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Samenvatting 24-25 Hematologie 3 deel 3 : hemostase
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Samenvatting vak hematologie deel 3 : hemostase Gegeven in 3de jaar MLT
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HEMATOLOGIE 3:DEEL 3 : HEMOSTASE
Lector. Flies Reinoud
Academiejaar
2024 - 2025
,IN HOUD
1. Inleiding / herhaling vorig jaar.............................................................................................................................. 2
1.1 Primaire hemostase........................................................................................................................................ 3
1.2 Secundaire hemostase.................................................................................................................................... 4
1.3 Trombofilie ..................................................................................................................................................... 5
1.4 Anticoagulatie................................................................................................................................................. 5
2. Stollingsziekten ..................................................................................................................................................... 6
2.1 Verworven stollingsziekten ............................................................................................................................ 6
2.2 Erfelijke stollingsziekten ................................................................................................................................. 6
3. Trombopenie – Trombocytose ............................................................................................................................. 9
3.1 Trombopenie .................................................................................................................................................. 9
3.2 Trombocytose............................................................................................................................................... 10
4. Trombocytopathie .............................................................................................................................................. 11
5. Diffuse Intravasale Stolling (DIC) ........................................................................................................................ 12
6. Trombofilie - Trombosen .................................................................................................................................... 13
6.1 Inleiding ........................................................................................................................................................ 13
6.2 Risicofactoren ............................................................................................................................................... 13
6.3 Kliniek ........................................................................................................................................................... 14
6.4 Oorzaken....................................................................................................................................................... 14
7. Laboratorium ...................................................................................................................................................... 18
7.1 Pre-analytische variabele ............................................................................................................................. 18
7.2 Hemostasetesten van primaire hemostase.................................................................................................. 18
8. Hemostase therapiemonitoring ......................................................................................................................... 20
8.1 Orale anticoagulantia (OAC) ......................................................................................................................... 20
8.2 Nieuwe orale anticoagulantia (NAOC).......................................................................................................... 20
8.3 Directe Trombine Inhibitor (DTI) .................................................................................................................. 20
8.4 Anti-aggregantia ........................................................................................................................................... 20
1
Moons N / Vermeulen A
, 1. IN LEIDING / HE RHALIN G VORIG JAAR
Primair
Secundair
Fibrinolyse
Primaire hemostase
Samenspel tussen bloedplaatjes en vaatwand
→ m.b.v. VWF (=Von Willebrandt factor)
Stoornissen in de primaire hemostase leiden tot
• Trombopenie of trombastenie
• Gedaald gehalte VWF of slecht functionerend
• Vooral mucosale bloedingen en huidbloedingen
Secundaire hemostase
• Omvorming fibrinogeen → fibrine
• Belang van verschillende stollingsfactoren die elkaar activeren in een soort cascade
• Voornaamste vertegenwoordiger: weefselfactor
• Vorming van ‘stolsel’
• Daling van 1 van de stollingsfactoren leidt tot vooral inwendige bloedingen (bv. Hemofilie)
Fibrinolyse
Proces waarbij stolsel gedeeltelijk afgebroken wordt door plasmine en de vaatwand hersteld wordt
→ zorgt voor tegengewicht van het stollingsproces dat op die manier op tijd wordt gestopt
Inhibitoren
Inhibitoren dienen in heel het proces van stolling als een soort evenwicht
• Primaire
→ inhibitie van de plaatjesaggregatie
• Secundaire
→ Plasma-eiwitten die inhiberend werken op bepaalde stappen in coagulatie van sec hemostase
• Fibrinolyse
→ Antiplasmine, PAI
2
Moons N / Vermeulen A
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