bleeding time, clotting time pt and ptt2

8/10/2019 Bleeding Time, clotting Time PT and PTT2

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Hemostasisor haemostasis:

is a complex process which causes thebleeding process to stop. It refers to theprocess of keeping blood within adamaged blood vessel.


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Hemostasis is maintained in the bodyvia three mechanisms:

Vascular spasm- Damaged blood vesselsconstrict.

Platelet plug formation- Plateletsadhere to

damaged endothelium to form platelet plug(primary hemostasis) and then degranulate.

Blood coagulation- Clots form upon theconversion of fibrinogento fibrin, and itsaddition to the platelet plug (secondaryhemostasis).
http://en.wikipedia.org/wiki/Vasoconstrictionhttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Fibrinogenhttp://en.wikipedia.org/wiki/Fibrinhttp://en.wikipedia.org/wiki/Fibrinhttp://en.wikipedia.org/wiki/Fibrinogenhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/Vasoconstriction


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THE CLOTTING MECHANISM

INTRINSIC

EXTRINSC

PROTHROMBIN THROMBIN

FIBRINOGE

N

FIBRIN(II) (III)

(I)V

X

Tisue ThromboplastinCollagen

VII

XII

XIIX

VIII


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FIBRINOLYTIC PHASE

ANTICLOTTING MECHANISMS ARE ACTIVATEDTO ALLOW CLOT DISINTEGRATION ANDREPAIR OF THE DAMAGED VESSEL.


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HEMOSTASIS

DEPENDENT UPON:

Vessel Wall Integrity

Adequate Numbers of Platelets

Proper Functioning Platelets

Adequate Levels of Clotting Factors

Proper Function of Fibrinolytic Pathway


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So What Causes Bleeding Disorders?

VESSEL DEFECTS

PLATELET DISORDERS

FACTOR DEFICIENCIES


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VESSEL DEFECTS

VITAMIN C DEFICIENCY

BACTERIAL & VIRAL INFECTIONS

ACQUIRED


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PLATELET DISORDERS

THROMBOCYTOPENIA(INADEQUATE NUMBER OF PLATELETS)

Causes DRUG INDUCED

BONE MARROW FAILURE

HYPERSPLENISM OTHER CAUSES


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THROMBOCYTOPATHY)ADEQUATE NUMBER BUT ABNORMALFUNCTION (.

causes UREMIA

INHERITED DISORDERS MYELOPROLIFERATIVE DISORDERS

DRUG INDUCED(ASPIRIN, NSAIDS)


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FACTOR DEFICIENCIES

Inherited:

1. HEMOPHILIA A

2. HEMOPHILIA B

3. VON WILLEBRANDSDISEASE

Acquired:

1. Anticoagulant

therapy

2. Liver diseases

3. DIC


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LABORATORY EVALUATION

PLATELET COUNT

BLEEDING TIME (BT)

PROTHROMBIN TIME (PT)

PARTIAL THROMBOPLASTIN TIME (PTT)

THROMBIN TIME (TT)


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PLATELET COUNT (CBC)

NORMAL 100,000 - 400,000CELLS/MM3

< 100,000Thrombocytopenia

50,000 - 100,000Mild Thrombocytopenia

< 50,000Sever Thrombocytopenia


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BLEEDING TIME

PROVIDES ASSESSMENT OF

PLATELET COUNT AND FUNCTION

NORMAL VALUE2-8 MINUTES


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PROTHROMBIN TIME

Measures Effectiveness of the Extrinsic

Pathway

NORMAL VALUE

10-15 SECS


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PT

The prothrombin time: is therefore the time required for the plasmato clot after an excess of thromboplastin and an optimalconcentration of calcium have been added.

Measures the function of the Extrinsic Pathway.

Sensitive to Factors I, II, V, VII, X.

The PT evaluates patients suspected of having an inherited oracquired deficiency in these pathways.


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INTRINSIC

EXTRINSC


FIBRINOGE

N

FIBRIN(II) (III)

(I)V

X


VII

XII

XI

IX

VIII


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When is it ordered?

Used to monitor oral anticoagulant therapy (Warfarin /

Coumadin).

When a patient who is not taking anti-coagulant drugshas signs or symptoms of a bleeding disorder.

When a patient is to undergo an invasive medical

procedure, such as surgery, to ensure normal clottingability.


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An elevated prothrombin time may indicatethe presence of:

Vitamin K deficiency(Vitamin K is needed to make prothrombin and other clotting factors)

DIC

liver disease

a deficiency in one or more of the following factors:

I, II, V, VII, X.

Anticoagulant (warfarin)


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INR

A PT test may also be called an INR test.

INR (international normalized ratio) stands for a way of

standardizing the results of prothrombin time tests, no

matter the testing method.

So your doctor can understand results in the same way

even when they come from different labs and different

test methods.

Using the INR system, treatment with (anticoagulant

therapy) will be the same. In some labs, only the INR is

reported and the PT is not reported


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An INR of 1.0 means that the patient PT is normal.

