HEMATLOGY 2

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UIC-MLS
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Clinical Hematology
Prelim Topic 2- ADDITIONAL NOTES

[TRANS] TOPIC 2: PRIMARY HEMOSTASIS

FORMATION OF PRIMARY HEMOSTASTIC PLUG

OUTLINE  Platelet lang ang makakagawa. Kapag mababa ang
1) PROCESS OF HEMOSTASIS
A. Vascular Spasm platelet, magbibleed
B. Platelet Plug Formation ACTIVATION SECONDARY HEMOSTASIS
C. Blood Clotting  Key component ng secondary hemostasis ay
2) ROLE OF PLATELETS coagulation factors (kailangan pa din ang platelet)
3) VASCULAR INJURY
4) OVERVIEW OF PRIMARY HEMOSTASIS without the primary hemostasis, without the activated
5) LOCAL VASOCONSTRICTION platelet, hindi mangyayari ang secondary
6) PLATELET PLUG FORMATION ACTIVITY HEALING
A. Platelet Adhesion  Platelets have special role in the healing process,
B. Platelet Activation
C. Platelet Secretion final repair and the final process of fibrinolysis
D. Platelet Aggregation VASCULAR INJURY
 Serotonin and thromboxane A2 (TxA2) for
PROCESS OF HEMOSTASIS vasoconstriction
 Blood clot formation is being achieved if there are  Prostacyclin PGI-2 for arteriole relaxation to increase
clotting factor, platelet, and fibrin including the red blood flow
blood cells that clogs the damage in the blood vessel.  Exposure of basement membrane and collagen
 Following an injury to blood vessels several actions (negatively charged surface)
may help prevent blood loss, including: OVERVIEW OF PRIMARY HEMOSTASIS
VASCULAR SPASM  First, kapag may vascular injury, serotonin and
 Kapag nasugatan, may usual na nangyayari. First thromboxane A2 will be released from the damaged
one to happen ang Vascular Spasm, kapag may vessel and it is the signal for the blood vessel itself for
vessel injury, mayroong contraction (that’s vascular vasoconstriction. Siya ang nadamage, siya ang
spasm) para mabawasan ang blood flow papunta sa magrerelease ng bagay, at siya rin ang makakakuha
damaged vessel. Ang involve o requirement for ng signal para magkaroon ng vasoconstriction (is the
hemostasis ay platelet at endothelial cells.] vascular spasm) to decrease the flow of blood
 Result or End Product: Decreased blood flow, towards the damaged vessel
decreased escape of blood from the blood vessels.  Collagen and basement membrane will serve as
[Hindi tumigil, nabawasan lang. negatively charged surface para kumapit sa kanila
PLATELET PLUG FORMATION yung platelet at matakpan ang sugat
 Second activity na nangyayari. Kapag may injury FORMATION OF PLATELET AGGREGATE
naaactivate ang platelet at magfoform ang temporary  Injured blood vessel releases ADP, which attracts
or primary platelet plug platelets (PLT)
 Hindi narereconstruct ang blood vessel kasi o First step, there will be an injured blood vessel,
temporary platelet plug palang kapag na-injured ang blood vessel,
 Result or End Product: Bleeding stopped and the end magrerelease ‘to ng ADP.
product is primary platelet plug. o Serotonin and Thromboxane na galling sa
BLOOD CLOTTING damaged vessel para sa epithelium mismo.
 Will happen after the process of coagulation Prostacyclin o prostaglandin para sa epithelial
 Result or End Product: Fibrin meshwork, Fibrin cells. ADP(?) para naman kay platelet. Kaya
Network. Bleeding stopped and there’s a permanent sabay na narerelease ang ADP, serotonin, at
platelet plug. thromboxane
 Hindi mangyayari ang formation of platelet plug o [The ADP na narelease ang marereceive ng
without the collagen fibers. Because the collagen signal ay ang platelet para ang malayo na
fibers are the site kung saan kakapit ang individual platelet ay pupunta sa kaniya. For arteriole
platelets during the primary hemostasis. relaxation, to increase blood flow, yung
ROLE OF PLATELETS vasoconstriction o vascular spasm ay para
SURVEILLANCE FOR VASCULAR INTEGRITY mabawasan ang blood flow ppaunta sa
 Major actor is the platelet. Dahil sa sobrang dami ng damage vessel para hindi maghemorrhage.
substances na pinoproduce at nirerelease ng platelet This time, ang arteriole relaxation ay para
tulad ng antithrombotic property, platelet factors, at marelax ang arteriole – to increase blood flow
laman ng granules na (ito yung ginagamit) sa towards the damaged area para yung mga
vascular integrity platelet na nakareceive ng signal ay kumapit sa
kaniya.

