止血与血栓PPT课件

Examination of Hemostasis & Thrombus

Mechanism of Hemostasis

小血管、微血管(smll vessel)

血小板(Platelet)

凝血系统(Coagulation Protein System)

抗凝系统(Anticoagulation Protein System) 纤溶系统(Fibrinolysis System)

抗纤溶系统(Antifibrinolysis System)

1. Hemostasis

Coagulation Activation BV Injury

Platelet Activation Plt-Fusion Blood Vessel

Constriction

Stable Hemostatic Plug

Thromibin,

Fibrin

Reduced

Blood flow Tissue Factor

Primary hemostatic plug Neural

Capillary Wall

止血的过程Platelet System：

粘附功能（Adhesion）

聚集功能

（Aggregation）

释放功能

（Release）

5

Contact Tissue Factor + VII XIII a XIII Thrombin

Fibrin

(strong)Fibrinogen Fibrin (weak)IX XI

XI a

IX a X a V a

XII a Prothrombin TF-VII a (Prothrombinase)PL PL

(Tenase)

VIII a PL X Intrinsic Pathway

HK a

Extrinsic Pathway Common Pathway TF Pathway

Coagulation Pathways

Protein C, Protein S, Antithrombin III

凝血的过程

内源性凝血Intrinsic

XIIa

XIa Xa III VIIa

Ca 2+VIIIa

Ca 2+

IXa PF3

Va PF3

Ca 2+外源性凝血Extrinsic IIa Ia Ib XIII

FDP

（四）Anticoagulation System：

1、from Cell：Monocytes-Macrophage cells

2、from tissue：AT-III、Protein C、Protein S、TFPI。

1) AT-III: II，IX，X，XI，XII et al

2) PC, PS：Va, VIIIa et al;

3) TFPI (tissue factor pathway inhibitor)

（五）Fibrinolysis and Anti-fibrinolysis

◆Plasminogen activator：XIIa，IIa，HMWK，prekallikrein，uPA，tPA，PL

◆Anti-fibrinolysis：PAI, a2-AP

coagulation Fibrinolysis

vessel

platelet

Anti-coagulation Anti-fibrinolysis

Homeostasis

止血与凝血性疾病的分类

血管因素

血小板数量和质量异常

凝血因子异常

纤溶蛋白溶解亢进

病理性循环抗凝物质增多

实验室检查 （一）血管壁的检测CRT，BT

（二）血小板的检测PLT

（三）凝血因子的检测CT,APTT,PT

（四）抗凝物质的检测TT，AT-III

（五）纤溶系统的检测3P, D-dimer

（一）血管壁的检测

1、Capillary fragility(resistance) test, CFT/CRT 【Diseases】petechia or blood points

1)、Abnormal structure or function of vessel wall: e.g.

allergic purpura, hereditary hemorrhagic

telangiectasia(HHT)

2)、Platelet disease: ITP

3)、von Willebrand’s Disease

2、Bleeding Time

【Diseases】BT prolonged

1）Low count of Platelet: e.g. ITP

2）Dysfunction of Platelet: e.g. Thromasthenia 3）blood vessel diseases: e.g. HHT(hereditary hemorrhagic telangiectasia)

4）anticoagulation drugs:aspirin

（二）Platelets count

【Reference value】（100～300）×109／L 【Diseases】

1）Thrombocytopenia：e.g. ①generation reasons: AA；②destruction or consumption: ITP, SLE, DIC、tumors;③distribution: liver cirrhosis

2）Thrombocytosis：e.g. Thrombocytosis(CML)