Definition of Terms Historical Background Historical Development of Clinical Hemostasis The Hemostasis Laboratory Today

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marjisimmeingjamias,rmt

STOPPAGE of bleeding Arrest of bleeding

By physiologic properties of vasoconstriction and coagulation or by surgical means

Normal Hemostasis depends on:

Types of surrounding tissues Integrity of blood vessels Normal platelet number Function and presence of adequate amounts of functioning coagulation promoting and inhibiting proteins
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Escape of blood from the vessels into the surrounding tissue or into the environment

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Purpura
Hemorrhage of blood into small areas of the skin, mucus membranes and other tissues
Areas first appear red but later turn purple and finally brownish-yellow (conversion of heme to biliverdin) As the color fades, biliverdin is converted to bilirubin which is removed form the area and processed in the liver
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Ecchymoses
A form of purpura in which blood escapes into large areas of skin or mucus membranes, but not into deep tissue The area turns black and blue (bruise) and later, greenish brown or yellow

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Petechiae
Purplish red, pinpoint hemorrhagic spots (<3mm in diameter) in the skin caused by loss of capillary ability to withstand normal blood pressure and trauma Poor capillary integrity allows erythrocytes to leak out of capillary beds into tissue Many petechiae close together can create a purpura
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Epistaxis
Nose bleed

Hemoptysis
Expectoration of blood secondary to hemorrhage in the larynx, trachea, bronchi or lungs

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Hematemesis
Vomiting of blood

Melena
Stool containing dark red/black blood

Hemarthrosis
Leakage of blood into the joint cavity

Menorrhagia
Excessive uterine bleeding occurring at the usual intervals of menstruation
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marjisimmeingjamias,rmt

Aristotle and Plato 2nd Century AD

HEMOPHILIA was the first coagulation disorder to be recognized

5th Century Talmud (Writing)

Two male children were described to have died from excessive bleeding after circumcision

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OTTO (1803)
Published clinical descriptions of families with hemophilia

Schnlein
Gave the name hemophilia (love of hemorrhage)

Hopff (1828)
Published a thesis that described the disorder as hemophilia
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marjisimmeingjamias,rmt

Lee and White Whole Blood Coagulation Time

WBCT 1st laboratory test to evaluate the clotting mechanism Described in 1913

1930s
Quick developed the Prothrombin Time Test

1940s
Few routine tests for evaluating the hemostatic mechanism Platelet count, bleeding time, WBCT, PT
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marjisimmeingjamias,rmt

Tests for Coagulation and Fibrinolytic System

Test reagents Automated Techniques

Visual Examination of Clot Formation

Replaced by mechanical or photo-optical clot detection

Immunoassays and Spectrophotometric Determinations

Quantitation of substances involved in enhancement or inhibition of coagulation or fibrinolysis
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