1. Review of haemostasis EACTS/ Hannes Meyer symposium 2012 Dr J Jordaan
Dept Cardiothoracic surgery and Critical care
University of the Free State
Bloemfontein

3. Blood
Jean-Baptiste Denis first blood transfusion-3U Sheep blood in 1667.
Dr P Physick, Philadelphia first successful blood transfusion in 1795.
Dr Karl Landsteiner discovered A B and O blood types in 1900.
First blood bank USA, 1937.
14 MU packed cells given in 2001 in USA.

4. Theories on the coagulation of blood have existed since antiquity
Theories on the coagulation of blood have existed since antiquity. Physiologist Johannes Peter Müller in 1858 described fibrin, and isolated chemically by Prosper Sylvain Denis in 1863
Alexander Schmidt suggested that the conversion from fibrinogen to fibrin is the result of an enzyme process, and labeled the hypothetical enzyme "thrombin" and its precursor "prothrombin".
Nicolas Maurice Arthus discovered in 1890 that calcium was essential in coagulation.
Platelets were identified in 1865, and their function was elucidated by Giulio Bizzozero in 1882.
The theory that thrombin is generated by the presence of tissue factor was consolidated by Paul Morawitz in At this stage, it was known that thrombokinase/thromboplastin (factor III) is released by damaged tissues, reacting with prothrombin (II), which, together with Calcium, forms thrombin, which converts fibrinogen into fibrin (I).

5. Coagulation
1. Platelets
2. Coagulation factors
Blood clot

6. FIRST RESPONSE: Initial Vasoconstriction Release of TA2 and Endothelin
Reduction in Prostacyclin and Nitric oxide
Immediately limits blood loss

7. Endothelium: Endothelium damage Exposure of Collagen
Collagen and vWF interaction
Platelet activation

8. 1. Platelet agregation

9. 2. Platelet activaton

12. Traditional pathway: Intrinsic and extrinsic pathways
Activation of F X
Activation of F II
Fibrin formation with Fibrin clot
In Vitro and In Vivo results findings not supportive

13. Intrinsic pathway Extrinsic Pathway FXII FXIIa Hageman factor
TF- FVIIa
F XI
F XIa
FIX
FIXa Ca Ca
F VIII
Phospholipid FX
FXa
F V Ca
Fibrinogen
Pro thrombin
Thrombin
Fibrin
F XIII
Firm clot

14. Left with fibrin strands free floating binding to platelets and red cells

15. Cell based coagulation
Initiation
Priming
Propagation
Monroe DM, Arterioscler Thromb Vasc Biology 22: , 2006

16. Cell based coagulation
Vascular injury
Tissue factor exposed by TF bearing cell
Endothelium
Myoepithelium
Adventitia
Monocytes
Macrophages

17. 1. Initiation: Tissue factor bearing cell Endothelium
Adventitial cells
Myoepithelium
Squamous cells
Monocytes
Macrophages
FVII FX
Pro thrombin
FVIIa
FXa
F X-F Va TF
Thrombin
Tissue factor bearing cell
Enhance platelet activation
Accelerate coagulation response TF
F IX
FVIIa
FIXa

18. Priming: Tissue factor bearing cell Platelet
Platelet primed due to collagen exposure through GP 1b reseptor
vWF Va
Thrombin
vWF/F VIII
VIIa Xa TF
F VIIIa
Tissue factor bearing cell
F XI
F V
Platelet
F XIa
F Va
Shape conformation and release of granules

19. Priming:
F VIIIa
F XIa
F Va
Activated Platelet

20. 3 Propagation: Activated Platelet F IXa F IX F X F IXa F IXa F VIIIa
F Xa
Pro Thrombin
F XIa
FVa
F VIIIa
Activated Platelet
Thrombin burst.