff
Pressure midway between systole and diastole
For 5 minutes (Hess test)
Interpretation
• (+): small red dots difficult to be seen
• (++): bigger dots and easily seen
• (+++): not only easily seen but also quite
prominent and sometimes confluent
• (++++): true bruising
Bleeding Time
• As a global test to measure roughly
• Platelet’s function
• Platelet’s number
Put blood pressure at 40 mmHg
First blood drop is wiped
Next, blood is tipped off by filter paper every 30 sec

Normal is less than 5 min


PLATELET
NUMBER (USUALLY SEVERE)

PLATELET

FUNCTION (LESS SEVERE)


Bleeding Time
• As a global test to measure roughly
• Platelet’s function
• Platelet’s number
PLATELET NUMBER IS MEASURED FROM FULL BLOOD COUNT

CELL COUNTER
PLATELET FUNCTION IS TESTED USING PLATELET AGGREGOMETER
PLATELETS

PLATELET ADHESION
PLATELET AGGREGATION
Platelet Aggregation
● Platelet adhesion is mediated by vWF. This activates platelets
causing release of TxA2

● During activation, a receptor for fibrinogen becomes exposed on


the platelet membrane.

● Activated platelets release by ADP, Epinephrin,


serotonin:

Fibrinogen ADP/ATP
vWF Serotonin dense core granules
a-granules

Factor V Ca2+
Factor VIII
Platelet derived growth factor (PDGF) ~ promotes healing
Platelet factor IV – prevents formation of active thrombin
inhibitor from heparin and anti-thrombin III.
AGGREGATION OF PLATELET

IS MEASURED AFTER ADDING

THE PLATELET AGONISTS

SUH AS

ATP
EPINEPHRIN
SEROTONIN
RISTOCETIN
Graph seen in the platelet aggregometer after adding of some agonists
Basic Principle of
von Willebrand’s Factor Test

• FUNCTIONAL TEST
• Ristocetin co-factor assay dg Plt aggregometer
• ANTIGEN TEST (immunoassay)
• Radioimmunoassay (RIA)
• Enzyme-linked immunoassay (ELISA)
Basic Principle of
Fibrinogen test
• Among other coagulation factors,
Fibrinogen has no enzymatic activity and
hence there is no functional test but only
detection of protein
Intrinsic pathway

XIIa

Extrinsic Pathway
XIa
TF
Prothrombin
IXa VIIa
VIII VIIIa Xa
Va V

Soft clot
Thrombin
Fibrinogen Fibrin
XIIIa Hard clot
Fibrin
FIBRINOGEN ASSAYS
• Radial immunodifussion
• Clauss method (pure clotting-based)
• Blomback and Blomback (+thrombin –Ca++)
soluble and unstabilized. The tyrosine content is
measured after adding urea.
• Ratnoff and Menzies: Fibrinogen is clotted into
Fibrin in glass beads, washed and bolied
+NaOH, tyrosine measured with Fiolin Calcateu-
Phenol reagent
COAGULATION AND
FIBRINOLYSIS
Intrinsic pathway Extrinsic pathway

Final Common pathway


X, V,
Prothrombin Thrombin

Fibrinogen Fibrin
Intrinsic pathway Extrinsic pathway

Final Common pathway


X, V,
Prothrombin Thrombin

Fibrinogen Fibrin

Prothrombin Time (PT)


Intrinsic pathway Extrinsic pathway

Final Common pathway


X, V,
Prothrombin Thrombin

Fibrinogen Fibrin

Activated Partial Thromboplastin Time (APTT)


Intrinsic pathway Extrinsic pathway

Final Common pathway


X, V,
Prothrombin Thrombin

Fibrinogen Fibrin

Thrombin Time (T.T)


BASIC HAEMORRHAGIC
SCREENING TEST
MEASURES ROUGHLY
• Full Blood Count
• Torniquet test
• Bleeding time
• Prothrombin time
• Activated partial thromboplastin time
• Thrombin time
To give a rough idea of what
happened in disturbed
HAEMOSTASIS
THANK YOU