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Pathogenesis, Appr oach to Blee ding Disorders
Mechanism of Haemostasis
2° Hemostasis
Platelet
Platelet Adhesion
1° Hemostasis
Provide a procoagulant surface
(eg. Phospholipid for coagulation cascade to act)
Expression of Factor V, Factor VIII receptors
also initiate propagation of cascade
Regulation of 1° Hemostasis
Prostacyclin
(Potent Inhibitor of Platelet Aggregation)
Regulation of 2° Hemostasis
Serine Protease Inhibitors
Antithrombin
Heparin cofactor II
Tissue Factor Pathway Inhibitor(TFPI)
Inhibits FVII-TF Complex
Protein C Pathway
Fibrinolytic System
Plasmin
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Disorder of Hemostasis
Assessing
Bleeding Real
Bleeding due to Factor Deficiencies or Platelet Defects
Acquired or Inherited Disorder
Tests
Bleeding
Spontaneous
Prolonged, Excessive bleeding after Surgical procedures, Trauma
Simultaneous bleeding from Multiple sites
Petechiae Hematoma
Purpura Joint Bleeding
Platelet Defects Coagulation Factor Deficiencies
Mucosal Blee ding Common Rare
Petechiae Common Rare
Deep Hematomas Rare Characteristic
Bleeding from Skin Persistent Minimal
Cuts
History
Abnormal bruising Haemarthrosis/ Deep Bleeding
Abnormal bleeding - cuts, abrasions Dental extraction bleeding
Epistaxis Surgery bleeding
Gum bleeding/ GIT bleeding Previous anaemia, transfusion
Haematuria Drug history – warfarin, aspirin
Menorrhagia Family history
Physical Examination
Pallor
Purpura, Petechiae, Ecchymoses, Bruises, Haematoma
Fever, Jaundice, Lymphadenopathy, Hepatosplenomegaly
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Special Tests
Bleeding Disorders Platelet Function
Coagulation Factors Assay Platelet Aggregation
Platelet Function Tests Platelet Adhesion,
DIC Tests Adhesion-Aggregation
vW Factor Assay Storage Pool,
Tests for Inhibitor Release Reaction of Platelets
Tests for Pathological Fibrinolysis Platelet Factor 3