fisiologia e avalia o laboratorial da hemostasia

7/25/2019 Fisiologia e Avalia o Laboratorial Da Hemostasia

1/41

01/02/16 1

FISIOLOGIA E AVALIAOLABORATORIAL DA

HEMOSTASIA


2/41

01/02/16 2

Objetivos o!"eit#$% &e'ost$si$ o!&e"e% os e(e'e!tos

e!vo(vi)os e %es*e"tivos *$*+is Des"%eve% os 'e"$!is'os )$

&e'ost$si$ o!&e"e% os *%i!"i*$is e,$'es

#s$)os !$ $v$(i$-.o($bo%$to%i$( )$ &e'ost$si$


3/41

01/02/16 3

He'ost$si$ o!"eito o'*o!e!tes

V$sos ($#et$s F$to%es )$ "o$#($-.o I!ibi)o%es )$

"o$#($-.o Siste'$ b%i!o(3ti"o SRE


4/41

01/02/16 4

Coagulao

Hemostasia

Vasodilatao

Agregao

Anticoagulao

Antiagregao

Fagocitose

Antifibrinlise

Fibrinlise

Vasoconstrio


5/41

01/02/16 5

He'ost$si$ %i'4%i$

V$sos s$!53!eos ($#et$s

Se"#!)4%i$ F$to%es )e

"o$#($-.o


6/41

01/02/16 6

V$sos s$!53!eos E!)ot+(io 3!te%o Ativi)$)e

A!ti"o$#($!te A!ti*($#et$ Fib%i!o(3ti"$

E!)ot+(io (es$)o Ativi)$)e

%ot%o'bti"$ He'ost4ti"$


7/4101/02/16 7

+(#($s e!)ote(i$isSUB-ENDOTLIO CLULAS EDOTELIAIS SANGUE FUNO

COLGENO: III, IV

MEMBRANA BASAL

MICROFIBRILAS

ELASTINA

NUCOPOLISSACRIDES

FIBRONECTINA

PROSTACICLINA Inibe a a!ea"#$ %&a'(e)*

FATOR TISSULAR A)i+a a $a(&a"#$

F VON ILLEBRAND A.e/#$ %&a'(e)*!ia T!an/%$!)a FVIII

ANITROMBINA III Inibe a $a(&a"#$

ATIVAO DA PROTEINA C Inibe a $a(&a"#$

)PA A)i+a a 0b!in1&i/e

TROMBOMODULINA:


8/4101/02/16 8

Res*ost$ v$s"#($%

E2POSIO DO COLGENO

ADESO PLA3UETRIA

TROMBO2ANE, ADP

AGREGAO PLA3UETRIA

PLUG 4EMOSTTICO PRIMRIO

FUSO PLA3UETRIA

PLUG 4EMOSTTICO SECUNDRIO

LESOTISSULAR

FATORTISSULAR

COAGULAO

TROMBINA

FIBRINA

VASOCONSTRICO

FLU2O REDU5IDO

SEROTONINA FPP


9/4101/02/16 9

Me$"$%i"ito


10/4101/02/16 10

($#eto7!ese


11/41

01/02/16 11

($#et$8#(t%$est%#t#%$


12/41

01/02/16 12

($#et$8 #(t%$est%#t#%$


13/41

01/02/16 13

($#et$s8 9#!-:es

A)es.o

Se"%e-.o A%e$-.o F#s.o %o"o$#($!te


14/41

01/02/16 14

($#et$s8 9#!-:es

Endotlio normal

Leso endotelial

Adeso e secreo

Agregao, fuso e coagulao


15/41

01/02/16 15

($#et$8 %e"e*to%es


16/41

01/02/16 16

I!te%$-.o v$so;*($#et$sCLULAS ENDOTELIAIS PLA3UETASFOSFOL6PIDES

AC ARA3UID7NICO

ENDOPER82IDOS: PGG9, PG49

PROSTACICLINA

FOSFOL6PIDES

AC ARA3UID7NICO

ENDOPER82IDOS: PGG9, PG49

TROMBO2ANE A9

FOSFOLIPASE

CICLO-O2IGENASE

PROSTACICLINA SINTETASE

FOSFOLIPASE

CICLO-O2IGENASE

T2 SINTETASE

ATP

AMP

Ca

-ADENILATOCICLASE

FOSFODIESTERASE

AMP

-


17/41

01/02/16 17

F$to%es )$ "o$#($-.o

FATOR PESO ATIVIDADE MEIA-VIDA PRODUO VKDEP CONCFibrinognio 340.000 * 90 h Fgado No 300 mg/dL

Protrombina 72.000 Serina proteae !0 h Fgado Sim "0#"$ mg/dL

Fator % 330.000 &o'ator "2#3! h Fgado No 0($#"(0 mg/dLFator %)) 4.000 Serina proteae 4#! h Fgado Sim 0(" mg/dL

