Literature

1. Internal diseases an introductory course. - Vasilenko V., Grebenev A. - M.: Mir . Publishers, 1990. - 647 p

2. Propedeutics to internal medicine. Part 1.-Vinnytsya: NOVA KNYHA, 2006.- 424 p.

3. Propedeutics to internal medicine. Part 2.-Vinnytsya: NOVA KNYHA, 2007.- 264 p.

4. Introduction to the course of internal diseases. Book 1. Diagnosis: [Textbook/Zh.D. Semidotskaya, O.S. Bilchenko, et al.].-Kharkiv: KSMU, 2005. -312p.

5. Michael Swash Hutchison’s clinical methods / XIX edition. ELBS, 1989. -618p.

6. Mark H., Beers M.D., Robert Berkow The Merck Manual of diagnosis and therapy / XVII edition.- Published by Merk research laboratories, 1999.- 2833 p.

7. Harrison΄s principles off internal medicine / Fauci, Braunwald, Isselbacher and al.-XIV edition. - Vol. 1 and 2. - International edition, 1998.

Topic 15. Hemorrhagic syndromes and the pathology of blood coagulation system. The syndrome of disseminated intravascular blood micro coagulation

Class lasts: 3 hours

Chronological class structure:

Control of initial standard of knowledges- 20 min.

Teacher′s demonstration of practical skills - 60 min.

Sudents′ independent work: - 30 min.

Control of ultimate standard of knowledges- 15 min.

Sum up of the class, homework- 10 min.

Questions for theoretical preparation: The main components of blood coagulation system. The factors of bleeding development and the reasons of hemorrhagic syndromes thrombocytopenia, coagulopathy and hemorrhagic vasculitis. The characteristics of hemorrhagic syndrome in hemophilia, thrombocytopenia purple and Shenljan-Jenoh disease. The manifestations of articulate, abdominal, renal and anemia syndromes in all these diseases. The main methods of laboratory diagnostics of hemorrhagic syndromes. The reasons of development and the pathogenesis of disseminated intravascular coagulation syndrome. The stages and clinical manifestation of DIC-syndrome, its main laboratory criteria.

The three major components of the hemostatic mechanism are: the platelets, blood vessels, and the plasma protein factors involved in coagulation and fibrinolysis.

The function of platelets in hemostatic process:

• platelet are the instrumental in maintaining the integrity of the endothelial lining of the blood vessels;

• platelet play a major role in repairing any injury in the vascular system, especially at the microcirculatory level;

• platelets take part in regulation of local inflammatory reaction and immune damage initiation;

• platelets are responsible for the specific reaction related to the formation of hemostatic plug.

There are three stages of platelets activation:

• signal transduction from platelet membrane lo the structure responsible for the specific reaction;

• platelet adhesion, release of chemical substances of platelet, aggregation and finally formation a plug or clot in vessel damage.

The chemical substances of platelet include a number of enzyme, epinephrine, norepinephrine, ATP and ATP-ase. Many specific compounds participating in clotting of the blood have been revealed in platelets. There are called thrombocytic or platelet factors and are designated by Arabic numerals.

The liquid state of the blood and the closed uninterrupted system of blood vessels in which blood circulates are the principal conditions for body functioning. They are provided by the system of blood coagulation (hemocoagulation system). It keeps blood in a liquid state and restores the wholeness of the pathways of its circulation by formation of blood thrombi (plugs, clots) in the damaged vessels.

The coagulation blood system comprises blood and tissues which produce, utilize and secrete substances from the body that are indispensable for the process of coagulation. The neurohumoral apparatus also belongs to this system.

The coagulation of blood is the process of clotting of whole blood, which results in the formation of a fibrin clot. Three processes are involved in blood clotting such as formation of prothrombinase, thrombin and fibrin. In addition, the phase preceding and the phase following blood coagulation are distinguished. The primary phase is accompanied by vascular thrombocytic hemostasis (i.e. processes involved in stoppage of bleeding) in which bleeding from the microcirculatory vessels with low blood pressure is arrested. This process is also known as microcirculatory hemostasis. In the second phase two processes simultaneously occur, i.e. retraction and fibrinolysis of the blood clot. Thus, the process of hemostasis involves three components: vessel walls, formed blood elements, and enzymatic plasma system of blood clotting.