tugas 1 hemopoeitic dan hemotasis

8/18/2019 Tugas 1 Hemopoeitic Dan Hemotasis

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TUGAS I : HEMOPOEITIC SYSTEM DAN KOMPONEN

DARAH; HEMOSTASIS DAN GOLONGAN DARAH

BLOK HEMATOLOGY SISTEM (Fundamenta !"

Pat#!$#%&'!!%)

SEMESTER PENDEK

DISUSUN OLEH:

DIAN ARISTANTI

NIM. 115070201131021

KELAS. PSIK K3LN-11

PROGRAM STUDI ILMU KEPERA*ATAN

FAKULTAS KEDOKTERAN

UNI+ERSITAS BRA*I,AYA

MALANG

-./0

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BAGIAN I :

HEMOPOEITIC SYSTEM DAN KOMPONEN DARAH

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PEMBAHASAN

Darah merua!a" !#m#"e" e$e"$%a& mah&u! h%'u( mu&a% 'ar%

)%"a*a"+ r%m%*%, $ama% ma"u$%a. Da&am !ea'aa" ,%$%#+%!( 'arah $e&a&u

)era'a 'a&am em)u&uh 'arah $eh%"++a 'aa* me"a&a"!a" ,u"+$%"a

$e)a+a% em)a/a #!$%+e"( me!a"%$me er*aha"a" *u)uh *erha'a

%",e!$%( 'a" me!a"%$me hem#$*a$%$.

A1 KOMPOSISI DARAH

Darah mem)e"*u! $e!%*ar 'ar% )era* *u)uh *#*a& ma"u$%a. Darah

*er'%r% 'ar% *%+a e"%$ e&eme" $e&u&ar !hu$u$( er%*r#$%* $e& 'arah merah(

&eu!#$%* $e& 'arah u*%h( 'a" *r#m)#$%* !ee%"+ 'arah a"+ mem)e"*u!

$u$e"$% 'a&am 4a%ra" !#m&e!$ &a$ma 'arah.

/1 Pa&ma Da2a#

er%!u* a'a&ah !#m#"e" P&a$ma 'arah )e$er*a ,u"+$%"a *er'%r%

'ar%:

a. A%r : Me'%um *ra"$#r 6 mem)a/a a"a$

). E&e!*r#&%* : E!$%*a)%&%*a$ mem)ra" 6 '%$*r%)u$% #$m#*%! 4a%ra"

a"*ara ES 'a" IS 6 me"a"++a eru)aha" PH

4. Nu*r%e"( 8a* $%$a( +a$( h#rm#" : '%a"+!u* 'a&am 'arah6 +a$

O2 'arah )erera" 'a&am !e$e%m)a"+a" a$am-)a$a

'. Pr#*e%" P&a$ma : $e4ara umum( me"+ha$%&!a" e,e! #$m#*%!

a"+ e"*%"+ 'a&am '%$*r%)u$% ES a"*ara !#mar*eme"

9a$!u&ar 'a" %"*er$*%$%um6 me"a"++a eru)aha" PH

- A&)um%" : me"+a"+!u* )a"a! )aha" 6 )erera" a&%"+

)e$ar 'a&am me"e"*u!a" *e!a"a" #$m#*%! !#%'

- )u&%" A&,a 'a" )e*a : me"+a"+!u* )a"a! )aha" *a! &aru* a%r6

m#&e!u& re!ur$#r %"a!*%, ama : A"*%)#'%

e. ;%)r%"#+e" : Pre!ur$#r %"a!*%, u"*u! a&%"a" ,%)r%" a'a

em)e!ua" 'arah

-1 Eemen Seue2

er%!u* a'a&ah !#m#"e" e&eme" $e&u&er 'arah )e$er*a ,u"+$%"a

*er'%r% 'ar%:

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a. Er%*r#$%* : me"+a"+!u* O2 'a" O2 *eru*ama O2

). Leu!#$%*

• Neu*r#,%& : ,a+#$%* a"+ me"e&a" )a!*er% 'a" 'e)r%$

• E#$%"#,%& : me"era"+ 4a4%"+ ara$%*%!6 e"*%"+ 'a&am

rea!$% a&er+%!

• a$#,%& : Me"+e&uar!a" H%$*am%"( a"+ e"*%"+ 'a&am

rea!$% a&er+%!( 'a" hear%"( a"+

• mem)a"*u mem)er$%h!a" &ema! 'ar% 'arah

• M#"#$%* : 'a&am *ra"$%* me"a'% ma!r#,a+

• L%m,#$%* :

- L%m,#$%* : me"+ha$%&!a" a"*%)#'%

- L%m,#$%* T : re$#" %mu" $e&u&ar

4. Tr#m)#$%* : Pem)e!ua" 'arah( 'a" h#me#$*a$%$.

am)ar 1. *a)e& !#m#$%$% 'arah.

am)ar 2. N%&a% "#rma& hema*#+% 'e/a$a

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B1 HEMATOPOIESIS (Pem3entu4an Se Da2a#)Hema*##%e$%$ a'a&ah r#$e$ em)e"*u!a" 'a" ema*a"+a" $e&-

$e& 'arah. er%!u* %"% a'a&ah ,a$e-,a$e hema*##%e$%$ a"+ *era'% $e4ara

umum a'a ma"u$%a :

1. Me$#)&a$*%!

Tera'% a'a ma$a re"a*a&( a%*u $aa* em)r%# )erumur 2 <

10 m%"++u. Tera'% '% 'a&am #&! $a4 a"+ )era'a 'e!a* 'e"+a"

me$e"!%m )a*a"+ *u)uh. Me$e"!%m %"% me"u$u*!a"

4a)a"+4a)a"+"a &a&u )er!em)a"+ me"a'% er%*#)&a$ r%m%*%,( $e&

)a$#h%& )u&a* a"+ me"+umu& mem)e"*u! a+re+a* a"+ '%$e)u*

'e"+a" u&au 'arah. Mere!a )er#&%,era$% mem)e"*u! hem#+)%"

'a" er%*r#$%* #&%!r#ma*#,%&%!. La&u )a$#h%&-)a$#,%& mu&a% me"+h%&a"+

'a" a'%&ah er%*r#$%* r%m%*%,( a%*u er%*r#$%* a"+ mem%&%!% %"*% $e&.

2. Hea*%!

;a$e %"% *era'% a'a ma$a re"a*a& u+a( !e*%!a a"%" $u'ah

)eru$%a = m%"++u. Pa'a u$%a = m%"++u %"% $e& )a$#h%& mu"4u& '%

rem#'%um ha*% &a&u )er#&%,era$% me"a'% er%*r#)&a$ 'e,%"%* a"+

)er!em)a"+ me"a'% er%*r#$%* 'e,%"%* a"+ $u'ah *%'a! )er%"*% &a+%.

