Platelets
Dr. Shehrina Nazmin
Platelets or thrombocyte
Platelets or thrombocytes are nonnucleated
colourless, round or oval biconvex discs (cc)
They are formed in the bone marrow from
Megakaryocytes
Diameter: 1-4 μm
Life span: 10 days
Normal count: 150000-400000/ cu mm of blood
Platelets contain
Their cytoplasm contain (gn, Sm & cc)
• Contractile element- Actin, myosin and thrombosthenin
• Glycogen
• Lysosomes
• Golgi apparatus
• Endoplasmic reticulum
• A few small mitochondria
• Macrovesicles, microtubules and filaments
• Hormonal substances – 5HT, histamine, adrenalin (sw)
• von Willebrand factor
• Granules- alpha granules and dense granules
Platelets contain contd..
Dense granules contain-
• Serotonin
• ADP and other nucleotide
• Calcium
• Lysosome
• Phospholipids
Alpha granules contain-
• Clotting factors ( fibrinogen, factor V and XIII)
• Platelet derived growth factor (PDGF)
Structure of Platelets
Function of platelets (sw)
1. Role in all stages of hemostasis
2. Blood coagulation
3. Phagocytosis – carbon particles, immune
complexes and virus particles
4. Storage & transport of substances- 5HT &
histamine
Hemostasis
Hemostasis means spontaneous arrest of bleeding by
physiological process after rupture of minute blood
vessels.
Events (Gy)
1. Vascular constriction /spasm
2. Formation of platelet plug
3. Formation of blood clot as a result of blood coagulation
4. Eventual growth of fibrous tissue into the blood clot to
close the hole in the vessel permanently
Vascular spasm
Immediately after the trauma to the vessel wall causes
the smooth muscle in the wall to contract, which reduces
the flow of blood from the ruptured vessels.
This results from-
I. Nervous reflexes
II. Local myogenic spasm
III. Local autacoid factors from the traumatized tissues and
blood platelet
IV. Blood platelet (thromboxane A2)
Formation of platelet plug
On contact with extracellular matrix, platelet undergo
three general reaction:
Adhesion and shape change
Activation
Aggregation
Clotting Factors
Factor І Fibrinogen
Factor II Prothrombin
Factor ІII Tissue factor (tissue
thromboplastin)
Factor ІV Calcium
Factor V Labile factor
Factor VII Stable factor
Factor VIII Antihemophilic factor
Factor IX Christmas factor
Factor X Stuart power factor
Factor XI Plasma thromboplastin antecedent
Factor XII Hageman factor
Factor XIII Fibrin stabilizing factor
Prekallikrein
High molecular weight kininogen
Platelets
Essential clotting factors
Essential factors are-
Factor І - Fibrinogen
Factor II - Prothrombin
Factor ІII - Tissue factor (tissue thromboplastin)
Factor ІV - Calcium
They are called essential because due to absence of any
one of them coagulation does not occur.
Vitamin K dependent clotting factors –
• Factor II, VII, IX and X
Blood coagulation
The process by which the soluble fibrinogen is convert to
insoluble fibrin and form a clot is known as coagulation.
Mechanism of blood coagulation:
Formation of complex of activated substances called
prothrombin activator by extrinsic & intrinsic pathway
The prothrombin activator catalyzes conversion of
prothrombin into thrombin
Thrombin acts as an enzyme to convert fibrinogen to fibrin
Formation of prothrombin activator
Prothrombin activator is formed in two ways-
1. Extrinsic pathway -begins with a traumatized
vascular wall or traumatized extravascular tissues
that come in contact with the blood
2. Intrinsic pathway -begins with trauma to the blood
or exposure of the blood to collagen from
traumatized blood vessel wall
Extrinsic pathway for initiating clot
Intrinsic pathway for initiating clot
Conversion of prothrombin into thrombin &
Conversion of fibrinogen to fibrin
Blood clot (Gy)
A meshwork of fibrin fibers running in all directions
and entrapping blood cells, platelets and plasma
Thrombus – an abnormal clot that develops in a
blood vessel
Why blood does not clot inside the blood vessel
Continuous circulation of blood
Endothelial surface factor:
• Smoothness of endothelial surface
• A layer of glycocalyx on endothelium
• Secretion of thrombomodulin
Presence of natural anticoagulant-
• Heparin
• Antithrombin III
• Fibrin fiber (itself absorbed thrombin)
The platelet disorders-
Thrombocytopenia: Decrease in platelet count below
normal limit is called thrombocytopenia.
Cause-
• Acute infections
• Acute leukemia
• Aplastic anemia
• Chickenpox
• Small pox
• Splenomegaly
• Typhoid fever
• Tuberculosis
• Purpura
The platelet disorders contd..
Thrombocytosis: The increase in platelet count above
normal limit is called thrombocytosis.
Cause-
• Allergic conditions
• Hemorrhage
• Bone fracture
• Surgical operations
• Splenectomy
• Rheumatic fever
• Trauma
Bleeding disorders
Hemophilia
Purpura
Hemophilia
• Inherited sex linked disorder invariably transmitted by
female, who themselves show no symptoms, to male who
manifest signs of the disease.
• The condition is characterized by a marked increase in the
coagulation time.
• The bleeding time is not prolonged
Types-
• Hemophilia A or classical hemophilia- due to deficiency
of Factor VIII (85%)
• Hemophilia B or Christmas disease- due to deficiency of
factor IX (15%) gy
Symptoms of Hemophilia (sm)
Spontaneous bleeding
Prolonged bleeding due to cuts, tooth extraction and
surgery
Hemorrhage in gastrointestinal and urinary tracts
Bleeding in joints followed by swelling and pain.
Appearance of blood in urine
Treatment (gy)
For classical Hemophilia - injection of purified Factor
VIII
Purpura (sw)
It is a condition in which there is a tendency to
spontaneous hemorrhages usually beneath the skin,
from the various mucous membrane and internal
organs.
The coagulation time remains normal but the
bleeding time is prolonged.
Types (sm)
The purpura is classified into different types
depending upon the causes -
1. Thrombocytopenic purpura
2. Idiopathic thrombocytopenic purpura
3. Thrombasthenic purpura.
Thrombocytopenic purpura (gy)
There is very low platelet count in the circulating blood
People with this disease have a tendency to bleed and
the bleeding is usually from many small venules or
capillaries
As a result, small punctate hemorrhages occur
throughout all the body tissues
The skin of such person displays many small, purplish
spots, giving the disease the name thrombocytopenic
purpura
Test for assessing a patient for bleeding disorder
I. Platelet count
II. Bleeding time
III. Clotting time
IV. Prothrombin time
V. Activated partial thromboplastin time (APTT)
VI. The international normalized ration (INR)
VII. Thrombin time (12 to 20s)
Bleeding time
• It is the time interval from oozing of blood after a cut
or injury till arrest of bleeding.
• Its normal duration 1-6 minutes. (gy)
• It is prolonged in purpura.
Clotting time
• Clotting time is the time interval from oozing of blood
after cut or injury till the formation of clot.
• Its normal duration 6-10 min. (gy)
• It is prolonged in hemophilia.
Prothrombin time (gy)
• Prothrombin time gives an indication of the
concentration of prothrombin in the blood. It is the
time taken by blood to clot after adding tissue
thromboplastin to it.
• The normal duration of prothrombin time is about 12
seconds
Anticoagulants
Substance which prevent coagulation of blood
Types-
• Heparin
• Coumarin derivatives – warfarin
• EDTA (Ethylenediamine tetra acetic acid)
• Oxalate compound- sodium and potassium
oxalate
• Citrate- sodium, potassium and ammonium citrate
