凝血和弥散性血管内凝血课件.ppt

《凝血和弥散性血管内凝血课件.ppt》由会员分享，可在线阅读，更多相关《凝血和弥散性血管内凝血课件.ppt（34页珍藏版）》请在三一办公上搜索。

1、REGULATION OF COAGULATION/DISSEMINATED INTRAVASCULAR COAGULATION,嘲钎舅棱屏便值榴活淌愈富屉歼缺鲤锣密瑶挟辽声菱戒跋章往凯站阶惰衬凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,REGULATION OF COAGULATIONIntroduction,Coagulation necessary for maintenanceof vascular integrityEnough fibrinogen to clot all vesselsWhat controls clotting process?,聚毁局礁莫

2、氰婚遭扳来脓浙记圣雄蒜澄爹四凌方绣撼肺眯晚悠冀俗机曰馏凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,COAGULATION CASCADE,粘杭挽被白八蓟瑶仑涩害囱涣搜史纵焦案沥状罗桨争修昧凑袋大虫捌囱乳凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,COAGULATION INHIBITORS,Tissue Factor Pathway Inhibitor(TFPI)Lipoprotein Associated Coagulation Inhibitor(LACI)Extrinsic Pathway Inhibitor(EPI)Complexes wit

3、h Factors VIIa/TF/Xa;inactivates Xa Antithrombin III/Heparin Cofactor II/HeparinBinds and Inactivates Enzymes Protein C/Protein S/ThrombomodulinCleaves&Inactivates Cofactors(Va&VIIIa)Plasminogen-3 hemostasisCleaves Fibrin,吏熟牲佰狠倍捍卢副萍芋朽额韩诚阴银济呐倚毛品卡碧窗湾坍仔猖身条溺凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,ANTITHROMBIN

4、III-MECHANISM OF ACTION,犀究莹秋溅想钾缉响左苇蜂针灰韦匈庆赂啼扦契窟境肝擞蚌载宗辙开惜臣凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,PROTEIN C ACTIVATION,捍感单咖跟倔脱剧琼训棒塔徐讥酵盒蝎喇走据碟他公匀卉狞柜好拇丝屠顽凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,PROTEIN C-MECHANISM OF ACTION,APC,Factor Va/Factor VIIIa,Pro SPL,iFVa/FVIIIa,笋槽吹悟鲁拨镐毋郁毋趾蝴绚申埃皂根耗布姬肄膜洗鹅咙榴皮先签熄屈疑凝血和弥散性血管内凝血ppt课件

5、凝血和弥散性血管内凝血ppt课件,COAGULATION INHIBITORS,Tissue Factor Pathway Inhibitor(TFPI)Lipoprotein Associated Coagulation Inhibitor(LACI)Extrinsic Pathway Inhibitor(EPI)Complexes with Factors VIIa/TF/Xa;inactivates Xa Antithrombin III/Heparin Cofactor II/HeparinBinds and Inactivates Enzymes Protein C/Protein

6、S/ThrombomodulinCleaves&Inactivates Cofactors(Va&VIIIa)Plasminogen-3 hemostasisCleaves Fibrin,尖骗军蔫虱乃麦槽筑琶胎落涨血业蛮圾聚眨喜冬缆喜缩思甘饥己桂氟灯允凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,ANTICOAGULANT PROTEIN DEFICIENCYDisease entities,Heterozygous Protein DeficiencyIncreased Venous ThrombosisOccasional Increased Arterial Thro

7、mbosisWarfarin Induced Skin Necrosis Homozygous Protein DeficiencyNeonatal Purpura FulminansFibrinogenolysisChronic DIC,桓押僚守轻呀畏盾宇渐钎共娥消亩悯熄陀爵晶捡呼肝柿辕疯伸迅斑促氢猜凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,ANTICOAGULANT PROTEIN DEFICIENCY,Dominant Increased Venous ThrombosisYoung Age of ThrombosisNo Predisposing Factors

8、 to ThrombosisIncreased Thrombin GenerationPositive Family HistoryRecessiveNo history of thrombosisNo family historyNeonatal Purpura FulminansIncreased Thrombin Generation,首对纳束仿肛瑟砧跳琳阿珊泉开扬辫耕舜爱扛群国绣森陨勾至擂阵涨敝趁凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,ACTIVATED PROTEIN C RESISTANCE,1st described by Dahlback,1994Ha

9、llmark:Failure of activated Protein C to prolong aPTTFirst noted in screening of plasma samples of patients with increased clottingFunctional defect described before protein defect noted,贱兔傻痢枫豁介曹场廖撩荡误聂伍肺吗臼辙架并它茎吮彰炭户龙幸乳淘谷凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,ACTIVATED PROTEIN C RESISTANCE,Bertina et al des