Pa'a m%"++u !e- '%*emu!a" u+a &eu!#$%* +ra"u&er 'a"

me+a!ar%#$%* a'a ha*%. La&u a'a u$%a 12 m%"++u &%m,a u+a

me"a'% *ema* *era'%"a hema*##%e$%$.

3. M%e%'

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;a$e %"% '%mu&a% $aa* ra"+!a a"%" $u'ah *er)e"*u! a%*u

$e!%*ar m%"++u !e-20. Ra"+!a a"+ *er)e"*u! a'a a"%" ma$%h

)er)e"*u! *u&a"+ ra/a" h%a&%". La&u $e& 'arah 'a" me$e"!%m

me"er#)#$ ma$u! !e 'a&am r#"++a *u&a"+ ra/a" *er$e)u*

!emu'%a" )er'%,ere"$%a$% me"a'% #$*e#)&a$* 'a" $e& re*%!u&um a"+

mem)e"*u! $*r#ma $um-$um *u&a"+. Se*e&ah *er)e"*u!"a u$a*

e"u&a"+a"( '%mu&a%&ah r#$e$ r#'u!$% $e& 'arah 'a&am $um-$um

*u&a"+ 'a" *era'% u&a e"uru"a" r#'u!$% $e& 'arah a'a ha*% 'a"

&%m,a.

I1 Se Indu45 Fa4t!2 Pe2tum3u#an5 dan D'"e2en&'a&'

Se& 'arah ma*a"+ memu"a% a"+!a h%'u re&a*%, e"'e!( 'a"

!are"a"a #u&a$% %*u haru$ $e4ara *e*a '%+a"*% #&eh *uru"a" $e&

%"'u! a"+ '%ha$%&!a" 'a&am#r+a" hema*##%e*%! haima > 'arah(

poiesis> em)ua*a". Pa'a *aha a/a&em)r%#+e"e$%$( $e&-$e& 'arah

mu"4u& 'ar% me$#'erm yolk sac . e)eraa $aa*!emu'%a"( ha*% 'a"

&%ma )er,u"+$% $e)a+a% ar%"+a" hema*##%e*%! $eme"*ara(

*e*a%me"e&a"+ )u&a" !e'ua !&a9%!u&a *e&ah mu&a% me"u&a"+ 'a"

mu&a% mem)e"*u! $um$um *u&a"+ '% u$a*"a. Se/a!*u e"u&a"+a"

ra&ah%r 'ar% $%$a !era"+!a me&au($um$um *u&a"+ me"a'% ar%"+a"

hema*##%e*%! u*ama.

Se)e&um me"4aa% !ema*a"+a" 'a" $u'ah '%&ea$!a" !e

'a&am $%r!u&a$%( $e&-$e&'arah haru$ me&a&u% *aha-*aha '%,ere"$%a$%

'a" ema*a"+a" !hu$u$. Kare"a r#$e$%"% )er&a"u* *eru$( $e&-$e&

'e"+a" 4%r%-4%r% 'ar% )er)a+a% *aha $er%"+ '%*emu!a" 'a&am$e'%aa"au$ 'arah a*au $um$um *u&a"+.

Hema*##%e$%$ a'a&ah r#$e$ em)e"*u!a" $e&-$e& 'arah.

?#&! $a4( ha*% 'a"&%ma a'a&ah u$a* hema*##%e$%$%$ a'a ma$a

a"%". Se*e&ah &ah%r( ,u"+$% %"% *era'% '%$um$um *u&a"+. a% mem%&%!%

%"*% $um$um hema*##%e$%$ a'a $emua *u&a"+"a( *a% a'a

'e/a$a ha& %"% ha"a *era'% a'a uu"+ r#!$%ma& 'ar% *u&a"+-*u&a"+

a"a"+. Da&am em)e"*u!a""a $emua )era$a& 'ar% r%m%*%9e $*em

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4e&& a"+ a!a" )ere&%!a$%( r#&%,era$% 'a" )er'%,ere"$%a$% me"a'% $e&-

$e& ma*a"+ a"+ '%!e"a& $e)a+a% $e& 'arahmerah er%*r#$%*( $e&

+ra"u$%*( $e& m#"#$%*( &%m,#$%* 'a" &a*e&e*. Tema* hem##e$%$

a'a ma"u$%a )er%"'ah-%"'ah $e$ua% 'e"+a" umur :

a @a"%" : umur 0-2 )u&a" !a"*u"+ !u"%"+ *e&ur

umur 2-7 )u&a" ha*%( &%ma

umur 5- )u&a" $um$um *u&a"+

) a% : Sum$um *u&a"+

4 De/a$a. : 9er*e)ra( *u&a"+ %+a( $*er"um( *u&a"+

*e"+!#ra!( $a4rum 'a" e&9%$( uu"+

r#!$%ma& ,emur.

Pa'a #ra"+ 'e/a$a 'a&am !ea'aa" ,%$%#+%! $emua hem##e$%$

*era'% a'a $um$um *u&a"+. U"*u! !e&a"+$u"+a" hem##e$%$ '%er&u!a":

1. Se& %"'u! hem##e*%! (hematopoietic stem cell)

Se& %"'u! hem##e*%! %a&ah $e&-$e& a"+ a!a" )er!em)a"+ me"a'%

$e&-$e& 'arah( *erma$u! er%*r#$%*( &e!#$%*( *r#m)#$%*( 'a" u+a

)e)eraa $e& 'a&am $um$um *u&a"+ $eer*% ,%)r#)&a$*. Se& %"'u!

a"+ a&%"+ r%m%*%, $e)a+a% pluripotent (totipotent) stem cell .

Se& %"'u! &ur%#*e"* memu"a% $%,a* :

a. Self renewal : !emamua" memer)aru% '%r% $e"'%r% $eh%"++a

*%'a! a!a" er"ah ha)%$ me$!%u" *eru$ mem)e&ah6

). Proliferative : !emamua" mem)e&ah a*au memer)a"a! '%r%6

4. Diferensiatif : !emamua" u"*u! mema*a"+!a" '%r% me"a'% $e&-

$e& 'e"+a" ,u"+$%-,u"+$% *er*e"*u.

Me"uru* $%,a* !emamua" '%,ere"$%a$%"a ma!a $e& %"'u!

hem##e*%! 'aa* '%)a+% me"a'% :

a. Pluripotent (totipotent)stem cell : $e& %"'u! a"+ memu"a% a"+

memu"a% !emamua" u"*u! me"uru"!a" $e&uruh e"%$ $e&-$e&

'arah.