PADAYHAG, RIGIDOR S. | MLS-3D 1

 HEMATLOGY
Clinical Hematology UIC-MLS
2
Prelim Topic 2- ADDITIONAL NOTES

 PLT coming in contact with exposed collagen release: o Platelet-derived Growth Factor (PDGF)
serotonin, ADP, TXA2, which accelerate o vWF o Permeability Factor
vasoconstriction and causes PLT to swell and o Fibrinogen o
become stickier. o Factor V
o Ang platelet swelling at sticky ay tinatawag na o Fibronectin
platelet activation. Nangyayari ang plt  DENSE Granules – important for Platelet Aggregation
activation after niya mag-bind with the exposed o Magnesium
collagen o Phosphate
o Paano nagbabind sa exposed collagen? o Calcium
Dumidikit ang platelet sa Von Willebrand Factor o ADP & ATP
LOCAL VASOCONSTRICTION o Serotonin / hydroxy tryptamine
 Due to local spasm of the smooth muscle (symp. o Epinephrine
Reflex)  LYSOSOMES – contains acid hydrolases
 Can be maintained by platelet vasoconstrictors. AGGREGATION
o Ang platelet vasoconstrictors ay ang serotonin,  After platelet secretion, another platelet will bind with
thromboxane, at ADP the platelet na nag-adhere kaya magkakaroon ng
 First activity na nangyayari kapag nagkakaroon ng platelet aggregation.
sugat ay ang vascular spasm or vasoconstriction.  Use of GP – For aggregation, Glycoprotein IIb and
PLATELET PLUG FORMATION ACTIVITY IIIa ang gamit na nagbabind with another platelet.
 Four steps na mangyayari para makapagproduce ng Nagbabind with another platelet kasi may
platelet plug aggregation na dapat may mediator sa gitna. It is
 Damaged blood vessel, na-expose ang collagen, either a fibrin or fibronectin. Technically, hindi sa
nag-iintay ang vWF, nagrelease ang endothelial cells platelet nakakapit kundi sa fibrin or fibronectin that
ng kaniyang platelet stimulator tapos pupunta ang makes the activated platelet sticky.
platelet sa site  Tested using Platelet Aggregometry
ADHESION  Using platelet-rich plasma + aggregating agents
 Ang unang mangyayari kapag pumunta na ang  If aggregation occurs, PRP (Platelet Rich Plasma) will
platelet sa site. Didikit siya sa damaged vessel change from turbid suspension to one that transmit
through the collagen specifically on the Von light
Willebrand Factor. o Hindi katulad ng clear plasma dahil ang clear plasma
 Adhere to the foreign body – para sa platelet, ay platelet poor dahil kakaunti ang platelet niya.
collagen fibers are foreign body. Pwede din Kapag nag-centrifuge, in 15 minutes when the cap is
on at clear ang plasma na makikita, kasi ang
magadhere sa bacterial wall. Kapag pumasok ang
uppermost portion ng RBC na settled, nandun ang
microorganism, made-detect ng immune system na platelet. Pero kapag platelet rich plasma, ang
foreign. Isa sa mga paraan para ma-eliminate ang platelet ay kasama mismo sa plasma that will make
foreign body is to be clotted. Ibabalot ng clot by the normal plasma turbid. Kaya PRP ang ginagamit.
platelet at pwede siya mag-adhere thru platelet If pagkalagay ng aggregating agents, ang
clump. By that, mae-enclose ang foreign body na aggregating agents ay may kasamang fibrin. Ang
pumasok. mangyayari sa platelet ay magkaclump at
 Dependent to GP (Glycoprotein) – [Glycoprotein 1B mababawasan ang turbidity. Visible lang ang clumps
ang kailangan ng platelet na dumidikit sav WF.] of platelet.
 Initiated by exposure to subendothelium collagen o Kapag nabawasan ang turbidity, more light will be
transmitted. Kapag tumaas ang transmittance, it
ACTIVATION means nag-aggregate ang platelet
 After the adhesion, magsisimula na mag-activate ang o Platelet aggregometer measures and records a
platelet at magkakaroon ng change of shape. Kapag change in transmission Note: Patient is fasting and
nag-change of shape, maeexpose na ang platelet has a fat-free meal Patient should not take in
granules. After ma-expose, magse-secrete ang aspirin or NSAID’s
platelets ng kaniyang components.  Test for primary hemostasis, bleeding time.
 Change in shape  Test for platelet is enough for aggregation, platelet count.]
 Granule Secretion [If the platelet count is normal and bleeding time is high, and
SECRETION the transmission of light is also normal, the problem will be
 pagkatapos ma-activate ang platelet, lahat ng the aggregation of platelet.]
components ay ise-secrete ng platelet
 ALPHA Granules "The greatest glory in living lies not in never falling,
o PF4 (Plt Factor IV) but in rising every time we fall."
o Beta-thromboglobulin -Nelson Mandela
o Thrombospondin
LABAN FUTURE RMT!

PADAYHAG, RIGIDOR S. | MLS-3D 2