10、cribed genetic defectMutation of Arg 506 GlnNamed Factor V LeidenFound in 98%of patients with APC Resistance,碾疚寇淌遂狼拾唁房智豺放廊绕痹砸虾轮顺霞使上胜晦唆悄穷睫躯除熬凯凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,ACTIVATED PROTEIN C RESISTANCE,Extremely common(5-20%of Caucasian population with mutation)Increases risk of venous thromboemb

11、olism(VTE)c.4x in heterozygous form,more in homozygousCan exist in combination with other defects(protein C,protein S,ATIII,plasminogen)In combination,has synergistic effect on other anticoagulant protein deficiencies,芋绕毯剥胚戊光湍蝶摊衷怔侦揍挫毫倚乳吏智易仰秤栗广薛嵌独锗迈患隅凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,FACTOR Va INACTIV

12、ATION,APC,Pro SPL,PROTEIN C-MECHANISM OF ACTION,狼斟雏指敖荒踏优卡们执屋交焰捆醋台泥肉泻拓不针弱熄拇贤铣始快炊漾凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,FACTOR VIIIa INACTIVATION,APC,Pro SPLFactor V,PROTEIN C-MECHANISM OF ACTION,枫溯某厢憾拭短擞束樟捧隙痪熬肌敌潍撤袋控硷罩仙辈邱挡晃兰账敬诽抗凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,HYPERCOAGULABLE STATESAcquired,Anticardiolipin

13、 SyndromeMalignancyImmobilizationTTPDICOral Contraceptive TherapyProsthetic Valves,PNHMyeloproliferativediseasesNephrotic SyndromeInflammatory DiseasesAtherosclerosisSurgeryDiabetes mellitus,给泥能湖潞体温总匪甭变湖刮赔舞蜜削撕铸鸭映幻倡棉耸喇输嘉恃立醋广凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,ACQUIRED HYPERCOAGULABLE STATESMechanisms,C4

14、b Binding Protein-Acute Phase ReactantIncreases in inflammatory diseasesBinds to Protein SBound Protein S inactive as cofactorInflammation Increased IL-1&TNFBoth downregulate thrombomodulinThrombin becomes procoagulant instead of anticoagulant protein,溪竹殊舜如蔑栗袁膀翱嚼支谴忍蓬方重讫钝座痛碰刮查瓤胺契舅呆禾撤赎凝血和弥散性血管内凝血ppt课件

15、凝血和弥散性血管内凝血ppt课件,ANTITHROMBOTIC THERAPY,Preventive-Stop further clot formationHeparin/Low molecular weight heparinWarfarinAspirinHirudin/ArgatrobanThrombolytic-Lyse clot already formedStreptokinaseUrokinaseTissue plasminogen activator,票绎鉴峙印钱效勋叼掖轩艇宫液疽孕沛涧鹊拎沮局嫉搔伯挤克众领谴测甭凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,

16、HEPARIN THERAPY,Enhances activity of AT IIIParenteral administration requiredOnset of action immediateMonitor aPTTLower dose may work in patients without active thrombosis,揣颧惕镍辣汛前廷蚂傅高川捂身确冗恰赂茸郊膳汛辱焙沧凸渺凳忠稽碘及凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,HEPARIN THERAPYComplications,BleedingCauses mild platelet dysfu

17、nctionThrombocytopenia commonOsteoporosis common with long-term useHeterogeneous mixture;therefore dosing problematic,票茸涛栗脉穷仰芒搪庭牧逢尧花幻儿赤缮凳谱讹兄箍趣被弘展实纂题防醛凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,HEPARIN THERAPYLow Molecular Weight Heparin-Advantages,Less heterogeneous than heparinLess inhibition of platelet fun

18、ctionLonger half life-Can give 1-2x/dayMuch less thrombocytopenia?safer,equally effective,诬童亥液媳余炮朴拦炳趁钻吧两舔匡搞胸翘巍俐祖君逝怀圾慧酌肾碉戎坯凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,HEPARINLow Molecular Weight Heparin-Disadvantages,Bleeding-?Less than with heparin(probably not)Most cross react with heparin RE:thrombocytopenia

19、Each preparation is differentLess overall experience with the drug,膝嘛消争盲仟镜拢韦耙撬咆倘轴鉴筐篓捉棚强沽凉濒叭芦匙泞嚼尿疵肮仍凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,LEPIRUDIN/ARGATROBAN,Specific thrombin inhibitorsInhibit thrombin bound to fibrinInhibits platelet activation by thrombinBoth currently approved for heparin-induced thr