). Committeed stem cell : $e& %"'u! a"+ memu"a% !#m%*me* u"*u!

)er'%,ere"$%a$% me&a&u% $a&ah $a*u +ar%$ *uru"a" $e& (cell line). Se& %"'u!

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a"+ *erma$u! +#"+a" %"% %a&ah $e& %"'u! me%' 'a" $e& %"'u!

&%m,#%'.

4. Oligopotent stem cell : $e& %"'u! a"+ 'aa* )er'%,ere"$%a$% me"a'%

ha"a )e)eraa e"%$ $e&. M%$a&"a ;U-M (colony forming unit

granulocytelmonocyte) a"+ 'aa* )er!em)a"+ ha"a me"a'% $e&-$e&

+ra"u$%* 'a" $e&-$e& m#"#$%*.

'. !nipotent stem cell : $e& %"'u! a"+ ha"a mamu )er!em)a"+

me"a'% $a*u e"%$ $e& $aa. #"*#h ;U-E (colony forming unit

erythrocyte) ha"a 'aa* me"a'% er%*r#$%*( ;U- (colony forming unit

granulocyte) ha"a mamu )er!em)a"+ me"a'% +ra"u$%*.

2. L%"+!u"+a" m%!r# m%4r#e"9%r#"*me"* $um$um *u&a"+

L%"+!u"+a" m%!r# $um$um *u&a"+ a'a&ah $u)$*a"$% a"+

memu"+!%"!a" $e& %"'u! *um)uh $e4ara !#"'u$%,. K#m#"e" &%"+!u"+a"

m%!r# %"% me&%u*% :

a M%!r#$%r!u&a$% 'a&am $um$um *u&a"+

) Se&-$e& $*r#ma :

%. Se& e"'#*e&

%%. Se& &ema!

%%%. ;%)r#)&a$*

%9. Ma!r#,a+

9. Se& re*%4u&um

4 Ma*r%!$ e!$*ra$e&u&er : ,%)r#"e!*%"( haem#"e!*%"( &am%"%"(

!#&a+e"( 'a" r#*e#+&%!a".

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am)ar 3. ;%$%#+% 'a" Pa*#+% Haem##e$%$

Haema*#+ a* a &a"4e( #&eh B%4*#r H#,,)ra"'(

e'%$% !e-2( L#"'#" 2005( ha&

L%"+!u"+" m%!r# $a"+a* e"*%"+ 'a&am hem##e$%$ !are"a

)er,u"+$% u"*u! :

a. Me"e'%a!a" "u*r%$% 'a" )aha" hem##e$%$ a"+ '%)a/a #&eh

ere'ara" 'arah m%!r# 'a&am $um$um *u&a"+.

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). K#mu"%!a$% a"*ar $e& (cell to cell communication)( *eru*ama '%*e"*u!a"

#&eh a'a"a adhesion molecule.

4. Me"+ha$%&!a" Ca* a"+ me"+a*ur hem##e$%$ : hematopoietic growth

factor" cytokine" 'a" &a%"-&a%".

3. aha"-)aha" em)e"*u! 'arah

aha"-)aha" a"+ '%er&u!a" u"*u! em)e"*u!a" 'arah a'a&ah :

1. A$am ,#&a* 'a" 9%*am%" 12 : merua!a" )aha" #!#!

em)e"*u! %"*% $e&.

2. e$% : $a"+a* '%er&u!a" 'a&am em)e"*u!a" hem#+)%".

3. #)a&*( ma+"e$%um( u( 8".

. A$am am%"#.

5. B%*am%" &a%" : 9%*am%" . 9%*am%" !#m&e!$ 'a" &a%"-&a%"

. Me!a"%$me re+u&a$%

Me!a"%$me re+u&a$% $a"+a* e"*%"+ u"*u! me"+a*ur arah 'a"

!ua"*%*a$ er*um)uha" $e& 'a" e&ea$a" $e& 'arah a"+ ma*a"+ 'ar%

$um$um *u&a"+ !e 'arah *e% $eh%"++a $um$um *u&a"+ 'aa* mere$#"

!e)u*uha" *u)uh 'e"+a" *ea*. Pr#'u!$% !#m#"e" 'arah a"+

)er&e)%ha" a*auu" !e!ura"+a" 'e,%$%e"$% $ama-$ama me"%m)u&!a"

e"a!%*. 8a*-Ca* a"+ )ere"+aruh 'a&am me!a"%$me re+u&a$% %"%

a'a&ah :

a. ;a!*#r er*um)uha" hem##e$%$ (hematopoietic growth factor) :

%. #ranulocytemacrophage colony stimulating factor (#$CS%)

%%. #ranulocyte colony stimulating factor (#CS%)

%%%. $acrophagecolony stimulating factor ($CS%)

%9. &hrom'opoietin

9. urst promoting activity (P)

9%. Stem cell factor (kit ligand)

). S%*#!#" (Cytokine) $eer*% m%$a&"a IL-3 %"*er&eu!%"-3( IL-( IL-5( IL-7(

IL-( IL-( IL-( IL-10.

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#rowth factor 'a" $%*#!%" $e)a+%a" )e$ar '%)e"*u! #&eh $e&-$e&

'arah $e"'%r%( $eer*% &%m,#$%*( m#"#$%*( a*au ma!r#,a+( $er*a $e)a+%a" #&eh

$e&-$e& e"u"a"+( $eer*% ,%)r#)&a$* 'a" e"'#*%&. S%*#!%" a'a a"+

mera"+$a"+ er*um)uha" $e& %"'u! (stimulatory cytokine)" $e)a+%a" &a+%

me"e!a" er*um)uha" $e& %"'u! (inhi'itory cytokine). Ke$e%m)a"+a"

!e'ua e"%$ $%*#!%" %"% $a"+a* me"e"*u!a" r#$e$ hem##e$%$ "#rma&.

4. H#rm#" hem##e*%! $e$%,%! a%*u *rythrpoietin : merua!a" h#rm#"

a"+ '%)e"*u! '%+%"a& !hu$u$ mera"+$a"+ re4ur$#r er%*r#%'.

'. H#rm#" "#"$e$%,%!

e)eraa e"%$ h#rm#"e '%er&u!a" 'a&am um&ah !e4%& u"*u!

hem##e$%$( $eer*% :

%. A"'r#+e" : )er,u"+$% me"$*%mu&a$% er%*r##e$%$.

%%. E$*r#+e" : me"%m)u&!a" %"h%)%$% er%*r##e$%$.

%%%. &u!#!#r*%!#%'.

