BLOOD COAGULATION
[Link] SRI PALA
OMFS 1ST YEAR PG
The term hemostasis means prevention of blood loss.
Whenever a vessel is severed or ruptured, hemostasis is achieved by several mechanisms:
(1) vascular constriction,
(2) formation of a platelet plug,
(3) formation of a blood clot as a result of blood coagulation, and
(4) eventual growth of fibrous tissue into the blood clot to close the hole in the vessel permanently.
Vascular constriction
(1) local myogenic spasm,
(2) local autacoid factors from the traumatized
tissues and blood platelets, and
(3) nervous reflexes.
CLOTTING FACTORS
Extrinsic Pathway for Initiating Clotting
Intrinsic Pathway for Initiating Clotting
Conversion of prothrombin to thrombin and polymerization of fibrinogen to form fibrin fibers .
BLOOD COAGULATION TESTS
BLEEDING TIME :Bleeding time (BT) is the time interval from oozing of blood after a cut or injury
till arrest of bleeding. Duke's, Ivy's, Template methods are used.
Its normal duration is 3 to 6 minutes.
Prolonged Bleeding time: Thrombocytopenia, Platelet Function Disorders(von Willebrand's disease,
Glanzmann's thrombasthenia, Bernard Soulier syndrome)
Drugs ( aspirin , NSAiDs ,anticoagulants , tricyclic antidepressants, high dose betalactams,
phenothiazines, anesthetics,etc.)
DIC, liver disease
CLOTTING TIME:Clotting time (CT) is the time interval from oozing of blood after a cut or injury till
the formation of clot. It is usually determined by capillary tube method, Lee and White Method
Its normal duration is 3 to 8 minutes.
Clotting time is prolonged in:
• Deficiency of factor VIII, IX, XI or XII
• Afibrinogenemia, dysfibrinogenemia
• Vitamin K deficiency
• Deficiency of factor II, V or X, von Willebrand's
• Liver disease, warfarin therapy.
PROTHROMBIN TIME :Prothrombin time (PT) is the time taken by blood to clot after adding tissue
thromboplastin to it. This is an important screening test for defects of the extrinsic and common
coagulation
pathways since the intrinsic pathway is bypassed by adding tissue factors and calcium.
Normal PT is 10-14 secs.
Prothrombin time is prolonged in:
1. Congenital deficiencies of one or more of factors II, V, VII or X
2. Therapy with coumarin or inadanedione (anticoagulant) drugs.
3. Obstructive jaundice
4. Hemorrhagic disease of the newborn.
5. Liver disease
6. Fibrinogen deficiency
7. Vitamin K deficiency
PARTIAL PROTHROMBIN TIME OR ACTIVATED PROTHROMBIN TIME:
Partial prothrombin time (PPT) is the time taken for the blood to clot after adding an activator such as
phospholipid, along with calcium to it. It is also called activated partial prothrombin time (APTT). This
test is useful in monitoring the patients taking anticoagulant drugs.
Normal PTT is 30-40 secs.
PTT is prolonged in:
1. Hemophilia A (Factor VIII: C deficiency)
2. Christmas disease (Hemophilia B) (Factor IX deficiency)
3. Von Willebrand's disease (Factor VIII: Vwf deficiency)
4. Contact factor (XII) or factor XI deficiency
5. Heparin and oral anticoagulant therapy
6. Hepatic failure
Thrombin Time (TT}
In this test, thrombin is added to citrated plasma and the clotting time noted. This tests the conversion of
fibrinogen to fibrin monomers by thrombin. This test involves observation of clotting time after adding
thrombin to patient’s plasma.
Normal duration of thrombin time is 12 to 20 seconds.
Prolonged TT is obtained in:
1. Hypofibrinogenemia.
2. Dysfibrinogenemia.
3. Heparin, fibrinogen or fibrin degradation
products.
4. Chronic liver disease.
INTERNATIONAL NORMALIZED RATIO
• International normalized ratio (INR) is the rating of a patient’s prothrombin time when compared to an
[Link] measures extrinsic clotting pathway system
• Blood takes longer time to clot if INR is higher.
• Normal INR is about 1. In patients taking anticoagulant therapy for atrial fibrillation, INR should be
between 2 and 3. For patients with heart valve disorders, INR should be between 3 and 4. But, INR
greater than 4 indicates that blood is clotting too slowly and there is a risk of uncontrolled blood
clotting.
Anticlotting (fibrinolysis) mechanism
REFERENCES
GUTON AND HALL,TEXTBOOK OF MEDICAL PHYSIOLOGY 13TH EDITION
K SEMBULINGAM ESSENTIALS OF MEDICAL PHYSIOLOGY ,6TH EDITION
P J MEHTA’S PRACTICAL MEDICINE.
COMPREHENSIVE TEXTBOOK OF MEDICAL PHYSIOLOGY,G K PAL.
HARRISONS’S MANUAL OF MEDICINE,18TH EDITION .