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Bleeding Timeclotting Time PT and PTT2
Bleeding Timeclotting Time PT and PTT2
and PTT
Dr.Haya Al-Ghazali
Hemostasis or haemostasis :
is a complex process which causes the
bleeding process to stop. It refers to the
process of keeping blood within a
damaged blood vessel.
Hemostasis is maintained in the body
via three mechanisms:
Vascular spasm - Damaged blood vessels
constrict.
Platelet plug formation - Platelets adhere to
damaged endothelium to form platelet plug
(primary hemostasis) and then degranulate.
Blood coagulation - Clots form upon the
conversion of fibrinogen to fibrin, and its
addition to the platelet plug (secondary
hemostasis).
THE CLOTTING MECHANISM
INTRINSIC EXTRINSC
Collagen Tisue Thromboplastin
XII
XI VII
IX
VIII
V FIBRINOGE
N (I)
PROTHROMBIN THROMBIN
(II) (III) FIBRIN
FIBRINOLYTIC PHASE
ANTICLOTTING MECHANISMS ARE ACTIVATED
TO ALLOW CLOT DISINTEGRATION AND
REPAIR OF THE DAMAGED VESSEL.
HEMOSTASIS
DEPENDENT UPON:
VESSEL DEFECTS
PLATELET DISORDERS
FACTOR DEFICIENCIES
VESSEL DEFECTS
VITAMIN C DEFICIENCY
BACTERIAL & VIRAL INFECTIONS
ACQUIRED
PLATELET DISORDERS
THROMBOCYTOPENIA
(INADEQUATE NUMBER OF PLATELETS)
Causes
DRUG INDUCED
BONE MARROW FAILURE
HYPERSPLENISM
OTHER CAUSES
THROMBOCYTOPATHY )
ADEQUATE NUMBER BUT ABNORMAL
FUNCTION .(
causes
UREMIA
INHERITED DISORDERS
MYELOPROLIFERATIVE DISORDERS
DRUG INDUCED(ASPIRIN, NSAIDS)
FACTOR DEFICIENCIES
Inherited: Acquired:
1. HEMOPHILIA A
1. Anticoagulant
2. HEMOPHILIA B therapy
3. VON WILLEBRAND’S
DISEASE 2. Liver diseases
3. DIC
LABORATORY EVALUATION
PLATELET COUNT
BLEEDING TIME (BT)
PROTHROMBIN TIME (PT)
PARTIAL THROMBOPLASTIN TIME (PTT)
THROMBIN TIME (TT)
PLATELET COUNT (CBC)
Thrombocytopenia 100,000>
PROVIDES ASSESSMENT OF
PLATELET COUNT AND FUNCTION
NORMAL VALUE
2-8 MINUTES
PROTHROMBIN TIME
NORMAL VALUE
10-15 SECS
PT
The prothrombin time: is therefore the time required for the plasma
to clot after an excess of thromboplastin and an optimal
concentration of calcium have been added.
INTRINSIC EXTRINSC
Collagen Tisue Thromboplastin
XII
XI VII
IX
VIII
V FIBRINOGE
N (I)
PROTHROMBIN THROMBIN
(II) (III) FIBRIN
?When is it ordered
Used to monitor oral anticoagulant therapy (Warfarin /
Coumadin).
NORMAL VALUE
25-40 SECS
PTT
The partial thromboplastin time (PTT) or activated partial
thromboplastin time (aPTT or APTT( is a performance
indicator measuring the efficacy of both the "intrinsic"
and the common coagulation pathways.
INTRINSIC EXTRINSC
Collagen Tisue Thromboplastin
XII
XI VII
IX
VIII
V FIBRINOGE
N (I)
PROTHROMBIN THROMBIN
(II) (III) FIBRIN
Normal PTT times require the presence of
the following coagulation factors:
I, II, III, IV, V, VI, VIII, IX, X, XI, & XII
?When is it ordered
INTRINSIC EXTRINSC
Collagen Tisue Thromboplastin
XII
XI VII
IX
VIII
V FIBRINOGE
N (I)
PROTHROMBIN THROMBIN
(II) (III) FIBRIN
FACTOR DEFICIENCIES
Inherited: Acquired:
1. HEMOPHILIA A
1. Anticoagulant
2. HEMOPHILIA B therapy
3. VON WILLEBRAND’S
DISEASE 2. Liver diseases
3. DIC
HEMOPHILIA A (Classic Hemophilia)
80-85% of all Hemophiliacs
Deficiency of Factor VIII
Lab Results - Prolonged PTT
HEMOPHILIA B (Christmas Disease)
10-15% of all Hemophiliacs
Deficiency of Factor IX
Lab Test - Prolonged PTT
VON WILLEBRAND’S DISEASE
Deficiency of VWF & amount of Factor VIII
Factor VIII is bound to vWF while inactive in
circulation; Factor VIII degrades rapidly when not
bound to vWF
Lab Results - Prolonged BT, PTT
ANTICOAGULANTS
An anticoagulant is a substance that prevents
coagulation; that is, it stops blood from clotting
This prevents deep vein thrombosis, pulmonar
embolism, myocardial infarction and stroke.
ANTICOAGULANTS
1. Coumadins (Vitamin K antagonists)
2. Heparin
Coumadins
Vitamin K deficiency or
prolonged prolonged unaffected unaffected
Warfarin
Disseminated intravascular
prolonged prolonged prolonged decreased
coagulation
Bernard-Soulier syndrome unaffected unaffected prolonged decreased
THANK YOU