Fator %)))+& 70#240.000 &o'ator "2 h Fgado , No "#2 mg/dL

Fator )- $7.000 Serina proteae 20 h Fgado Sim 4 mg/mL

Fator - $.000 Serina proteae 24 h Fgado Sim 0(7$ mg/dL

Fator -) "!0.000 Serina proteae 40 h Fgado No "#2 mg/dL

Fator -)) 0.000 Serina proteae 4#$2 h Fgado No 0(4 mg/dL

Preaireina 0.000 Serina proteae 4#$2 h Fgado No 0(30 mg/dL1 "20.000 &o'ator !($ d Fgado No 0(70 mg/dL

Fator -))) 320.000 rang5taminae 3#$ d Fgado No 2($ mg/dL

Protena & !2.000 Serina proteae #"2 h Fgado Sim 4#$ mg/mL

Protena S 4.000 &o'ator * Fgado Sim 2$ mg/L


18/41

01/02/16 18

o$#($-.o8 "$s"$t$VIA INTR6NSECA VIA E2TR6NSECA

2II

2I

I2

VIII

2

V

II

I

VII

IIICONTATO

LESO TISSULAR

;


19/41

01/02/16 19

Fo%'$-.o e est$bi(i


20/41

01/02/16 20

I!ibi)o%es )$ "o$#($-.o;a2IIa

2Ia

VIIIa

Va

I2a

2a

IIa

ATIII

PROTEINA C

PROTEINA S


21/41

01/02/16 21

I!ibi)o%es )$"o$#($-.o


22/41

01/02/16 22

Fib%i!(ise

PLASMINOG=NIO PLASMINA

FIBRINA

FRAGMENTO 2

FRAGMENTOS >D

FRAGMENTOS EDSRES;

)PA2IIa;;

a9-ANTIPLASMINAa9-MACROGLOBULINA

VIAINTR6NSECA VIA E2TR6NSECA


23/41

01/02/16 23

He'ost$si$8 %es#'o

ANT

ICOAGULAN

TES

ATIVAD

ORES

PLASMINO

G=NIO

PLASMINA

FIBRINA

PDF?%.@

INIBID

ORES

SRE

2II

2I

I2

VIII

2

V

II

I

III

VII

CaFP

Ca

;


24/41

01/02/16 24

Av$(i$-.o ($bo%$to%i$(

T%i$e' Di$!sti"o o!t%o(e te%$*7#ti"o


25/41

01/02/16 25

Testes *$%$ t%i$e'

T

TTATT Fib%i!o7!io

($#et$s="o!t$e'


26/41

01/02/16 26

T= TTA e TT2II

2I

I2

VIII

2

V

II

I

III

VII

CaFP

Ca

;


27/41

01/02/16 27

Testes *$%$ )i$!sti"o Dos$e' )e 9$to%es I= II= V= VII= VIII= I>= >= >I= >II= >III ???

Fib%i!(ise D3'e%o D @*)9

es#is$ )e DF/*)9


28/41

01/02/16 28

Testes *$%$ )i$!sti"o A%e$-.o *($#et4%i$

AD A"i)o A%$#i)!i"o o(4e!o Risto"eti!$ A)%e!$(i!$ T%o'bi!$


29/41

01/02/16 29

A%e$-.o *($#et4%i$


30/41

01/02/16 30

A%e$-.o *($#et4%i$


31/41

01/02/16 31

A%e$-.o *($#et4%i$


32/41

01/02/16 32

A%e$-.o *($#et4%i$


33/41

01/02/16 33

A%e$-.o *($#et4%i$


34/41

01/02/16 34

Testes *$%$ )i$!sti"o

T%o'bo(i$ %ote3!$

Resist7!"i$ $ A %ote3!$ S C L/T A!tit%o'bi!$ III F$to% V )e Lei)e! @DA

Ge!e )$ %ot%o'bi!$ @DA Ho'o"iste3!$ A" $!ti;$%)io(i*i!$ G/M I!ibi)o% L*i"o


35/41

01/02/16 35

Testes *$%$ "o!t%o(e te%$*7#ti"o

A!ti"o$#($!tes o%$is T "o' RI

RI @T/T ISI

He*$%i!$ TA TTA

He*$%i!$ )e b$i,o *eso

F$to% >$ A!ti;$%e$!tes

A%e$-.o *($#et4%i$ @AD= AA e o(4e!o

PN9/PP9/P?N9,RNI9,

PN/PP/PN9,

ISI,9


36/41

01/02/16 36

Es#e-$' Te'*o )e s$!%$'e!toTe'*o )e "o$#($-.o %ov$ )o ($-o Ret%$-.o )o "o4#(o o$#(o%$'$8 TS= T= L= R= ??? Motivo8 )es"o!9o%to= 9$(t$ )e

*$)%o!i


37/41

01/02/16 J

E#i*$'e!tos


38/41

01/02/16 38

o$#('et%o se'i;$#to'4ti"o

( t


39/41

01/02/16 39

o$#('et%o$#to'4ti"o

A%e'et%o )e


40/41

01/02/16 40

A%e'et%o )e*($#et$s


41/41

01/02/16 41

FIM

fisiologia e avalia o laboratorial da hemostasia

Documents