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Platelets: Veena Shriram
Platelets: Veena Shriram
VEENA SHRIRAM
Platelets
Formed in bone marrow, 150-350,000 /µl
Sequestered in spleen (30%)
2-4 m in diameter, life span 8-12 days, no nucleus
Active cytoplasm
actin + myosin
enzyme synthesis + storage of calcium
synthesis of prostaglandins
dense granules containing ADP and ATP
a-granules (fibrinogen, PDGF, vWF, fibronectin)
fibrin stabilizing factor
THROMBOPOEISIS
Pluripotent hemopoitic stem cell
CSF
Megakaryoblast
Premegakaryocyte
Thrombopoietin
Promegakaryocyte FIVE
DAYS
Megakaryocytes
Endomytosis
Protoplatelets
Platelets
Each megakaryocyte produces between 5,000 and 10,000 platelets.
Structure and composition
Non nucleated
1-4 µm
Colourless,Refractile
Spherical or Oval
Discoid shape
Normal count – 1.5 to 4.5 lac / cumm
Three pools – BM , Blood stream , Spleen
Life span – 7 to 9 days
Leishman’s stain : appear as cell with
faint bluish cytoplasm
with reddish-purple granules
Electron microscopic structure :
Cell membrane
Microtubules
Cytoplasm
and Organelles
Cell membrane
P 6 nm ,trilaminar
Similar to plasma membrane
Lipid ,carbohydrates and Proteins
• Phospholipid
Plat. Factor 3 – Thx A2 – Aggregation
• GLP
Glycocalyx ( Repellant,Adhesion )
• Receptors :
- IbIx – VWF – Adhesion
- II b IIIa – Fibrinogen – Aggregation
- P2Y1 and P2Y2 – for action of ADP
Microtubule :
p
• Encircle the whole cytoplasm
• Made by polymerised protein
(Tubulin)
• maintained discoid shape
CYTOPLASM
Endoplasmic reticulum Contractile protein
• Metabolism Actin
• Protein synthesis. Myosin
Thrombosthenin
Golgi apparatus
Ca++ storage α – Granules
PDGF, factor V, VIII
Fibrinogen
Mitochondria Thrombospondin
- ATP Dense granules
Serotonin ,Ca++, ADP
Properties of Platelets,
Adhesion
Activation
Aggregation
Retraction
…………role in Haemostasis
Haemostasis
Definition :
Steps :
1) Vasoconstriction
2) Platelet plug formation
3) Clot formation
4) Clot retraction
Vasoconstriction
myogenic spasm, neural involvement,serotonin
Role of platelets
Platelet plug formation
:
Adhesion
Activation
Aggregation
Adhesion
vWF
IbIx
Endothelium
Activation
Thromboxane A2 PGH2
Dissolved microtubules
Platelet Aggregation
And plug formation
Functions of platelets :
4) Transport function – 5 HT
Applied :
1) Vasoconstriction
Causes :
- Decrease production
- Bone marrow depression
- Increase destruction
- post splenomegaly
- auto A/B
- Drugs ( quinine,linid and sulfa )
- Diseases ( Dengue,HIV ,HIT)
Platelet function tests :
1) Bleeding time :
- Duke’s method or IVY method
Platelet count
Manual : Automated :
- PBS ( Qualitative ) - with machines
- with Neubaur’s chamber ( more accurate )
( Quantitative )
Platelet count with Neubaur’s chamber
1) Dengue fever :
- Treatment
: Plasma pheresis,
4) Heparin induced thrombocytopenia ( HIT )
- Rare disorder
- When IG g A/B develops against (heparin + Plt. Factor
4)
- This complex – Activates platelets,monocytes and
endothelial cells – induced clot formation
and used up platelets
- Treatment : Direct Thrombin inhibitor
– Argatroban,Lepirudin
Qualitative / functional abnormality
Inherited thrombocytopenia
Aquired (drugs)
Inherited
VWB
IbIx
Endothelium
ADHESION DEFECT
Ristocetin agglutination test :
VWB
IbIx
Endothelium
Thromboesthenia or Glanzman’s disease
IIbIIIa
Aggregation defect
Drugs :
Activation of phospholipase A2
Aspirin
Liberation of Arachidonic acid
from Platelet membrane
Cyclo-oxegenase Lipo-oxygenase
pathway (80%) pathway( 20%)
Thromboxane A2 PGH2
c c
Abciximab
And
Tyrofiban
Indication :
1) platelet count < 20,000
2) platelet count < 40,000
with acute bleeding
Centrifuge ( 22
degree )
Platelet rich plasma
Storage at 22 degree
in AGGITATOR
LIFE SPAN OF STORED PLATELETS IS ONLY 5 DAYS )
RDP :
- Random donated platelet
- Blood collection from various donors
and separate the platelets
- also includes collection of other
component ( PCV ,plasma) from same
donated blood
Actiaaavators of platelets
Leukotrienes (chemoattractants)
Thromboxane (release more granules)
Release of thrombospondin (stabilizes platelet-fibrin)
Release of PDGF (stimulates smooth muscle proliferation)
Release of ADP (attracts more platelets)
Platelet inhibition
Anti-platelet agent Mechanism of action Agonist pathway
affected
Thrombocytopenia
bleeding small capillaries and blood vessels
mucosal, skin
low number of platelets
ITP- autoimmune (common)
The first step in the extrinsic coagulation pathway is
(A) Activation of factor X
(B) Activation of factor XII
(C) Conversion of prothrombin to thrombin
(D) Release of tissue thromboplastin
(E) Conversion of fibrinogen to fibrin
Which of the following is the strongest activator of platelet?
a. Thrombin
b. Serotonin
c. Thromboxane A2
d. Epinephrine
A healthy 6-years-old girl is brought to the emergency department because of a
severe, uncontrolled nose bleed. She has numerous small pin point
hemorrhages (blotches) on her arms & legs. Her blood values are as follows:
◦ Hb = 13 g/dl, Leukocytes count = 7000/cubic mm, Platelet count = <
10,000/cubic mm
Key: a) Decreased hemoglobin concentration in this patient results in tissue hypoxia. Hypoxia stimulates respiratory
centre leading to increased rate of respiration. As a result, the respiratory muscles become over-worked leading to
exhaustion resulting into difficulty in breathing. (1)
b) Megaloblastic anemia. (1) c) Vitamin B12 is deficient. (1)
d) Maturation Failure of RBCs, caused by poor absorption of Vitamin B12, (which is required for RBC maturation)
from the Gastrointestinal Tract due to surgical removal of ileum (from where B12 is normally absorbed) as a
treatment of inflammatory bowel disease. (1)
3 to 4 years of defective B12 absorption are usually required to deplete its stores & cause maturation failure
anemia. (1)