%9. #rowth hormon

9. H#rm#"e *%r#%'

Da&am re+u&a$% hem##e$%$ "#rma& *er'aa* ,ee' )a4!

me4ha"%$m : $ua*u me!a"%$me uma" )a&%! a"+ 'aa* mera"+$a"+

hem##e$%$%!a *u)uh !e!ura"+a" !#m#"e" 'arah (positive loop) a*au

me"e!a" hema#e$%$ %!a *u)uh !e&e)%ha" !#m#"e" 'arah *er*e"*u

(negative loop).

am)ar . D%a+ram *a)u"+ a"+ )er%$% 'arah 'e"+a" &a$ma 'arah

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A e+%""er$ u%'e *# #' e&&$( #&eh ar)ara @ a%"( 2"' E'%*%#"( )

&a4!/e&& Pu)&%$h%"+ L*'( 200( ha&ama" 2

II1 E2't2!$!e'&'& (Pem3entu4an E2't2!&'t)

II1/Me4an'&me $em3entu4an

Pem)e"*u!a" er%*r#$%* er%*r##%e$%$ merua!a" $ua*u me!a"%$me

uma" )a&%!. Ia '%ham)a* #&eh e"%"+!a*a" !a'ar er%*r#$%r )er$%r!u&a$% 'a"

'%ra"+$a"+ #&eh a"em%a. Ia u+a '%ra"+$a"+ #&eh h%#!$%a 'a" e"%"+!a"

a!&%ma*%$a$% !e *ema* *%"++%. Er%*r##%e$%$ '%!e"'a&%!a" #&eh $ua*u h#rm#"

+&%!#r#*e%" )er$%r!u&a$% a"+ '%"ama% er%*r##%e*%" a"+ *eru*ama

'%$e!re$%!a" #&eh +%"a&.

Se*%a #ra"+ memr#'u!$% $e!%*ar 1012 er%*r#$%* )aru *%a har%

me&a&u% r#$e$ er%*r##%e$%$ a"+ !#m&e!$ 'a" *era*ur 'e"+a" )a%!.

Er%*r##%e$%$ )era&a" 'ar% $e& %"'u! me"a'% re!ur$#r er%*r#$%* a"+ 'aa*

'%!e"a&% er*ama !a&% '% $um$um *u&a"+( a%*u r#"#rm#)&a$.

Pr#"#rm#)&a$ a'a&ah $e& )e$ar 'e"+a" $%*#&a$ma )%ru *ua( 'e"+a" %"*%

'%*e"+ah 'a" "u4&e#&%( $er*a !r#ma*%" a"+ $e'%!%* me"++uma&.

Pr#"#rm#)&a$ me"e)a)!a" *er)e"*u!"a $ua*u ra"+!a%a" "#rm#)&a$

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a"+ ma!%" !e4%& me&a&u% $eum&ah em)e&aha" $e&. N#rm#)&a$ %"% u+a

me"+a"'u"+ $eu"&ah hem#+)%" a"+ ma!%" )a"a! a"+ )er/ar"a

merah mu'a 'a&am $%*#&a$ma( /ar"a $%*#&a$ma ma!%" )%ru u4a*

$ea&a" 'e"+a" h%&a"+"a RNA 'a" aara*u$ a"+ me"$%"*e$%$ r#*e%"(

$e'a"+!a" !r#ma*%" %"*% me"a'% ma!%" a'a*. I"*% a!h%r"a '%!e&uar!a"

'ar% "#rm#)&a$ &a"u* '%'a&am $um$um *u&a"+ 'a" me"+ha$%&!a" $*a'%um

re*%!u$%* a"+ ma$%h me"+a"'u"+ $e'%!%* RNA r%)#$#m 'a" ma$%h

mamu me"$%"*e$%$ hem#+)%".

am)ar. . am)ar $e&-$e& 'arah 'a&am hema*##%e$%$ #ur A*&a$ #,

Hema*#+( Pra4*%4a& M%4r#$4#%4 a"' &%"%4a& D%a+"#$%$( #&eh Hara&'

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a'a r%a 'ar%a'a /a"%*a. ea&a e"'er%*a )%a$a"a !u&%*"a

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me"+ura"+% !aa$%*a$ 'arah mem)a/a #!$%+e".

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Pr#*e%" heme )er,u"+$% 'a&am e"+%!a*a" 'a" e"+a"+!u*a" O2(

$er*a ,#*#$%"*e$%$. u+u$ r#$*e*%! heme merua!a" &en%aa tet2a$'2!

&'4'4( a"+ ear%"+ e!$*e"$%,"a *er'%r% a*a$ %!a*a" ra"+!a *er!#"u+a$%(

a"+ me"era 4ahaa a'a uu"+ )a/ah $e!*rum 9%$%)e& $eh%"++a

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m#&e!u& %r#& a"+ '%hu)u"+!a" 'a&am 4%"4%" &a"ar #&eh em)a*a"

me*%&e"-J. Su)$*%*ue" me"e"*u!a" )e"*u! $e)a+a% heme a*au $e"a/a

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*er#!$%'a$%( a!a" me"+ha"4ur!a" a!*%9%*.

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&a4!/e&& Pu)&%$h%"+ L*' ( ha&ama" 2

Haema*#+ a* a &a"4e( #&eh B%4*#r H#,,)ra"'( e'%$% !e-2( L#"'#" 2005(

ha&

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Ke'#!*era"T#r*#ra @. Derr%4!$#" . Principles of anatomy and physiology : 12*h

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/a'oratorium. @a!ar*a : E

h**:h%!%./%!%$a4e$.4#mS%4!&ee&&D%$ea$eu!u Aar H%$*#+%. E'%$% 12. #m 'a" ;a/4e**. Pe"er)%* u!u

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a*er)ur( Larr. 2001. u!u Sa!u Hema*#+%. @a!ar*a: E. A"*h#"% S ;au4% e* a&. 200. Harr%$#"$ Pr%"4%&e #, I"*er"a& Me'%4%"e 17*h

E'%*%#". Sa";ra"$%$4#: M4ra/ H%&&.S*ehee" @ M4Phee a"' ar D Hammer. Pathophysiology of Disease0

n ntroduction to Clinical $edicine 2th *dition. Sa" ;ra"$%$4#:

M4ra/ H%&&.Hema*#+. Dr.I. u%r* A'r%a"a %#&&e**%( Herem %&)er* a"' Su$ H#*a.

