platelets, coagulation system
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Platelets, and Coagulation System
Fadel Muhammad Garishah, BSc
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Thrombosis and Virchow’s Triad
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Platelets • Megakaryocytes’ daughters
• Actors of primary thrombosis
• Activated and inhibited by various stimuli
• Also involved in both hemostatic and immunity-inflammation processes
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Endothelial cells
• Lining of the vascular system• Possessed various adhesion molecules for the adhesion of platelets, WBCs during
thrombosis and inflammation processes
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Hemostasis – Thrombosis - Fibrinolysis
http://www.hopkinsmedicine.org/hematology/coagulation.swf
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Platelet Activation
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Coagulation Cascade and Fibrin Polymerization
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Fibrinolysis
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Clinical Evaluation of Thrombosis• Clotting Time• Bleeding Time• Prothrombin Time• Activated Partial Thromboplastin Time
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Bleeding time• Platelet functions to form clot• Wound in superficial area -> normally 1-9 min stops• Prolonged: platelet dysfunction, vWD, anticoagulant use,
uremia, liver failure, leukemias, MDS
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Thrombin time• Assess fibrin formation in plasma• TT time < 20 seconds• Shortened: hereditary, DIC, multple myeloma
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Prothrombin Time• Extrinsic factors and final common pathway• Factor II, V, VII, X• Adding Ca2+ and thromboplastin (activator) to blood sample,
and then measure the time• PT 9,5 – 13,5 seconds• INR < 1.• Prolonged PT: warfarin use, def vit K, liver disease, deficiency
of F II, VIII, V, X, DIC, fibrinogen abnormalities, heparinization
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Partial Thromboplastin Time or Activated Partial Thromboplastin Time
• Intrinsic coltting factors etc• aPTT additional activator that speeds up PTT• aPTT 30-40 seconds• PTT 60 – 70 seconds• Prolonged causes: Def F VIII, IX, XI, XII,
Fitzgeralnd/prekalikrein, vWD, hypofibrinogenemia, liver cirrhosis, def vit K, , DIC, heparinization, coumarin inhibition FI, IX and X
• Shortened: early DIC, cancers, hemorrhage,