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Download PG Medical 2nd Year Pathology Bleeding and Coagulation Blood Components Handwritten Notes

Download PG Medical ( Post Graduate Medical degree) 2nd Year Pathology Bleeding and Coagulation Blood Components Handwritten Notes

This post was last modified on 02 August 2021

Medical PG Handwritten Notes 1st Year, 2nd Year, 3rd Year and 4th Year (Study Material)


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No Spontaneous clotting?

due to smooth wall-glycocalyx coating

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minor cut

Bleeding stops spontaneously.

Reflex vasoconstriction!

?

alt endothelin.

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m/p/potent vasoconstrictor - urothelin>endothelin>Angiotensin

N/Factor cut. Platelet-platelet.

?

1° Hemostatic plug

?

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Platelet activated

?

PLT a-V, VIII, fibrinogen-PF-4

ß-ADP, Ca2+, Histamine, Serotonin

?

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Clotting Cascade

?

Fibrin-binds platelet.

?

Secondary Hemostatic plug.

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Coagulation pathway

Intrinsic

m/c in vitro

aPTT (30-40 s)

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XII ? XI ? IX

(Hageman)

Contact]

-vely charged Substance.

glass, silica

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Kaolin.

VIII

Ca2+

m/c in vivo

PT (11-16 s)

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VII

Tissue

Injury

Thromboplastin

(III)

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VIIa

X ? Xa

Prothrombin

Factor V+ Ca2+

Thrombin

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Fibrinogen

? Fibrin (monomer)

XIII

Polymer Fibrin

Fibrin Clot.

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Liver ? Plasmin

Clot-lysis

FDP

Routine protocols [analysis]:

1) Always use plastic syringe/vials.

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2) Blood sample should be processed within 2 Hours

Ideal ~ 30mins.

3) Storage Temp-Room temperature (20-24°c)

except

1) APLA Bodies.

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2) Factor assay 2-4c.

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schortatilet poor plasma

32. Trisodium citrate

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ESR- Westergren method - Trisodium citrate,

EDTA

Wintrobe ? Oxalat - disodium, dipotassium

CBC ? EDTA

Oxalate

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ABG analysis ? Heparin.

a) osmotic fragility

b) Immunophenotyping.

c) Leucocyte defect

Bleeding & Coagulation disorder

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minor

petechial

purpura

[mucosal bleed]

?

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Platelet disorders.

?

1) Plt. count

?

2) Bleeding Time (2-9 mins)

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Major

Spontaneous Hematoma/thigh

Haemarthrosis.

?

Clotting Factor posts (

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?

PT

aPTT

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VIII

X-linked Recessive

Bleeding times

PT (N)

aPTT-Prolonged.

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To diff-Hemophilia - A, B, C - Factor assay

VIII IX XI

2-4 C

Hemophilia-C Autosomal Recessive

? aPTT-Prolonged.

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m/c/presentation- asymptomatic

Chronic liver disease-

Bleeding time-?-thrombopoietin?

PT?; aPTT-?.

DIC - Consumptive Coagulopathy.

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Plt Count-?; BT?; PT?; aPTT?.

Sfibrinogen ?; FDP-?.

m/Sensitive - FDP?

m/Specific - D-dimers.

Best inv

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Platelet Disorders

Quantitative

Megakaryocytic Amegakaryocyte

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Immunogenic

Non-Immi.

Immunogenic

Ab-mediated

- ITP

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-autoimmune disorders.

- SLE/HIV

Qualitative

? Plt-count-

Function-defective

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? BT-?

?BNT-abnormal-Bernard Soulier

- Glanzmann thrombasthenia

No platelet - Von Willebrand disease"

eg-Aplastic Anemia

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megaloblastic An-

Leukemia/lymphoma.

Invading BM.

Non-Immunogenic.

? HUS

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?ITP

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Fibrinogen

Secdagen

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Gp-II b-IIIa

nof? Weibel palade bodies.

Adhesion. platelet with vessel wall / Ib-vWF

Aggregation-platelet to platelet aggregation

Platelet aggregation Test ADP, Collagen, epinephrine

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aliafibrinogen

Ristocetin adhesion Test

Ristocetin (drug banned for clinical use)

?

Blood

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?

GPIb

+

vWF

? RAT -ve - Abnormal

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GPIb

Absent

nof

?

adhesion

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RAT +ve

?

normal.