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22


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AIAN 2

HEMOSTASIS DAN OLONAN DARAH

PEMBAHASAN

A1 HEMOSTASIS

Hem#$*a$%$ a'a&ah $ua*u me!a"%$me er*aha"a" *u)uh a"+ ama*

e"*%"+ 'a&am me"+he"*%!a" er'araha" a'a em)u&uh 'arah a"+

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&u!a. Me!a"%$me hem#$*a$%$ memu"a% 'ua ,u"+$% r%mer a%*u u"*u!

me"am%" )ah/a $%r!u&a$% 'arah *e*a 4a%r !e*%!a '% 'a&am em)u&uh

'arah( 'a" u"*u! me"+he"*%!a" er'araha" a'a em)u&uh 'arah a"+

&u!a. Hem#$*a$%$ "#rma& *er+a"*u"+ a'a !e$e%m)a"+a" a"+ )a%! 'a"

%"*era!$% a"+ !#m&e!$( a&%"+ $e'%!%* a"*ara &%ma !#m#"e"-!#m#"e"

)er%!u* A.@. H#,,)ra"'( e* a&&( 2005 :

1. Pem)u&uh 'arah

2. Tr#m)#$%* em)e"*u!a" &a*e&e* &u+

3. ;a!*#r-,a!*#r !#a+u&a$%

. I"h%)%*#r

5. S%$*em ,%)r%"#&%$%$

A1/ S$a&me Pem3uu# Da2a#

D%"'%"+ em)u&uh 'arah memu"a% *%+a &a%$a"( a%*u : *u"%4a

%"*%ma a"+ *er'%r% 'ar% ar%"+ %!a* e"'#*e&%um 'a" $u)e"'#*e&%um( *u"%4a

me'%a 'a" *u"%4a a'9e"*%*%a. K#"$*r%!$% $e*e&ah *rauma merua!a" rea!$%

%"$*r%"$%! 'ar% em)u&uh 'arah( *eru*ama a'a ar*er%#&e !e4%& 'a" !a%&er.

Ba$#!#"$*r%!$% $e*e&ah *rauma 'aa* me"+ura"+%me"uru"!a" a&%ra" 'arah

!e 'aerah &u!a. Ba$#!#"$*r%!$% !a& a"+ '% %"'u!$% #&eh $er#*#"%" 3

hydro4ytriptamine) *e&ah '%*e&%*% $e4ara &ua$. Seum&ah )e$ar 'ar% $er#*#"%"

'%&ea$ 'ar% *r#m)#$%* a'a $um)a* hem#$*a$%$ r%mer. &hrom'o4ane 5

(&65) a"+ '%$%"*e$%$ 'a" '%&ea$!a" #&eh *r#m)#$%* a"+ *era!*%,a$%

u+a me"+%"'u!$% !#"*ra!$% #*#* #$ a'a !#"$e"*ra$% a"+ ama* !e4%&(

$er*a e,e! a"+ 'aa* mem)e"*u! $ua*u me!a"%$me hem#$*a$%$ a"+

e"*%"+. er)a+a% 9a$#!#"*r%!*#r &a%" 'aa* *er)e"*u! a'a $um)a*

hem#$*a*%!( $eer*% fi'ronepeptide " epinephrine dan norepinephrine.%i'rinogen Degradation Product (%DP) me"+ham)a* !#"*ra!$% #*#* #$(

$e'a"+!a" Prostaglandin *5 histamin" 'a" prostacyclin )e!era $e)a+a%

9a$#'%&a*#r.

E"'#*e&%um merua!a" $ua*u re+u&a*#r e"*%"+ 'a&am r#$e$ hem#$*a$%$

'a" a"*%*r#m)#*%!. E"'#*e&%um merua!a" $um)er u*ama 'ar% von

7ille'rand factor (v7%) a"+ &ea$ 'ar% $e&-$e& e"'#*e&%um $e*e&ah

*eraar ,%)r%"( *rauma( a*au em)er%a" 9a$#re$$%". Se&-$e& e"'#*e& u+a

24


25/47

me"+a"'u"+ $ua*u %"h%)%*#r 'ar% a!*%,a$% &a$m%"#+e". Patelet ctivating

%actor (P%)" fi'ronectin" dan tissue throm'oplastin '%$%"*e$%$ $e&-$e&

e"'#*e&%um a"+ *er$*%mu&a$%.

A1- T2!m3!&'t

Tr#m)#$%* merua!a" $e& !e4%& a"+ )er%"*%( )er)e"*u! '%$!#%'

'e"+a" '%ame*er ra*a-ra*a 1(5-3 mm. Tr#m)#$%* '%ha$%&!a" 'a" '%&ea$

'ar% me+a!ar%#$%* a"+ a'a '%$um$um *u&a"+ 'e"+a" /a!*u ma*ura$% -5

har%( 'a" ma$a h%'u '%'a&am $%r!u&a$% !%ra-!%ra -10 har%. @um&ah

*r#m)#$%* 'a&am 'arah 9e"a #ra"+ 'e/a$a "#rma& ra*a-ra*a 250.000mL

10-0.000mL.

A1-1/ P2!du4&' T2!m3!&'t

Pr#$e$ r#'u!$% *r#m)#$%* throm'ocytopoiesis) ma$%h )e&um e&a$.

Me+a!ar%#$%* )era$a& 'ar% pluripotential stem cell. Pr#+e"%*#r a"+ a&%"+

a/a& a'a&ah $egakaryocitic urst%orming !nit (%!$ega)( 'a"

r#+e"%*#r $e&a"u*"a a'a&ah Colony%orming !nit $egakaryocyte PU-

Me+a 'e"+a" %'Q 2N. Pre!ur$#r er*ama a"+ 'aa* '%!e"a& $e4ara

m#r,#+% a'a&ah me+a!ar%#)&a$. Se& %"% )er'%ame*er 15-50mm( )er%"*%

)e$ar(#9a& a*au )er)e"*u! +%"a& 'e"+a" )e)eraa a"a! %"*%. Se&a"u*"a

$e& %"% a!a" me"+a&am% ema*a"+a" me"a'% r#me+a!ar%#$%* ('asophilic

megakaryocyte. Se& %"% )er'%ame*er 20-0mm( )e"*u! %"*% #9a& a*au *%'a!

