HEMOSTASIS DAN KOAGULASI

Dr.Fedelia Raya, M.Kes,SpPK

Bagian Patologi Klinik

FK-UHO

FR/PK-FK/Maret/2017 1
Fungsi tubuh  mempertahankan
keenceran drh  drh tetap mengalir dlm
pembuluh drh & menutup kerusakan
ddg pembuluh drh  mengurangi
kehilangan drh  kerusakan pembuluh
drh

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 Hemostasis melibatkan
1. Sistem vaskuler
2. Sistem trombosit
3. Sistem koagulasi
4. Sistem fibrinolisis

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Sistem Vaskuler
Mencegah perdrhan  kontraksi pembuluh drh serta
aktivasi trombosit & pembekuan drh

Pembuluh drh luka  vasokonstriksi 

dipetahankan o/ faktor lokal (serotonin,epinefrin) 
pengurangan aliran drh pd daerah luka

Pembuluh drh kecil  menghentikan perdhan

Pembuluh drh besar  trombosit & pembekuan drh

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 Sistem Trombosit
 Hemostasis  pembentukan & stabilisasi
sumbat trombosit
 Tahap adhesi trombosit, agregasi trombosit &
reaksi pelepasan
 Adhesi trombosit  trombosit melekat pd
permukaan asing t.u. serat kolagen
 Adhesi trombosit  protein plasma (faktor
von Willebrand’s)  disintesa sel endotel &
megakariosit
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 Sistem Trombosit
 Trombosit melekat pd trombosit yg lain 
agregasi trombosit
 Agregasi  adanya pembentukan ikatan
antara fibrinogen yg melekat pd ddg
trombosit  ion Kalsium
 Agregasi  perubahan bentuk trombosit 
granula trombosit akan terkumpul 
melepasakan isi  reaksi pelepasan

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Sistem Koagulasi (Pembekuan Darah)

Rangkaian reaksi enzimatik  protein

plasma  fk pembekuan drh, fosfolipid & ion
kalsium

Prekursor yg diubah menjd enzim 

diaktifkan

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Sistem Koagulasi (Pembekuan Darah)

Melalui 2 jalur :
- jalur intrinsik  aktivasi kontak &
melibatkan F XII, F XI, F IX, F VIII,
HMWK,PK,PF 3 & ion Kalsium

- jalur ekstrinsik  tromboplastin jaringan

F VII & ion kalsium

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Faktor Koagulasi
Factor Alternative name Path- Half-life
way (hours)
I Fibrinogen C 90-120
II Prothrombin C 48-120
III Tissue factor I Not available
V Proaccelerin C 12-24
VII Proconvertin E 2-6
VIII Antihemophilic factor I 10-12
IX Christmas factor I 18-30
X Stuart - Prower factor I,E,C 24-60
XI Plasma thromboplastin antecedent I 45-80
XII Hageman factor I 40-70
XIII Fibrin - stabilizing factor I 72-200
HMW kininogen Fitzgerald factor I 150
Prekallikrein Fletcher factor I 48-52

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INTRINSIC SYSTEM
HMWK
XII XII a
Kallikrein

XI XIa EXTRINSIC SYSTEM

VII
IX IXa + VIII TF
Ca 2+ Ca 2+ Ca 2+
PF3

X Xa + V
Ca 2+
PF3
Prothrombin Thrombin

Fibrinogen Fibrin

XIII XIIIa Stable fibrin clot

Ca 2+
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Sistem Fibrinolisis
Penghancuran fibrin o/ sistem fibrinolitik 
aliran drh terbuka kembali
3 komponen:
- plasminogen  plasmin
- aktivator plasminogen mengaktifkan
plasminogen
- inhibitor plasmin

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 Prothrombin
Intrinsic system Extrinsic system
IXa
VIII VIIIa
PF3

Xa Xa
V Va Va V
PF3 TF

Thrombin

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 Prothrombin
Intrinsic system Extrinsic system

XIa TF
VIIa

IXa (Ca2+)
IX VIII
PF3
(Ca2+)

X Xa

Thrombin
Fig. 4. Linkage between extrinsic and intrinsic systems. Several interaction
occur at various levels of the two systems. Primary among these is the
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ability of TF and F VIIa and F IX.
 Pemeriksaan Laboratorium
Tes Penyaring
• Tes menilai pembentukan hemostatic plug:
- trombosit
- apusan darah tepi
- bleeding time
- Rumple-Leede
• Menilai pembentukan trombin:
- APTT (Activating plasma tromboplastin time)
 jalur intrinsik
- PT (Protrombin Time)  jalur ekstrinsik
• Menilai reaksi trombin – fibrinogen : TT
(trombin Time)
Tes Khusus  penyebab kelainan faal
hemostasis
- Tes faktor pembekuan
 TESTS OF COAGULATION SYSTEM

Screening Test
1. Partial thromboplastin time (PTT) and
activated partial thromboplastin time (aPTT)
2. Prothrombin time (PT)
3. Quantitative fibrinogen
4. Thrombin time (TT)
5. Screening test for factor XIII
6. CBC
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No Test Platelet Condition
PT APTT TT count
1 Long N N N Factor VII deficiency
Early oral anticoagulant

2. N Long N N Factor VIII, IX, XI, XII deficiency

Prekallikrein, HMWK deficiency
Von Willebrand’s disease
Anticoagulant

3. Long Long N N Vitamin K deficiency

Oral anticoagulant
Factor V,VII, X dan II deficiency

4. Long Long Long N Heparin

Liver disease
Fibrinogen deficiency
Hyperfibrinolysis

5. N N N Low Thrombocytopenia

6. Long Long N Low Massive transfusion

Liver disease

7. Long Long Long Low DIC

Acute liver disease

First-line tests used in investigating acute haemostatic failure

 THANK YOU

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