By H. C. Hemker (auth.), C. Th. Smit Sibinga, P. C. Das, J. J. van Loghem (eds.)
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Additional info for Bloodtransfusion and Problems of Bleeding
Improving the efficiency with which this valuable resource is used is essential if the transfusion needs of all patients are to be adequately met. Second, the transfusion of components rather than whole blood insures that patients receive precisely what is needed, and at its optimal dosage and functional capability. To fully appreciate the value of components it is worthwhile 24 at this point to briefly discuss the course of events from the time a unit of blood is collected to the time it can be released for transfusion.
Baanen. Nijmegen: Dr. Hemker explained very beautifully the loop which exists in the activation of the intrinsic or the final pathway by activation of factor VII through tissue thromboplastin. I still do not understand why people with factor XII or XI, or plasma kallikrein insufficiency do not bleed and people with factor IX and VIII deficiency do. C. Hemker, Maastricht: The most simple way to explain this is, that the essential operation in our opinion at the moment is the extrinsic pathway. Factors VIII and IX constitute a reinforcement loop, something that helps the extrinsic pathway.
Samples are sometimes collected from indwelling catheters. Such samples are not suitable for investigation of hemostasis, as all ar- I tificial surfaces adsorb plasma proteins (5). Fibrinogen, I factors VIII, XII and XI are adsorbed, thrombin is generated via the intrinsic pathway with gradual formation of a fibrin monolayer and platelet aggregates. We have studied the effect of collection through a catheter on the assays of factors VIII and V. Activation of the intrinsic pathway is present within 10 minutes of insertion.