HEMOSTASIS

Edited :Dairion Gatot, Heny Syahrini

Divisi Hematology -Onkology Medic

Internal Departement of Medical Faculty of North
Sumatera University /
Haji Adam Malik Hospital,
Medan 2015
HEMOSTASIS, (Virchow’s Triad)
Function of HEMOSTASIS

• ARREST BLEEDING
• MAINTAIN BLOOD IN FLUID STATE
 HOMEOSTATIC HEMOSTASIS
Fisiologic funtion Maintain blood in fluid state
 HEMOSTASIS
• Primary Hemostasis
– Blood vessel contraction
– Platelet Plug Formation
• Secondary Hemostasis
– Activation of Clotting Cascade
– Deposition & Stabilization of Fibrin
• Tertiary Hemostasis
– Dissolution of Fibrin Clot
– Dependent on Plasminogen Activation
 Lab Tests
Hemostasis •CBC-Plt
•BT,(CT)
BV Injury •PT
Tissue •PTT
Neural Platelet Factor
Adhesion
and
Activation

Blood Vessel Platelet Coagulation

Constriction Aggregation Cascade
Primary hemostatic plug

Reduced
Fibrin
Blood flow formation
Plt Study
Morphology
Stable Hemostatic Plug Function
Antibody
 The primary haemostatic system:
haemostasis and platelet plug formation

Primary haemostasis
Platelet aggregation

trombosit
Adhesion
endothelial cells

sub endothelial tissue Activation

Vascular Aggregation
injury
White clot

Formation of
platelet plug

exposed sub
endothelial tissue
 The haemostatic system:
secondary haemostasis and clot
formation
Prothrombin Thrombin Activation of the
Factor coagulation cascade
Intrinsic
Xa
Extrinsic Fibrinogen Fibrin
leads to generation of
pathway pathway thrombin and, in turn,
fibrin

Coagulation cascade
leads to clot formation

Clot
growth
Fibrin threads
 The haemostatic system:
Tertiary haemostasis and clot formation
Clinical Manifestation of Bleeding
Disorders
• Ptechia
• Purpura
• Echymosis
• Haematoma
• Haematemesis
• Melena
• Haemathrosis
• Haematophysis
• Hematuria
• Epistaxis
• Gum bleedeing
• Petechia : a minute, rounded spot of haemorrhage on a
surface, such as skin, mucous membrane, serious
membrane
• Purpura : a condition in which haemorrhage occur in the
skin
• Ecchymosis: extravasasion of blood into the
subcutaneous tissue. It is marked by purple discoloration
of the skin, the color gradually changing to brown green
and yellow
• Hematemesis : the vomiting blood
• Hemoptysis : the spitting of blood from larynx ,pharynx,
trachea, bronchi or lung
• Hematoma : a focalized extravasation of blood which
soon clot to form a solid mass and readily became
encapsulated by connective tissue
• Melena : the discharge of stool colored black by altered
blood
• Hemathrosis : extravasation of blood into a joint
• Hematuria : the discharge of urine containing blood
• Epistaxis : bleeding from nose
• Hematoschezia : the discharge of stool colored red or
brown
 Bleeding
disorders

Vascular
abnormalities
Clotting factor
Platelet disorders
abnormalities
 Disorders of Hemostasis

• Vascular disorders –
– Scurvy, easy bruising, Henoch-Schonlein purpura.

• Platelet disorders
– Quantitative - Thrombocytopenia
– Qualitative - Platelet function disorders
– Glanzmans, Bernard Soulier

• Combination Vascular And Platelet disorders

- DHF
 Disorders of Hemostasis

• Coagulation disorders
– Congenital - Haemophilia (A, B)
– Acquired - Vitamin-K deficiency, Liver disease

• Combination Coagulation And Platelet disorders

- Von-Willebrands

• Mixed/Consumption: DIC