Firstranker's choice
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.
Firstranker's choice
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
Firstranker's choice
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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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Firstranker's choice
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
Firstranker's choice
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.
Firstranker's choice
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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
Firstranker's choice
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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
Firstranker's choice
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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Firstranker's choice
? 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
Firstranker's choice
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
Firstranker's choice
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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