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Coagulation Time

Dian ayu novitasari

012116365

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HEMOSTASIS

Ada 4 fase :

1. Spasme Pembuluh darah / Vasokonstriksi(sistem vaskuler)2. Pembentukan Sumbat trombosit(sistem

trombosit)3. Koagulasi Darah(sistem koagulasi)4. Pertumbuhan Jaringan ikat(sistem

fibrinolisis)

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1. Platelet Adhesion

Platelets stick to exposed collagen underlying damagedendothelial cells in vessel wall

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2. Platelet Release Reaction

Platelets activated by adhesion

Extend projections to make contact with each other Release thromboxane A2, serotonin & ADP activating other

platelets

Serotonin & thromboxane A2 are vasoconstrictors decreasing bloodflow through the injured vessel. ADP causes stickiness

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3. Platelet Aggregation

Activated platelets stick together and activate new

platelets to form a mass called a platelet plug Plug reinforced by fibrin threads formed during

clotting process

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MEKANISME KOAGULASI DARAH

Terbentuknya aktivator protrombin akibatrusaknya pembuluh darah

Aktivator protrombin mengkatalisisrprotrombin menjadi trombin

Trombin sebagai enzim mengubah

fibrinogen menjadi benang-benang fibrin.

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Protrombin ekstrinsik

Ca2+ protrombin aktivatorintrinsik

Trombin

Fibrinogen Fibrin monomer

Ca2+

Fibrin Stabilizing Factor

Benang Fibrin

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Prothrombinase

(Prothrombin activator)

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Blood coagulation: factors involved

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Tissue trauma

Tissuefactor(TF)

Blood trauma

Damagedendothelial cellsexpose collagenfibers

(a) Extrinsic pathway (b) Intrinsic pathway

Activated XII

Ca2+

Damagedplatelets

Ca2+

Plateletphospholipids

Activated X

Activatedplatelets

Activated X

PROTHROMBINASECa2+

V

Ca2+

Prothrombin(II)

Ca2+

THROMBIN

Ca2+

Loose fibrinthreads

STRENGTHENEDFIBRIN THREADS

Activated XIII

Fibrinogen(I)

XIII

(c) Commonpathway

V

1

2

3

+

+

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Natural anticoagulants:

A. Endothelial surface factors B. Anticoagulants present in the blood which

remove THROMBIN

C. Anticoagulants may be used

1. Smoothness of endothelial wall:so has glycocalyx which

repels clotting factors

2. Protein C :inactivates

factors V and VIII

3. Thrombomodulin- a protein bound

to endothelium -combines with

thrombinto reduce clotting.

4. This combination also

activates Protein C

In patients:

i. Heparin

ii. Vit K antagonists

Outside the body:

i. Heparin

ii. Calcium antagonists

1. Fibrin itself

2. Antithrombin III

-antithrombin ( globulin)

+ heparin

-removes activated factors

XII, XI, X

-removes thrombin

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Normal coagulation time: 9-15 minutes (fingerprick method)

Clinical implications

Coagulation disorders :

i. not enough coagulations factors--?

(Hemophilia (factor VIII deficiency)

transmitted by female to males. Only males suffer)

ii. Not enough Vit K -

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PENCEGAHAN KOAGULASI

Ekstravaskular :

1. diaduk

2. didinginkan

3. + Na sitrat, K sitrat4. + EDTA

Intravaskular :

1. Coumarin , Warfarin

2. Heparin

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HEMOFILIA

Kelainan pembekuan darah

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VON WILLEBRAND

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ITP (idiophatic trombocytopenic purpura)