An INR greater than 1.0 means the clotting time is

elevated.

INR of greater than 5 or 5.5 = unacceptable high risk ofbleeding,whereas if the INR=0.5 then there is a high

chance of having a clot.

Normal range for a healthy person is 0.91.3, and for

people on warfarin therapy, 2.03.0, although the target

INR may be higher in particular situations, such as for

those with a mechanical heart valve.


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PARTIAL THROMBOPLASTIN TIME

Measures Effectiveness of the Intrinsic

Pathway

NORMAL VALUE

25-40 SECS


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PTT

Thepartial thromboplastin time (PTT) oractivated partial

thromboplastin time(aPTTorAPTT(is a performance

indicator measuring the efficacy of both the "intrinsic"

and the common coagulation pathways.

It is also used to monitor the treatment effects with

heparin a majoranticoagulant.

Kaolin cephalin clotting time (KccT) is a historic name for

the activated partial thromboplastin time


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INTRINSIC

EXTRINSC


FIBRINOGE

N

FIBRIN(II) (III)

(I)V

X


VII

XII

XI

IX

VIII


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Normal PTT times require the presence ofthe following coagulation factors:

I, II, III, IV, V, VI, VIII, IX, X, XI, & XII


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When is it ordered?

When a patient presents with unexplained bleeding or

bruising,

It may be ordered as part of a pre-surgical evaluation for

bleeding tendencies,

When a patient is on intravenous (IV) or injection heparin

therapy, the APTT is ordered at regular intervals to

monitor the degree of anticoagulation.


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Prolonged APTT may indicate:

use ofheparin.

antiphospholipid antibody:especiallylupus anticoagulant,

which paradoxically increases propensity tothrombosis

coagulation factor deficiency ,

e.g hemophilia DIC

Liver disease


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FACTOR DEFICIENCIES

Inherited:

1. HEMOPHILIA A

2. HEMOPHILIA B

3. VON WILLEBRANDSDISEASE

Acquired:

1. Anticoagulant

therapy

2. Liver diseases

3. DIC


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HEMOPHILIA A (Classic Hemophilia)

80-85% of all Hemophiliacs

Deficiency of Factor VIII

Lab Results - Prolonged PTT


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HEMOPHILIA B (Christmas Disease)10-15% of all Hemophiliacs

Deficiency of Factor IX

Lab Test - Prolonged PTT


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VON WILLEBRANDS DISEASEDeficiency of VWF & amount of Factor VIII

Factor VIII is bound to vWF while inactive in

circulation; Factor VIII degrades rapidly when notbound to vWF

Lab Results - Prolonged BT, PTT


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Coumadins

These oral anticoagulants that antagonize the effects of

vitamin K.

Examples include warfarin. It takes at least 48 to 72hours for the anticoagulant effect to develop. Where animmediate effect is required, heparinmust be givenconcomitantly.

Monitored by PT times

These anticoagulants are used to treat patients withdeep-vein thrombosis(DVT), pulmonary embolism(PE),atrial fibrillation(AF), and mechanical prosthetic heartvalves.
http://en.wikipedia.org/wiki/Vitamin_Khttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Heparinhttp://en.wikipedia.org/wiki/Deep-vein_thrombosishttp://en.wikipedia.org/wiki/Pulmonary_embolismhttp://en.wikipedia.org/wiki/Atrial_fibrillationhttp://en.wikipedia.org/wiki/Prosthetic_heart_valvehttp://en.wikipedia.org/wiki/Prosthetic_heart_valvehttp://en.wikipedia.org/wiki/Prosthetic_heart_valvehttp://en.wikipedia.org/wiki/Prosthetic_heart_valvehttp://en.wikipedia.org/wiki/Atrial_fibrillationhttp://en.wikipedia.org/wiki/Pulmonary_embolismhttp://en.wikipedia.org/wiki/Deep-vein_thrombosishttp://en.wikipedia.org/wiki/Deep-vein_thrombosishttp://en.wikipedia.org/wiki/Deep-vein_thrombosishttp://en.wikipedia.org/wiki/Heparinhttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Vitamin_K


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Heparin

Heparin is a biological substance.

It works by activating antithrombin III, which blocksthrombin from clotting blood.

Heparin Therapy is Monitored by PTT times

Low molecular weight heparinis a more highlyprocessed product that is useful as it does not requiremonitoring of the APTT coagulation parameter (it hasmore predictable plasma levels) and has fewer side

effects.
http://en.wikipedia.org/wiki/Antithrombin_IIIhttp://en.wikipedia.org/wiki/Low_molecular_weight_heparinhttp://en.wikipedia.org/wiki/Low_molecular_weight_heparinhttp://en.wikipedia.org/wiki/Antithrombin_III


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Liver Disease

Liver Disease can Result in ReducedProduction of Coagulation Factors

(I,II,V,VII,IX,X).