*era*ur 'a" !a"'u"+a" +ra"u&a a'a $%*#&a$ma )er*em)ah )a"a!. Dar%

re!ur$#r %"% '%)e"*u! me+a!ar%#$%* +ra"u&ar ma*a"+( a"+ merua!a" $e&

ra!$a$a 'e"+a" '%ame*er 30 < 1=0 mm( )e"*u! %"% *%'a! *era*ur( !r#ma*%"

)%ru +e&a( !aa a!a" $%*#&a$ma a"+ )er/ar"a )%ru *era"+ me"+a"'u"+

+ra"u&a a$%'#,%&%!. Da&am r#$e$ ema*a"+a"( me+a!ar%#)&a$ me"+a&am%e"'#'u&%!a$% e"'#m%*#$%$( a%*u r#$e$ '%ma"a *era'% e"++a"'aa" %"*%

*e*a% *%'a! mem)e&ah( 'a" %"% me"+ha$%&!a" %"*% a"+ polypoid. T%a-*%a

'%9%$% me"+ha$%&!a" $eum&ah %"*% 'ua !a&% &%a*( a"+ me"a'% $ua*u $er%

$e&-$e& a"+ me"+a"'u"+ (1=(32 'a" ara"+ = $e* !r#m#$#"( um&ah

%"% u+a '%"a*a!a" $e)a+a% %"*% N( %'Q( a*au class. Pema*a"+a"

$%*#&a$ma '%*a"'a% 'e"+a" e"%"+!a*a" r#+re$%, 'a&am )a"a!"a 'a"

+ra"u&ar%*( 'a" h%&a"+"a $%,a* )a$#,%&%!. Pema*a"+a" %"*% 'a" $%*#&a$ma

25


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me"+ha$%&!a" e"%"+!a*a" 9#&ume $e&. Pa'a ma"u$%a( &ama"a r#$e$

ema*a"+a" me+a!ar%#$%* !%ra-!%ra 5 har%. @um&ah *r#m)#$%* a"+ 'aa*

'%ha$%&!a" me+a!ar%#$%* *%'a! '%!e*ahu%( a!a" *e*a% er!%raa" )er'a$ar!a"

a'a )u!*% u&*ra$*ru!*ura& 'a" erh%*u"+a" 9#&ume $%*#&a$ma 'a" ma$$a

me+a!ar%#$%* me"u"u!a" )ah/a $e*%a me+a!ar%#$%* mu"+!%" 'aa*

me"+ha$%&!a" 1000 < 5000 *r#m)#$%*. I*u !%ra-!%ra erhar% '%ha$%&!a"

35.000 *r#m)#$%* erm%!r#&%*er 'arah. Pa'a /a!*u '%)u*uh!a"( r#'u!$%

*r#m)#$%* 'aa* me"%"+!a* 'e&aa" !a&% &%a*. Tr#m)#$%* a"+ )aru

'%)e"*u! a!a" '%$%ma" 'a&am &%ma $e&ama 2 < am $e)e&um ma$u!

!e $%r!u&a$% umum. K%ra-!%ra 'ua er*%+a 'ar% ma$$a *r#m)#$%* *#*a& )era'a

'a&am $%r!u&a$%( 'a" $eer*%+a 'a&am &%ma a*au e!$*ra9a$!u&er &a%".

A1-1- St2u4tu2 t2!m3!&'t

Te)a& mem)ra" *r#m)#$%* !%ra-!%ra 7(5 "m *er'%r% 'ar% *r%&am%"ar

&%#r#*e%" 'e"+a" ,%&ame"-,%&ame" !#"*ra!*%& $u)mem)ra"( *%+a *%e +ra"u&

'a" $ua*u ar%"+a" %"*er"a& !a"a&%!u&% a"+ %rre+u&er. @e"%$-e"%$ +ra"u&

*er$e)u* a'a&ah

1. Dense granule" a"+ me&ea$!a" adenosine diphosphate

ADP( adenosine triphosphate ATP( $er#*#"%" 'a" %#"-%#"

!a&$%um.

5. lpha granule ( a"+ me&ea$!a" u"$ur-u"$ur *erma$u!

plateletderived growth factor (PD#%)" platelet factor 8 (P%8)"

'eta throm'oglo'ulin (')von 7ille'rand %actor (v7%)" factor

9" fi'rinogen dan fi'ronectin.

:. /isosomal granule.

Mem)ra" *r#m)#$%* *er'%r% 'ar% ,#$,#&%%'( !#&e$*er#&( +&%!#&%%' 'a"a&%"+ $e'%!%* +&%!#r#*e%" P. &%!#r#*e%" a'a&ah !#m#"e" a"+

e"*%"+ 'ar% mem)ra" *r#m)#$%*( a"+ meme"uh% $eum&ah ,u"+$% $e$%,%!

'a&am ,%$%#+% *r#m)#$%*. &%!#r#*e%" Ia P Ia *er&%)a* 'a&am %"*era!$%

*r#m)#$%* 'e"+a" !#&a+e" $e&ama a'he$% *r#m)#$%* !e $u)e"'#*e&%um. P

I) me"+a"'u"+ 'inding site u"*u! 9;( ;uinidineinduced platelet

autoanti'odies 'a" ristocetin. @u+a me"+a"'u"+ 'inding site u"*u!

*r#m)%". De,%$%e"$% P I) '%uma% a'a a$%e" 'e"+a" ernardSoulier

26


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sindrome. n vitro" v7% *%'a! )er%!a*a" !e *r#m)#$%* ernardSoulier

aa)%&a '%*am)ah!a" r%$*#4e*%" a'a &a$ma !aa *r#m)#$%*. K#m&e!$ P

I)-I a'a&ah re$e*#r u"*u! 9;. D%&a)#ra*#r%um !&%"%!( ristocetin a!a"

me"+%"'u!$% a+&u*%"a$% *r#m)#$%* "#rma& a'a &a$ma 'e"+a" !#"$e"*ra$%

9; a"+ "#rma&( 'a" *%'a! *era'% %"*era!$% a"*ara 9; 'a" P I) a'a

*r#m)#$%* %!a *%'a! a'a ristocetin.

P I%) 'a" IIIa mem)e"*u! !#m&e!$ a*au heterodimer ( a"+

'%'aa*% a'a *r#m)#$%* a"+ a!*%,. K#m&e!$ %"% merua!a" re$e*#r

u"*u! ,%)r%"#+e"( a"+ e"*%"+ u"*u! a+re+a$% *r#m)#$%*. K#m&e!$

+&%!#r#*e%" %"% u+a me"+%!a* 9;. De,%$%e"$% PIIa 'a" P IIIa 'a&am

*r#m)#$%* '%uma% a'a a$%e" 'e"+a" #lan"a4t!2 4!aua&' $a&ma %an 3e2#u3uan denan

t2!m3!&'t

27


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Tr#m)#$%* me"+a"'u"+ um&ah a"+ $%+"%,%!a" 'ar% )er)a+a% ,a!*#r

!#a+u&a$% a%*u ,%)r%"#+e"( ,a!*#r B( von 7ille'rand ,a!*#r( ,a!*#r I( ,a!*#r

III 'a" igh$olekular 7eight -ininogen HMK. e)eraa 'ar% ,a!*#r-

,a!*#r %"% ,%)r%"#+e"( ,a!*#r B( 9; 'a" HMK '%$%"*e$%$ 'a&am

me+a!ar%#$%*( *er'aa* 'a&am a *r#m)#$%*( '%ma"a

merua!a" 'inding site u"*u! ,a!*#r a a"+ '%er&u!a" u"*u! mem)e"*u!

r#*r#m)%"a$e. Da" )a"a! 50 ,a!*#r III 'a&am 'arah )erhu)u"+a"

'e"+a" *r#m)#$%* 'a" '%$%"*e$a #&eh me+a!ar%#$%*.