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?AR

? Plt-adhesion deficiency

GPIb-16 ?

Lab- BT ?

PT (N)

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aPTT (N)

?RAT-negative (abnormal)

? Platelet aggregation Test- C A/C/E- normal

2) vWF i) adhesion

ii) vWF stabilization (of Factor VIII)

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BT-?

PT-N

aPTT- elevated

RAT-negative.

PAT- normal

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vWF: 20 Subtypes

Type I vWD (m/c)

m/c-AD inheritance

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?AR.

?Gb2b/III a

? Newborn baby with umbilical cord stump bleeding

? PT, aPTT-N Factor-XIII

umbilical cord stump PT, aPTT-N

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bleeding- GT> Factor XIII m/c-asymptomatic

GT- lin Ilac Bleeding from stump Rare

Lab: Bleeding time-? Incidence-?-1m/35/ac

PT, aPTT (N)

RAT - positive (N)

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Platelet aggregation Study with ACE - Defective.

ITP HUS

ADAMTS 13 ?(Flowcytometry) (N)

vWF-metalloprotease. Typical (D+) Atypical D-ve

No degradation of vWF <2yus adult

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? -infective non infective.

plt aggregation ? thrombosis: diarrhea. nodralutioen

i) Platelet ? m/c E.coli m/c Cause-

0157:H7. complement factor def

Factor H

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ii) microangiopathic Verotoxin ? pregnant female

- a/w! Autoimmune,

Hemolytic anemia - Shigella

Renal failure Rare-Streptococcal Disseminated malignancy

iv) CNS Neurological Pneumoniae Lung Pentad of TTP

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v) Fever infections

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ABO blood group- Chalmosome-9

Co-Dominance

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H-gene

?

Fucosyl Transferase.

Fucose + Glycolipid.

?

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H-Substance-

?

N-acetylgalactosamine galactose Both H-ag

? ? ?

'A' antigen. 'B'antigen AB NO A/B

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? ? ?

Group A. 'B'group. AB O

Sa. anti-B anti-A No Ab Both antiA,

Ab anti-B./1

ABH Antigens ? RBC,

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Serum,

Saliva.

Secretors Semen

except CSF Urine

gastric Juice

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? No 'H' gene

?AR pattern - hh

?Resembles O Blood group-:: Oh.

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? No h gene ? No. A, B, H antigen on RBC Surface

Serum-Anti-A, Anti-B,

Antibodies Anti-H

? Non-Secretors. Transfusion

Bombay Blood group? Same group only

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Storage Shelf life

Whole Blood 2-6°C 42 days

RBC s.

Components Platelets - Room Temperature 5 days

of WB continuous agitation

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FFP -18°c) 1 year.

Cryoprecipitate lower.

?WB Start within 30 minutes. ? Bacterial Contamination

? PRBC within 4 Hours.

Size of needle-18-17 Gauge

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Transfusion sets (filter size) -170nm

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Infection Transmit blood components

Malaria Trophozoites are very strong

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Multiple dot factor deficiency 77p

Cryoprecipitate- VWD, Hemophilia A,

Afibrinogenemia

Components-

?VWF

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?VIII

?Fibrinogen

?XIII

m/c Transfusion Reaction Febrile non-Hemolytic Transfus

Reaction.

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Leucocytes cytokines.

m/c Cause of Death: -TRALI

within 6 Hows of Blood Transfusion

m/c a/w TRALI- plasma >77p

Massive Blood Transfusion. 1) Transfusion of >1 Blood volume

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within 24 Howrs.

2) >50% Blood volume within 4 Hous

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Citrate ? HCO3

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Metabolic alkalosis

?) Hypocalcemia (Citrate complex with Ca2+]

iii) Hypothermia

iv) Hypokalemia

m/c Cause of death-massive Transfusion - Dilutional

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coagulopathy

1) Acid Citrate Dextrose [ACD] - 21days

2) CPDA ? 21 days. Phosphate act as buffer

3) CPD-A ? 35 days

4) SAGNT - Saline, adenine, Glucose, mannitol- 42 days

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(m/c used) nutrition

Citrate-Ca2+ chelater; Prevents clot formation.

Adenine ? ATP: RBC membrane Stabilization, Shelf life of

RBC.

Saline ? Tamaintain isotonicity of RBC.

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Platelet- most prone for Bacterial contamination

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