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DIC

Disseminated intravascular coagulation ( DICis apathological activation ofcoagulation)blood clotting)mechanisms that happens in response to a variety ofdiseases

DIC leads to the formation of small blood clots inside theblood vessels throughout the body

The small clots also disrupt normal blood flow to organs

(such as the kidneys), which may malfunction as a result
http://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Coagulation


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As the small clots consume coagulation proteins andplatelets, normal coagulation is disrupted and abnormalbleeding occurs from the skin the gastrointestinal tract,

the respiratory tract and surgical wounds. The PT and APTT are usually very prolonged and the

fibrinogen level markedly reduced

High levels of fibrin degradation products, including D-dimer, are found owing to the intense fibrinolytic activity

stimulated by the presence of fibrin in the circulation.
http://en.wikipedia.org/wiki/D-dimerhttp://en.wikipedia.org/wiki/D-dimerhttp://en.wikipedia.org/wiki/D-dimerhttp://en.wikipedia.org/wiki/D-dimerhttp://en.wikipedia.org/wiki/D-dimer


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Definitive diagnosis depends on the result of DIC:

Thrombocytopenia)prolonged bleeding time)

Prolongation ofprothrombin timeandactivated partialthromboplastin time

A lowfibrinogen concentration

Increased levels offibrin degradation products

PlateletBleedingPartial

Prothrombi
http://en.wikipedia.org/wiki/Platelet_counthttp://en.wikipedia.org/wiki/Bleeding_timehttp://en.wikipedia.org/wiki/Partial_thromboplastin_timehttp://en.wikipedia.org/wiki/Prothrombin_timehttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulationhttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulationhttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulationhttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulationhttp://en.wikipedia.org/wiki/Prothrombin_timehttp://en.wikipedia.org/wiki/Partial_thromboplastin_timehttp://en.wikipedia.org/wiki/Bleeding_timehttp://en.wikipedia.org/wiki/Platelet_count


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Platelet

count

Bleeding

timethromboplastin

time

Prothrombi

n timeCondition

unaffectedprolongedprolongedunaffectedVon Willebrand disease

unaffectedunaffectedprolongedprolongedVitamin K deficiencyor

Warfarin

unaffectedprolongedunaffectedunaffectedUremia

unaffectedunaffectedprolongedunaffectedHaemophilia

unaffectedunaffectedprolongedprolongedFactor Vdeficiency

unaffectedprolongedunaffectedunaffectedAspirin

decreasedprolongedunaffectedunaffectedThrombocytopenia

decreasedprolongedprolongedprolongedEnd-stage Liver failure

decreasedprolongedprolongedprolongedDisseminated intravascularcoagulation

decreasedprolongedunaffectedunaffectedBernard-Soulier syndrome
http://en.wikipedia.org/wiki/Platelet_counthttp://en.wikipedia.org/wiki/Platelet_counthttp://en.wikipedia.org/wiki/Bleeding_timehttp://en.wikipedia.org/wiki/Bleeding_timehttp://en.wikipedia.org/wiki/Partial_thromboplastin_timehttp://en.wikipedia.org/wiki/Partial_thromboplastin_timehttp://en.wikipedia.org/wiki/Prothrombin_timehttp://en.wikipedia.org/wiki/Prothrombin_timehttp://en.wikipedia.org/wiki/Von_Willebrand_diseasehttp://en.wikipedia.org/wiki/Vitamin_K_deficiencyhttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Uremiahttp://en.wikipedia.org/wiki/Haemophiliahttp://en.wikipedia.org/wiki/Factor_Vhttp://en.wikipedia.org/wiki/Aspirinhttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Bernard-Soulier_syndromehttp://en.wikipedia.org/wiki/Bernard-Soulier_syndromehttp://en.wikipedia.org/wiki/Bernard-Soulier_syndromehttp://en.wikipedia.org/wiki/Bernard-Soulier_syndromehttp://en.wikipedia.org/wiki/Thrombocytopeniahttp://en.wikipedia.org/wiki/Aspirinhttp://en.wikipedia.org/wiki/Factor_Vhttp://en.wikipedia.org/wiki/Haemophiliahttp://en.wikipedia.org/wiki/Uremiahttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Vitamin_K_deficiencyhttp://en.wikipedia.org/wiki/Von_Willebrand_diseasehttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulationhttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulationhttp://en.wikipedia.org/wiki/Prothrombin_timehttp://en.wikipedia.org/wiki/Prothrombin_timehttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulationhttp://en.wikipedia.org/wiki/Partial_thromboplastin_timehttp://en.wikipedia.org/wiki/Partial_thromboplastin_timehttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulationhttp://en.wikipedia.org/wiki/Bleeding_timehttp://en.wikipedia.org/wiki/Bleeding_timehttp://en.wikipedia.org/wiki/Disseminated_intravascular_coagulationhttp://en.wikipedia.org/wiki/Platelet_counthttp://en.wikipedia.org/wiki/Platelet_count


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bleeding time, clotting time pt and ptt2

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