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Hemostasis: HemoStasis

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Hemostasis: HemoStasis

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    3. Hemostasis:

    4. Hemostasis: Hemo/Stasis Hemo=??? Stasis=????

    5. ???? ???????:

    6. Causes of Bleeding(1) Thrombocytopenia: Primary: ITP Neonatal Isoimmune TAR Syndrome Wiskott-Aldrich Syn. Secondary: *Malignancy *Aplastic Anemia *DIC *Sepsis *HUS *Hypersplenism *Autoimmune(SLE)

    7. Causes of Bleeding(2) Coagulopathy: Primary: vWF Deficiency Hemophilia Platelet dysfunction Secondary: DIC Anticoagulants Vit K deficiency Hepatic Failure Renal Failure Maternal Anticonvulsant

    8. Causes of Bleeding(3) Vascular(Non-Hematologic) Child Abuse Vasculitis Ulcer Varices Ehlers-Danlos Syndrome Telangiectasia Angiodysplasia

    9. ????? ???? ???????: 1)??????? ?????:??? ????? ??? ?? ???? ????? ????? ????? ? ?? ??????? ?? ???? ???? ? ?????? ??????? ?????. 2)??????? ??????:??? ????? ??? ?? ???? ????? ????? ????? ? ?? ??????? ?? ???? ???? ??????? ?????.

    11. Differences of Primary and Secondary Hemostasis:

    16. Estimation of BT with desired Platelet count BT= 30.5- Platelet count (minute) 3,850

    24. Vitamin K Related Factors: Factor II Factor VII Factor IX Factor X

    26. Prolonged PTT No clinical bleeding ??? Mild or rare bleeding ??? Frequent,Severe Bleeding ???

    28. Prolonged PTT No clinical bleeding Factor XII , HMWK , PK Mild or rare bleeding Factor XI Frequent,Severe Bleeding Factors VIII and IX

    29. Prolonged PT ??? ??? ???

    31. Prolonged PT Factor VII Deficiency Vitamin K Deficiency(Early) Warfarin anticoagulant ingestion

    32. Prolonged PT and PTT ??? ??? ???

    34. Prolonged PT and PTT Factor II,V,X Deficiency Vitamin K Deficiency(Late) Warfarin anticoagulant ingestion

    35. Prolonged TT ??? ??? ???

    37. Prolonged TT Mild or rare bleeding: Afibrinogenemia Frequent,Severe Bleeding:Dysfibrinogenemia Heparin like inhibitors or heparin administration

    38. Prolonged PT and/or PTT not corrected with normal plasma Specific or nonspecific inhibitor Syndromes

    39. Clot Solubility in 5 M urea Factor XIII deficiency Inhibitor

    41. Secondary Hemostasis Approach: 1)What is diagnosis? 2)What is hemostatic level of Factor? 3)What is blood distribution of factor? 4)Which products contain desired factor? 5)What is half life of coagulation factor?

    46. APPROACH TO COAGULATION DISORDERS

    47. Clinical approach 1. Is the bleeding significant ? 2. Local Vs Systemic ? 3. Platelet Vs Coagulation disorder ? 4. Inherited Vs Acquired ?

    48. 1. Demonstration of the defect 2. Identification of the defect(s) 3. Assessment of severity 4. Consequential studies eg. carrier detection 5. Monitoring of treatment Laboratory Approach

    49. 1. Platelet count & morphology 2. Bleeding Time(BT) 3. Prothrombin Time(PT) 4. Activated Partial Thromboplastin Time(PTT) 5. Thrombin Time (TT) Screening Tests

    50. Collection of blood sample 1. Minimum circulatory stasis 2. Clean venous puncture 3. Proper anticoagulant 4. Proportion of blood to anticoagulant 5. Separation of plasma and storage 6. Effect of stress, pregnancy, drugs 7. Effect of PCV on the proportion of plasma to anticoagulant

    51. Coagulation factor deficiency/inhibitor Test plus control plasma - 1:1 Repeat PT/APTT > 50% correction Yes - Factor deficiency No - inhibitor Prolonged PT/APTT

    62. Factor XIII deficiency Thrombasthenia congenital drug induced Disorders of vascular hemostasis Factor XIII - clot solubility PT, APTT, TT, PLC - Normal Platelet function BT clot retraction 1 minute platelet count aggregation Tourniquet test

    63. Asymptomatic Patient Routine screening tests shows prolonged APTT Inhibitor - lupus anticoagulant Factor XII deficiency Mild congenital factor deficiency

    64. Antiphospholipid Antibody Syndrome Criteria by Branch and Silver 1996 Clinical Recurrent abortion Recurrent venous thrombosis Recurrent arterial thrombosis Persistent thrombocytopenia Livedo reticularis Laboratory IgG/IgM anticardiolipin Ab Lupus anticoagulant Diagnosis 1 clinical + 1 lab criteria Lab result must be positive on at least 2 occasions more than 3 months apart

    65. Kaolin clotting time Dilute Russel’s viper venom time Platelet neutralization test Tissue thromboplastin inhibition test Lupus Anticoagulant

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