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Hémostase.

Hémostase.

: cessation de l’écoulement du sang (4-3) Phases : 1e Phase : Constriction – diminue le flot sanguin ii) 2 aPhase : Thrombus blanc ii) 2b Phase: Thrombus rouge caillot iv) 3e Phase: Dissolution.

Coagulation.

Coagulation.

Platelet p I a tele t Red cell Bro n bloc) d •vessel II F i bri.

Clotting chain reaction in blood: Calcium and Blood clot Thrombrin Platelet Red blood cell Fibrin Fibrin "net" formed Blood clot Trigger other factors" Platelets become "sticky" medmowe com.

Norrnal Bleeding starts 2— Vessels constrict 3- Platelet plug Fibrin clot Bleeding Disorder -1 Bleeding starts 2— Vessels constrict 3— Incor-nplete platelet plug. confined bleed ing 4— and/or delayed fort-nation of fibrin clot. continued bleeding.

BALANCE OF HEMOSTASIS Clotting Activators Vessels Platelets Coagulatton Fibrinolysis Bleeding &.Jnhib1tors. ;.

PLASMA/SERUM.

PLASMA/SERUM.

Groupe Sanguin Microbiome Human Microbes: The Power Within: pp 127.

Coagulation Sanguine. Coagulation Sanguine.

[Audio] La formation du caillot Activation du prothrombine en thrombine Fibrinogène (Facteur I) se transforme en caillot sanguine avec l’aide de la thrombine Vitamine K --> impliquée dans la production de la prothrombine, produit par des bactéries dans l’intestin --> en métabolisant les plantes Antagoniste de la vitamine K --> Dicoumarol (hémorragie) --> feuille de trèfle Prothrombine (Facteur II) --> (activé par Ca plus et phospholipides) Thrombine (Facteur IIa) Thrombine --> serine protéase qui hydrolyse le fibrinogène Thrombine forme les caillots Plasmine dissous les caillots Héparine --> inhibe Thrombine Streptokinase --> active la plasmine.

inr.ry or remmral Uood trom Pre!imnary steps ciotmg ProttuocrWin Prothromtires.e Fibrinoyen Thrombin Forti tryeais Bloc.d cens p'astna.

[Audio] FacteursSanguins IlexisteXIIIfacteurs,silefacteurVIIIestabsenthémophilie FacteurI:Fibrinogène FacteurII:Thrombine(signauxinternesetexternes) Caillotsanguinestcomposepardescorpusculesetdesfibrinesformercommeunfilet Plasminedissoutlecaillot Sidescaillotsseforment,onalathrombose Sidescaillotsneseformentpas,onal’hémophilie.

EXTRINSIC PATHWAY Damage to tissues [leaks) Tissue Factor Ill (TF,) 2. Clotting Factor VII (CF7) (combine to form] Factor VII—Tissue Factor Complex (TF-F7) [activates) INTRINSIC PATHWAY Damage to endothelium [activates] Factor XII (Fu) Platelet Factor Ill (Ph) Clotting Factors VIII & IX (CFS, CF9) [combine to forml Factor X-Activator Complex (activates) Prothrombinase (Prothrombin Activator) Prothrombin Thrombin Fibrinogen Fibrin.

Major Components of Hemostasis Vascular Injury Vasoconstriction Collagen Platelet Activation vWF, fibrinogen Platele Plüg Primary Hemostasis Tissue factor Coagulation Cascade Thrombin Fibrin Antithrombotic Control Mechanisms Blood Clot Plasmin Fibrinolysis & Clot Degradation Secondary Hemostasis.

[Audio] Facteursdecoagulation. Facteurs de coagulation.

Facteurs de coagulation.

Biochemical role of Vitamin K Vitamin K is necessary for the coagulation. • Factors dependent on Vitamin K are 1 factor prothrombin); • 2.Factar VII ST-actor Charismas factor), • Factor X Stuart power factor • All these factors are synthesized in the liver as inactive zymogen,.

