Hematology-Immunology System
Faculty of Medicine Universitas Padjadjaran
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Hemostasis
A series of reactions that function to stop
bleeding, maintaining blood in a fluid state and
confined to the circulatory system
To prevent thrombosis
VASCULAR PHASE
PLATELET PHASE
COAGULATION PHASE
These phases are not separated but rather interconnected and related
FIBRINOLYTIC PHASE
HEMOSTASIS
Primary Hemostasis
Blood vessel contraction
Platelet plug formation
Secondary Hemostasis
Activation of coagulation cascade
Deposition & stabilization of fibrin
Tertiary Hemostasis (fibrinolysis)
Dissolution of fibrin clot
Dependent on plasminogen activation
Primary Hemostasis
(platelet plug)
Secondary Hemostasis
(Hemostatic Plug)
Plug Formation
Coagulation Factors
Extrinsic Pathway
Xa
Xa
V
VIIa
VII
Tissue factor
Ca
PF3
Prothrombin
activator
Thrombin
Prothrombin
Fibrinogen
Fibrin
XII
Intrinsic Pathway
Contact
XI
IX
VIII
X
Ca
PF3
Xa
V
Prothrombin activator
Prothrombin
Fibrinogen
Thrombin
Fibrin
XIIa
Intrinsic pathway
Extrinsic Pathway
XIa
TF
IXa
VIIIa
VIIa
Xa
Ca
PF3
Prothrombin activator
Prothrombin
Fibrin
Thrombin
Fibrinogen
Intrinsic pathway
XIIa
Extrinsic Pathway
XIa
TF
IXa
VIIIa
Prothrombin
VIIa
Xa
Va
Ca, PF3
Fibrinoge
n
Thrombin
Soft clot
Fibrin
XIIIa
Hard clot
Fibrin
Intrinsic pathway
XIIa
Extrinsic Pathway
XIa
VIII
TF
IXa
VIIIa
Fibrinoge
n
Prothrombin
Xa
Va
Thrombin
VIIa
V
Soft clot
Fibrin
XIIIa
Hard clot
Fibrin
Hemostasis Tests
Screening assays in hemostasis:
1. Patients without any signs/symptoms
preoperative
2. Monitoring of anticoagulant therapy
3. Disseminated Intravascular Coagulation
4. Thrombophilia
5. Inhibitor (Lupus Anticoagulant, Anti
Phospholipid Antibody)
Tourniquet Test
Bleeding Time
Clotting Time
Clot Retraction
Platelet Count*
PT*
APTT*
TT*
Fibrinogen*
Euglobulin Clot Lysis Test
D-Dimer
Thrombelastography
20
TORNIQUET TEST
= RUMPEL LEEDE TEST
= HESS TEST
Systolic/
diastolic
5 cm
5 cm
100 mmHg
5 min
PETECHIAE
> 10 ABNORMAL
Rough capillary fragillity evaluation
ABNORMAL :
- TROMBOCYTOPENIA
- PURPURA
- VON WILLEBRAND DISEASE
BLEEDING TIME
VASKULER
PLATELET
5 mm
N : 1 - 3 min
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