haemostasis & blood groups

Haemostasis & Blood Groups

• Presented By – • Prof.Dr.R.R.Deshpande • (M.D in Ayurvdic Medicine & M.D. in

Ayurvedic Physiology)• www.ayurvedicfriend.com• Mobile – 922 68 10 630• [email protected]

10/4/2017 1Prof.Dr.R.R.Deshpande

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Haemostasis


Contents of this PPT

• 1) What is Haemostasis ? 3 Steps in Blood Clotting

• 2) 13 Clotting Factors • 3) Process of Blood Clotting –Intrinsic &

Extrinsic Pathway • 4) Blood Group --Landsteiner’s Law• 5) Types of Blood Groups • 6) Importance of Blood Groups

10/4/2017 Prof.Dr.R.R.Deshpande 3

Haemostasis

• Haemostasis means stoppage of bleeding.• Process of clotting of blood• It consists of following 3 steps –

• i) Vascular spasm. • ii) Platelet plug formation.• iii) Clotting


Coagulation factors - Total = 13

• 1) Fibrinogen • 2) Prothrombin• 3) Thromboplastin ( Tissue Factor) • 4) Ca++• 5) Labile Factor or Proaccelerin • 6) 6th factor - Not named (Presence has not

been proved)


Coagulation factors - Total = 13

• 7) Proconvertin ( Stable Factor) • 8) Anti haemophilic factor A • 9) Christmas factor • 10) stuart Prower Factor• 11) Anti haemophilic factor C ( Plasma

Thromboplastin Antecedent ) • 12) Hageman factor ( Contact Factor) • 13) Fibrin stabilizing factor.( Fibrinase) 10/4/2017 Prof.Dr.R.R.Deshpande 6

Intrinsic Pathway

• Intrinsic Pathway for the Formation of Prothrombin Activator –

• In this pathway, the formation of prothrombin activator is initiated by Platelets, which are within the blood itself


Extrinsic Pathway

• Extrinsic Pathway for the Formation of Prothrombin Activator –

• In this pathway, the formation of prothrombin activator is initiated by the tissue Thromboplastin, which is formed from the injured tissues.


Clotting Process


Applied Part

• Investigations for Haemostasis• Normal values –

• B. T. = 2 - 3 min.• C. T. = 4 - 9 min.

• P. T = 10 - 25 sec. (P. T. = Prothrombin Time)


Why B. T. < C. T. ?

• B. T. is time interval between skin puncture and arrest of bleeding. Bleeding is arrested quickly by vascular spasm and platelet plug formation.

• C. T. is interval between skin puncture and formation of clot. Formation of clot occurs by Multiple reactions (Enzyme cascade) and so, it takes a longer time


BT -- When High ?

• Conditions in which B. T. ↑

• Thrombocytopenic Purpura and vascular purpura.

• Normal Thrombocyte or platelet count = 2.5 to 4. 5 laks/cmm


Conditions in which C. T. ↑

• Haemophilia - Due to lack of Antihaemophillic Globullin (Factor 8 and 11)

• Obstructive Jaundice - Because in absence of Bile, vit. K is not absorbed from Intestine.

From vitamin k - Pro - thrombin is synthesized. Due to deficiency of prothrombia, clotting will be delayed.


Conditions in which C. T. ↑

• Liver disease (Cirrhosis, cancer) - Due to disturbance of Prothrombin and fibrinogen forming functions of liver

• New born baby - Due to low prothrombin level, during early days of life


When BT ,CT is done ?

• 1) Pre Operative

• 2) When we suspect any bleeding disorders

• 3) Before Panchakarma –Leech Application for Raktamokshan or blood letting


Blood Group


Blood groups

• Landsteiner’s Law

• Antibodies present in plasma is of opposite type as that of Antigen on RBC


Blood groups


Blood Group Importance

• i) Before Blood transfusion → Grouping and Cross matching of donor and Recipient

• ii) Identifying paternity• iii) To identify criminals

• iv) In Rh – ve, pregnant lady, to avoid the problem of Erythroblastosis foetalis.


Erythroblastosis foetalis

• First one should know that anti D antibodies do not exist naturally.

• They are produced

• a) Only by Rh – ve person• b) When Rh +ve Blood is given to him.



• Now in Rh – ve lady, if Rh +ve baby in uterus. At birth +ve cells of baby escape to mother.

• Mother develops anti -D antibodies• (First baby may escape from complications).

Antibodies remain in circulation of mother. • When next pregnancy occur and the child is

Rh+ve, then in the child’s blood Rh Antigen of self and Rh antibodies coming through mother’s blood, will react with each other.



• Haemolysis occurs, Jaundiced baby. If reaction is severe, Miscarriage, Abortion also can occur.

• In this type of High Risk Pregnancy – Anti D Inj. is given to mother, to avoid sensitization by foetal blood.


Other Blood Groups

• LEWIS BLOOD GROUP --first found in a subject named Mrs Lewis.

• The antigens, named Lewis antigens are formed in the tissues, released in the body secretions and then absorbed by the RBC membrane.

• These antigens are also known as secretor antigens.


LEWIS BLOOD GROUP

• Presence of Lewis antigens in children create complications like retarded growth.

• Also it can cause transfusion reactions .


MNS BLOOD GROUPS

• Determined by their reactions with anti-M, anti-N and anti-S.

• But rarely cause any problem like hemolysis following transfusion


Different Blood Group system

• Diego group• Bombay group• Duffy group• Lutheran group • P group• Kell group


What is cross matching of blood ?

• Blood is collected from donor and recipient. Plasma and red cells are separated in each.

• Then Donor’s cells are mixed with Recipient’s plasma (major cross).

• Recipients cells are matched with Donor’s plasma (minor cross).

• This is called cross matching. • If there is No Agglutination - in either of the

cases above, recipient can safely receive donor’s blood.


Hazards of mismatched blood transfusion

• 1) Agglutination of Donor’s RBC in recipients circulation

• 2) Agglutinated cells may block certain vessels, leading to Tissue Ischaemia

• 3) Agglutinated RBCs get haemolysed - leading to greater breakdown of Hb and greater formation of bile pigments - causing “Haemolytic Jaundice”


Hazards of mismatched blood transfusion

• 4) Haemolysis of RBC also causes Haemoglobinaemia (increased amount of circulating Hb in blood).

• This free Hb gets excreted into renal tubules, forming Acid Haematin, which blocks renal tubules - Anuria or renal shutdown - uraemia - shock - unconsciousness - may be lethal (if untreated).


Distribution of Blood Group


Donor & Recipient

• O Group - Universal donor• AB Group - Universal recipient• Why O - Universal donor ?• Because their RBC do not carry any Antigen (so

no problem of Antigen - Antibody reaction)• Why AB - Universal recipient ?• Because No Antibodies in their serum.• (So no problem of Antigen - Antibody Reaction)


Susceptibility to disease

• i) Group A - Diabetes, cancer of stomach

• ii) Group O - Peptic ulcer


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