Coagulation Time

Dian ayu novitasari 012116365

HEMOSTASIS

Ada 4 fase : 1. Spasme Pembuluh darah / Vasokonstriksi (sistem vaskuler) 2. Pembentukan Sumbat trombosit(sistem trombosit) 3. Koagulasi Darah(sistem koagulasi) 4. Pertumbuhan Jaringan ikat(sistem fibrinolisis)

1. Platelet Adhesion
Platelets stick to exposed collagen underlying damaged endothelial cells in vessel wall

2. Platelet Release Reaction

Platelets activated by adhesion Extend projections to make contact with each other Release thromboxane A2, serotonin & ADP activating other platelets Serotonin & thromboxane A2 are vasoconstrictors decreasing blood flow through the injured vessel. ADP causes stickiness

3. Platelet Aggregation
Activated platelets stick together and activate new platelets to form a mass called a platelet plug Plug reinforced by fibrin threads formed during clotting process

MEKANISME KOAGULASI DARAH

Terbentuknya aktivator protrombin akibat rusaknya pembuluh darah Aktivator protrombin mengkatalisisr protrombin menjadi trombin Trombin sebagai enzim mengubah fibrinogen menjadi benang-benang fibrin.

Protrombin ekstrinsik Ca2+ protrombin aktivator intrinsik Trombin

Fibrinogen

Fibrin monomer Ca2+ Fibrin Stabilizing Factor

Benang Fibrin

Prothrombinase
(Prothrombin activator)

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Blood coagulation: factors involved

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(a) Extrinsic pathway

(b) Intrinsic pathway

Tissue trauma

Blood trauma
Damaged endothelial cells expose collagen fibers Tissue factor (TF)

Damaged platelets

Activated XII Ca2+ Ca2+ Activated platelets

+
Platelet phospholipids
Activated X V Ca2+

Activated X V

Ca2+

PROTHROMBINASE
(c) Common pathway Ca2+ Prothrombin (II)

THROMBIN
Ca2+ Fibrinogen (I) Loose fibrin threads XIII

Activated XIII

STRENGTHENED FIBRIN THREADS

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Natural anticoagulants:
A. Endothelial surface factors B. Anticoagulants present in the blood which remove THROMBIN
1. Fibrin itself

1. Smoothness of endothelial wall: so has glycocalyx which repels clotting factors

2. Protein C :inactivates factors V and VIII 3. Thrombomodulin- a protein bound to endothelium -combines with thrombin to reduce clotting.

2. Antithrombin III -antithrombin ( globulin) + heparin -removes activated factors XII, XI, X -removes thrombin

C. Anticoagulants may be used

In patients: i. Heparin ii. Vit K antagonists

4. This combination also activates Protein C

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Outside the body: i. Heparin ii. Calcium antagonists

 Normal coagulation time: 9-15 minutes (finger

prick method)

Clinical implications
Coagulation disorders :
i. not enough coagulations factors--?
(Hemophilia (factor VIII deficiency) transmitted by female to males. Only males suffer)

ii. Not enough Vit K

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PENCEGAHAN KOAGULASI
Ekstravaskular : 1. diaduk 2. didinginkan 3. + Na sitrat, K sitrat 4. + EDTA Intravaskular : 1. Coumarin , Warfarin 2. Heparin

Kelainan pembekuan darah

HEMOFILIA

 VON WILLEBRAND

 ITP (idiophatic trombocytopenic purpura)