A1-1? Fun&' t2!m3!&'t1

Aa)%&a em)u&uh 'arah ru$a!( $*ru!*ur $u)e"'#*e&%um *erma$u!

'asement mem'rane" kolagen dan mikrofi'ril *er)u!a. Tr#m)#$%* a!a"me"eme& !e ermu!aa" a"+ ru$a! u"*u! mem)e"*u! $um)a* platelet

plug). Da&am me!a"%$me em)e"*u!a" &u+ *er$e)u*( *r#m)#$%* )e!era

'e"+a" :

A1-1@ Ad#e&' t2!m3!&'t

dhesi *r#m)#$%* a'a&ah er&e!a*a" *r#m)#$%* !e ermu!aa" "#"-

*r#m)#$%*. Pr#$e$ %"% *era'% $e*e&ah *rauma 9a$!u&er( '%ma"a *r#m)#$%*

me"eme& me&e!a* *eru*ama a'a $era* !#&a+e" '% $u)e"'#*e&%um.

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A'he$% *r#m)#$%* $a"+a* )er+a"*u"+ a'a 9;( $ua*u r#*e%" &a$ma

a"+ '%ha$%&!a" 'a" '%$e!re$% #&eh $e&-$e& e"'#*e& 'a" *er'aa* a'a

ma*r%!$ $u)e"'#*e&%um( 'a" u+a '%$e!re$% #&eh *r#m)#$%* a"+ a!*%,. 9;

'aa* )er%!a*a" !e mem)ra" *r#m)#$%* 'e"+a" er*#"+a" 3 re$e*#r

a"+ )er)e'a a%*u re$e*#r P I) 'e!a* N-*erm%"a&( re$e*#r P II)-IIIa

a'a *erm%"a&( 'a" )%"'%"+ $%*e N-*erm%"a& !e *%+a. Tr#m)#$%* )er%!a*a"

!e !#&a+e" me&a&u% 9; 'a" P I)-9; mu&a-mu&a me&e!a* a'a $era*

!#&a+e"( !emu'%a" 'e"+a" %!a*a" *r#m)#$%* !e 9; me&a&u% P I)-I

mem)ra" *r#m)#$%*. 9; '%$e!re$% #&eh e"'#*e&%um em)u&uh 'arah( 'a"

9; &a$ma 'a" 9; a"+ a'a $u)e"'#*e&%um 'aa* memera"*ara%

a'he$% *r#m)#$%*. ?a"+ me"ar%! )ah/a( *r#m)#$%* $%r!u&a$% "#rma& *%'a!

)er%"*era!$% 'e"+a" 9; a"+ a'a 'a&am &a$ma /a&auu" *er"a*a

*r#m)#$%* memu"a% P I)-I a'a ermu!aa""a.

Se*e&ah a'he$%( *r#m)#$%* me"+a&am% eru)aha" )e"*u! 'ar% )e"*u!

disk me"a'% )e"*u! a"+ &e)%h $,er%$ 'e"+a" mem)e"*u! pseudopodia.

Pa'a /a!*u a"+ $ama *era'% r#$e$ $e!re$% '%ma"a )e)eraa $u)$*a"$%

a"+ a!*%, $e4ara )%#+%$ a"+ '%$%ma" 'a&am +ra"u& *r#m)#$%* $e4ara

a!*%, '%!e&uar!a" 'ar% $e&-$e& a"+ me&e!a* rea!$% e&ea$a".

8a*-Ca* a"+ '%&ea$!a" *erma$u! ADP( $er#*#"%"( )-T( P;( PD;( T-

A2( 'a" 9;. Su)$*a"$%-$u)$*a"$% a"+ '%&ea$!a" memer4ea*

em)e"*u!a" &u+ *r#m)#$%* 'a" )erera" 'a&am r#$e$ er)a%!a"

ar%"+a".(

A1-1 A2ea&' t2!m3!&'t

ADP a"+ '%&ea$!a" #&eh *r#m)#$%* mera"+$a"+ er&e!a*a"

*r#m)#$%* 'e"+a" *r#m)#$%* &a%". ;e"#me"a %"% '%$e)u* a+re+a$% *r#m)#$%*(a"+ a!a" me"%"+!a*!a" u!ura" &u+ a'a *ema* a"+ &u!a. A+re+a$%

*r#m)#$%* '%%!u*% 'e"+a" e&ea$a" %$% +ra"u& a"+ mera"+$a"+ *r#m)#$%*

&a%" u"*u! )era+re+a$%. D%$am%"+ ADP )er)a+a% a+e"* *erma$u!

e%"e,r%"( !#&a+e"( *r#m)%"( !#m&e!$ %mu" 'a" ,a!*#r a"+ me"+a!*%,a$%

*r#m)#$%* plateletactivating factor) 'aa* me"e)a)!a" a+re+a$% 'a"

$e!re$% *r#m)#$%*.

29


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Pr#$*a+&a"'%" )erera" e"*%"+ 'a&am memera"*ara% rea!$%

e&ea$a" 'a" a+re+a$%. K#&a+e" 'a" e%"e,r%" me"4e*u$!a" a!*%,a$% 'ar%

$a*u a*au &e)%h ,#$,#&%a$e a"+ a'a 'a&am mem)ra" *r#m)#$%*.

;#$,#&%a$e %"% !emu'%a" me"+h%'r#&%$a ,#$,#&%%' mem)ra"( me&ea$!a"

a$am ara!h%'#"a*. A$am ara!h%'#"a* '%me*a)#&%$me #&eh e"C%m

$%!#!$%+e"a$e u"*u! mem)e"*u! r#$*a+&a"'%" e"'#er#!$%'a a"+

*%'a! $*a)%&( 'a" %"% !emu'%a" '%ru)ah me"a'% *r#m)#!$a" A2.

Tr#m)#!$a" A2 a'a&ah $ua*u $u)$*a"$% a"+ $a"+a* #*e" a"+

me"+%"'u!$% a+re+a$% 'a" $e!re$% *r#m)#$%*.

