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Haemostasis and blood component therapy

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Abstract

Haemostasis refers to the cessation of bleeding, which is achieved by a complex arrangement of balanced interactions between blood cells, the vasculature, plasma proteins and low molecular weight substances. A system of checks and balances ensures that, although a thrombus (clot) is formed and protected at the site of vessel damage to stop bleeding, vessel occlusion (thrombosis) is prevented. Haemostasis represents an equilibrium between the opposing processes of bleeding on the one hand and hypercoagulability and thrombosis on the other. Unbalanced or altered haemostasis most often tends towards haemorrhage, but when excessive thrombosis occurs it may cause significant disease. As a general overview, bleeding following vascular injury must be stopped to prevent excessive blood loss. This chapter considers the following topics: Stages of haemostasis; Pathophysiology of altered haemostasis; Assessment of haemostasis in the surgical patient; and Blood component therapy. Also included are techniques for the buccal mucosal bleeding time (BMBT) test; Feline in-house cross-match procedure; Canine whole-blood collection procedure; and Blood collection via syringe.

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Figures

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20.2 Primary haemostasis. Platelet adhesion. Circulating platelets adhere to von Willebrand factor (vWf) bound to the exposed subendothelium (extracellular matrix) after the creation of a vascular defect. Note that red blood cells (RBCs) are able to pass through the defect, out of the vascular compartment (haemorrhage). Platelet activation and aggregation. Activated platelets undergo a shape change, secrete granular contents and aggregate at the injury site to form a temporary platelet plug. Aggregation is enhanced by fibrinogen bridging between the GPIIb–IIIa receptors of adjacent platelets. Stabilization of the platelet plug by fibrin and cessation of bleeding.
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20.3 Primary and secondary haemostasis resulting in the formation of a stable clot.
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20.4 A simplified coagulation cascade.
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20.5 Fibrinolysis.
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20.7 Vitamin K carboxylation and recycling in the liver.
Image of (a) Bleeding time device. (b) Inner workings of bleeding time device demonstrating spring-loaded retractable blade.
(a) Bleeding time device. (b) Inner workings of bleeding time device demonstrating spring-loaded retractable blade. Bleeding time device. Inner workings of bleeding time device demonstrating spring-loaded retractable blade.
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20.12 Blood component processing. Following collection, whole blood can be separated by centrifugation into various compound products, based on different centrifugation speeds and time. CPP = cryoprecipitate-poor plasma; CRYO = cryoprecipitate; FFP= fresh frozen plasma; PC = platelet concentration; PRBCs = packed red blood cells; PRP = platelet-rich plasma.
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Image of Macroscopic red cell agglutination identified on major cross-match.
Macroscopic red cell agglutination identified on major cross-match. Macroscopic red cell agglutination identified on major cross-match.
Image of Microscopic red cell agglutination.
Microscopic red cell agglutination. Microscopic red cell agglutination.
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20.13 Example of a blood transfusion monitoring sheet.

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