Hémostase primaire : YTempsde salgnement. Numération plaquettaire. tests Adhésivité des plaquettes (in vivo ou in vitro). Agrégabilité des plaquettesr par méthode microscopique ou méthode photométrique..

TESTS.

Anticoagulants - Classification Drugs used to reduce coagulability of Blood — Heparin and Vitamin K antagonists: — Used in vivo: • Parenteral: Indirect thrombin inhibitor - Heparin, Low molecular weight heparin (LMWH) and Heparinoids — Heparan sulfate, Danaparoid Direct TI — Lepirudin, Bivalirudin and argatroban • Oral anticoagulants: — Coumarin derivatives: Bishydroxycoumarin (dicumarol), Warfarin sodium, Acenocoumarol and Ethylbiscoumacetate Indadione derivative: Pheninidione — Used in vitro: • Heparin: 150 U for 100 ml of blood • Sodium citrate: 1.65 gm for 350 ml of blood: anticogulant acid citrate dextrose solution 2.2g/100 ml — 75 ml for 1 unit of blood.

Anticoagu lant thromboembolism Drug Class Anticoagulant Parenteral Anticoagulant Oral Antiplatelet drugs Thrombolytic Drugs Prototype Heparin Warfarin Aspirin Action Inactivation of clotting Factors Decrease synthesis of Clotting factors Decrease platelet aggregation Streptokinase Fibinolysis Effect Prevent venous Thrombosis Prevent venous Thrombosis Prevent arterial Thrombosis Breakdown of thrombi.

Wolters Kluwer Lippincott Williams & Wilkins Antiplatelet Drugs They are used when overactive platelets pose long-term risks for hypercoagulability. Platelet aggregation is important in hemostasis. Antiplatelet drugs reduce platelet aggregation. Antiplatelet drugs differ in their modes of action and adverse effects. Prototype drug: clopidogrel (Plavix) 2012 I W—ns &.

Wolters Kluwer Lippincott Williams & Wilkins Hemostatic Drugs Hemostatics stop blood loss by enhancing blood coagulation. There are two types of hemostatic agents: systemic and topical. Systemic agents interfere with the breakdown of clots. Topical agents are used to control small amounts of bleeding or oozing, usually following surgery. Prototype drug: aminocaproic acid (Amicar) 2012 I &.

Composition of blood clots Drugs used Natural products Arteries Mostly: platelets Aspirin • • Plavix@ Aggrenox@ • NSAIDs Heparin • LMWH Warfarin (coumadin@) • Ginkgo • Garlic • Vitamin E • Nattokinase* Veins Mostly: clotting protein fibrin • Heparin • Low molecular weight heparins: oFragmin@ olnnohep@ oLovenox@ • Warfarin (coumadin@) • Arixtra@ (Fondaparinux) •Nattokinase*.

Composition of blood clots Drugs used Natural products Arteries Mostly: platelets Aspirin • • Plavix@ Aggrenox@ • NSAIDs Heparin • LMWH Warfarin (coumadin@) • Ginkgo • Garlic • Vitamin E • Nattokinase* Veins Mostly: clotting protein fibrin • Heparin • Low molecular weight heparins: oFragmin@ olnnohep@ oLovenox@ • Warfarin (coumadin@) • Arixtra@ (Fondaparinux) •Nattokinase*.

o Bromadiolone OH OH Vitamin K NADP+ C02, 02 Warfarin NADPH + 2 GSH OH OH o Warfarin OH.

[Audio] Hemophilie MedicamentsAntifibrinolytiques bloqueladissolution Acidetranexamiqueetacideaminocaproique Desmopressin(D-D-A-V-P)–hormone factorVIII Replacementdu facteurVIII(HemophiliaA) &IX(HemophiliaB).

[Audio] Médicaments Thrombose production excessive des caillots sanguins (anticoagulants) Coumadine (Warfarin) Héparine. Médicaments thrombolytiques (dissous des caillots sanguin) Streptokinase Urokinase..