Haemostasis

SL BLOOD CLOTTING COMMON NAME SYNTHESIS SITE VIT K

NO. FACTORS DEPENDENT
1 I Fibrinogen Liver No
2 II Prothrombin Liver Yes
3 III Thromboplastin Tissue factor No
4 IV Calcium - -
5 V Proaccelerin Liver No
6 VI
7 VII Proconvertin Liver Yes
8 VIII Liver No
9 IX Christmas factor Liver Yes
10 X Stuart- Power factor Liver Yes
11 XI Liver No
12 XII Hageman factor/ Contact factor Liver No
13 XIII Fibrin stabilizing factor Liver No

Haemostasis:
1. Primary haemostasis:
 Platelet plug formation
 Adhesion
 Activation
 Aggregation
2. Secondary haemostasis:
 Intrinsic Pathway: XII > XI> IX> VIII
 Extrinsic Pathway: Tissue injury > III > VII
 Common pathway: X> II> I (Fibrinogen to Fibrin)
3. Fibrinolysis:
 Thrombi is removed by action of Plasmin
 Plasmin degrades fibrin to Fibrin degradation product (FDP)-
 D-dimer (or D dimer) is a Dimer is a fibrin degradation product (or FDP), a small protein fragment
present in the blood after a blood clot is degraded by fibrinolysis. It is so named because it contains two
D fragments of the fibrin protein joined by a cross-link, hence forming a protein dimer.
Coagulation disorder:
a) Thrombocytopenic purpura
b) Haemophilia
 Haemophilia A: Factor VIII def
 Haemophilia B (Christmas disease): Factor IX def.
c) Von Willebrand disease
d) Disseminated intravascular coagulation (DIC)
Diagnosis:
A. Bleeding Time:
 Ivy’s method:
 Duke method
 Normal Range: 2 to 7 min
 Prolonged bleeding time is due to:
 Thrombocytopenia
 Von Willebrand disease
 Platelet defect
B. Coagulation time:
  Capillary tube method
 Normal range: 3 to 10 Min
 Prolonged clotting time is due to
 Haemophilia A & B
 Von Willebrand disease
 Liver disease etc.
 Do not increase in thrombocytopenia
C. Prothrombin time:
 Measure Activity of Extrinsic coagulation pathway
 Used to monitor Warfarin anticoagulant therapy
 Thromboplastin (Tissue factor) is used in P time reagent
 Citrated platelet poor plasma is used to test P time.
 Normal value of P Time is 10s to 13s


 INR: International Normalized Ratio (INR)
 The INR was devised to standardize the results and to avoid the variations between different
types and batches of manufacturer's tissue factor used in the reagent to perform the test
 Normal range of INR is 0.8 to 1.1
 On warfarin therapy INR range is 2.0 to 3.0
 P Time increases in:
 Liver disease
 Vit K deficiency
 Factor deficiency: VII/ X/ I/ 11 etc.
D. Activated partial thromboplastin time (APTT):
 Measure activity of Intrinsic pathway of coagulation pathway viz: XII/ XI/ IX/ VIII etc
 Kaolin / Ellagic acid is used in reagent that activate factor XII
 Normal range is 21 to 35 sec.
 Increases in haemophilia A/B, Factor deficiency, Liver disease, Vit K def., Anti phospholipid
antibody syndrome, Lupus anticoagulants etc.
 It is used to monitor Heparin therapy.