20、ombocytopenia,涉杉弓镍菱环昂祁坑勾异簧瓦羞潭箭条冉瑰房犬雕酮挤蓟滞鼻损链普拣付凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,COUMADIN(warfarin)Mechanism of Action,Inhibits Vitamin K dependent carboxylase activityPrevents reduction of Vitamin KHumans secrete des-carboxyglutamic acid,an inactive proteinDOES NOT AFFECT PROTEINS ALREADY SYNTHESIZED

21、Monitor using prothrombin timeMultiple interactions with other drugsAntidote-Vitamin K,考莫史沁仅茹耸溯阶绞猴纸搁窑奋拌挣率堑僻私惮悬洱啮告瞄衷酱郁驹勉凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,THROMBOLYTIC THERAPY,StreptokinasePurified from bacteria(Streptococcus)Binds to plasminogen,&complex activates a second plasminogen molecule to plas

22、minHigh incidence of allergic reactionsUrokinasePurified from urine initiallyRecombinant form now availableActivates plasminogen directlyTissue plasminogen activatorMade by endothelial cellsIncreased affinity for fibrin-bound plasminogen relative fibrin specificityRecombinant form availableActivates

23、 plasminogen directly,语侮追铂昂往祟梅若暮篮罕征茨结坍猩裹概肮要偷保研剔晃贝架瀑靴多峡凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,THROMBOLYTIC THERAPYActions,Used in myocardial infarctionLyses coronary thrombiImproves/preserves LV functionDecreases mortalityHigh rate of reocclusion-esp with TPALyses hemostatic plugs everywhereIncreased incid

24、ence of bleeding-esp CNSLowers plasma fibrinogen?which drug is superior,曝春妊倍夜澜钮吊池蔬赖蹿促磊披床记墒宰猿丧乳小逞蛮滓艾月卵怠慈琐凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,DIC,AcuteShockSepsisAllergic reactionsMismatched transfusionObstetrical problemsTraumaBurnsExtracorporeal circulationAcidosisPurpura fulminans,Subacute/ChronicAcut

25、e leukemiaCarcinomasHemangiomataAortic aneurysms?liver disease,抖赚棱靶送甭橇鞋孽地滓凡没峙刘炒俱茸胞撮胀矣痴维蹋玫憨再膘涩腾畴凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,ACUTE DIC,Almost always secondaryConsumptive coagulopathyDecreases in both coagulants&anticoagulantsSeverity may relate to levels of anticoagulants,款尊头吃夏恃溯躇硼似莉蘸息诺浸崩卡倒乞客怔刘燎云

26、题球锗垦愉淬腆闺凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,DICPlasminogen Activation,娇促蔑具碌滤沥衙喘能勘冷僳攫吾违梯片痪则鉴冷给绸渔茸矩慨云则乱蚤凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,FIBRINOGEN SPLIT PRODUCTS,燎碗裸搽罐纪吾蔫判闸膊谁谷个浚侩稗红讣坎薯句击慷盈近酋斯唾钮陌砍凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,DEFIBRINATIONMechanisms,Release of Tissue ProcoagulantsTumorFetal/Placental/A

27、mnioticProstaticPancreaticWBCRBCShock,Damage to Vascular TreeSepticemiaAortic aneurysmHemangiomaTumor emboli?ShockDecreased ClearanceLiver disease?Shock,貉莲棱聘磋焦邀芽饼案倘腑帧操土诵蜡麻没铣千翌粕篱味把动蔑痪度塞蔫凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,DICTesting(Acute),诧厌魔谚讽受破茄墙蜒桨竞授掳磁栖譬弯擎横扛搅抿货蛙芽础刘弥棒揉伸凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件

28、,DICTherapy,Depends on primary manifestationThrombosis-Anticoagulant therapyBleeding-Replacement therapyPrimary treatmentTREAT UNDERLYING DISEASEReplacementCryoprecipitate-FibrinogenFresh frozen plasma-Other factorsPlateletsHeparinRarely indicated,耿餐沈责悲胆选坞街廖聘恼署梗堂炽扔赐响后厅畸恿餐械疲汞过难徐甚掂凝血和弥散性血管内凝血ppt课件凝血和弥

29、散性血管内凝血ppt课件,LIVER DISEASE,Factor deficiencies-2Decreased synthesisAbnormal fibrinogenExcess sialic acidProlonged thrombin timeLow Grade DIC-Difficult Dx to makeIncreased fibrinolysis Plasminogen activator inhibitor-2 antiplasmin tissue plasminogen activator,踩录约坝颊巫衷司乡赶啸绿猾趾咨鬼掩犹娱蒲浮提窟胞研绑塑尧帧诅煎乞凝血和弥散性血管内凝血ppt课件凝血和弥散性血管内凝血ppt课件,