;%)r%"#+e" '%er&u!a" u"*u! a+re+a$% *r#m)#$%*. ;%)r%"#+e"

)er%!a*a" 'e"+a" re$e*#r-re$e*#r $e$%,%! a'a ermu!aa" *r#m)#$%*

a%*u +&%!#r#*e%" II)IIIa PII)IIIa( 'a" me"+hu)u"+!a" *r#m)#$%*

'e"+a" *r#m)#$%* &a%""a. Pa$%e"-a$%e" 'e"+a" !e&a%"a" !#"+e"%*a&

'%ma"a *%'a! *er'aa* ,%)r%"#+e" afi'rinogenemia) a*au PII)IIIa

#lan


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Se'a"+!a" ,a!*#r B( ,a!*#r BIII( highmolecularweight kininogen HMK(

'a" tissue factor a"+ *er'aa* '% e!$*ra9a$!u&er 'a" haru$ !#"*a!

'e"+a" 'arah u"*u! )er,u"+$%( )u!a" merua!a" r#e"C%m *e*a%

)er,u"+$% $e)a+a% !#,a!*#r. ;a!*#r B( ,a!*#r BIII( 'a" HMK haru$

'%a!*%,a$% a+ar )er,u"+$% $e)a+a% !#,a!*#r.

;a!*#r ( ,a!*#r I( ,a!*#r BII( 'a" r#*r#m)%" '%$e)u* ,a!*#r-,a!*#r a"+

*er+a"*u"+ 9%*am%" K vitamin -dependent factor)( !are"a u"*u!

em)e"*u!a""a a"+ $emur"a memer&u!a" 9%*am%" K. Pr#*e%"-r#*e%"

%"% me"+a"'u"+ re$%'u a$am am%"# a"+ u"%!( +-car'o4yglutamic acid

(#la).

B%*am%" K *er'aa* 'a&am $aur-$aura" a"+ )er/ar"a h%au 'a" u+a

'%$%"*e$%$ #&eh )a!*er%a '% 'a&am u$u$. B%*am%" K )er,u"+$% $e)a+a% $ua*u

!#,a!*#r a"+ e"*%"+ u"*u! $%"*e$%$ ,a!*#r II( ,a!*#r BII( ,a!*#r I( ,a!*#r (

r#*e%" 'a" r#*e%" S( '%ma"a 9%*am%" K merua!a" !#,a!*#r e"*%"+

a"+ '%er&u!a" u"*u! me"e&e$a%!a" posttranslational 'ar% $%"*e$%$

,a!*#r-,a!*#r em)e!ua" a"+ *er+a"*u"+ 9%*am%" K( a%*u u"*u! rea!$%

!ar)#!$%&a$% 'ar% a$am +&u*ama* me"a'% residu +-car'o4yglutamic acid.

Re$%'u &a a'a&ah *ema* %!a*a" !e r#*e%"-r#*e%" %"% 'a" '%er&u!a"

u"*u! %"*era!$%"a 'e"+a" ,#$,#&%%' mem)ra". Ke+a+a&a" 'a&am

!ar)#!$%&a$% a"+ *era'% a'a 'e,e$%e"$% 9%*am%" K a*au a'a )e)eraa

!e&a%"a" ha*% cirrhosis" hepatocelluler carcinoma( *era'% e"umu!a"

,a!*#r-,a!*#r em)e!ua" 'e"+a" *%'a! a'a a*au e"uru"a" +

car'o4ylation sites. ?on a*au descar'o4ylated r#*e%" %"% u+a '%$e)u*

proteininduced in vitamin - a)$e"4e PIBKA.

O)a*-#)a*a" a"*%!#a+u&a" #ra& #umar%"( ar,ar%"( *%'a! )e!era '%'a&am $%r!u&a$% *e*a% '% ha*%( '%ma"a #)a*-#)a*a" *er$e)u* me"+ham)a*

$%"*e$%$ 'ar% ,a!*#r-,a!*#r em)e!ua" a"+ *er+a"*u"+ 9%*am%" K.

A161/ Fa4t!2 +II

;a!*#r BII a'a&ah $ua*u +&%!#r#*e%" ra"*a% *u"++a&( 'e"+a" )era*

m#&e!u& .000 a'a ma"u$%a 'a" a'a &em)u 53.000. !#"$e"*ra$%"a

'%'a&am &a$ma $a"+a* re"'ah( a%*u 0.13 < 1 m+m&.2(51 Seer*% ,a!*#r-

,a!*#r em)e!ua" &a%" a"+ *er+a"*u"+ 9%*am%" K ,a!*#r II(IB( 'a" (

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,a!*#r BII '%$%"*e$%$ '% 'a&am ha*%( 'a" +%"a& u+a merua!a" $um)er ,a!*#r

BII. B%*am%" K '%)u*uh!a" u"*u! !ar)#!$%&a$% re$%'u a$am +&u*ama* me"a'%

+-car'o4yglutamic acid a"+ e"*%"+ u"*u! a2-mediated phospholipid

'inding.

Ka'ar ,a!*#r BII me"%"+!a* $e&ama !eham%&a" 'a" a'a ema!a%a"

!#"*ra$e$% a"+ me"+a"'u"+ #e$*r#+e". Ha& %"% me"u"u!a" )ah/a

$%"*e$%$ a*au $e!re$%"a '%)a/ah !#"*r#& h#rm#"a&( *e*a% me!a"%$me"a

*%'a! e&a$.

;a!*#r BII merua!a" $ua*u r#e"C%m 3entu4 "a4t!2 +II

;a!*#r BII *er'aa* 'a&am )e)eraa )e"*u! '%'a&am &a$ma( /a&auu"

)e&um $emua )e"*u! '%)u!*%!a" 'e"+a" $*u'% &a)#ra*#r%um. Se4ara

*e#r%*%$( ,a!*#r BII 'aa* 'a&am )e"*u! ra"*a% *u"++a&( ,a!*#r BIIa ra"*a% 'ua(

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!#m&e!$ ,a!*#r BII-*%$$ue ,a4*#r( !#m&e!$ ,a!*#r BIIa-*%$$ue ,a4*#r( ,a!*#r

BII-,#$,#&%%'( 'a" !#m&e!$ ,a!*#r BIIa 'e"+a" tissue factor pathway

inhi'itor . a&auu" ma$%h !#"*r#9er$%a&( '%&a#r!a" ha"a ,a!*#r BII a"+

memu"a% a!*%,%*a$ e"C%ma*%!.

,en'&>


34/47

&issue factor Tr#m)#&a$*%"( ,a!*#r III( a'a&ah $ua*u &%#r#*e%"

a"+ 'a&am um&ah )e$ar *er'aa* 'a&am ar%"+a" 'a" )er,u"+$% 'a&am

!#a+u&a$% 'e"+a" )er%"*era!$% 'e"+a" ,a!*#r BII a'a a&ur e!$*r%"$%!.

Se&a%" %*u tissue factor u+a *er'aa* a'a '%"'%"+ em)u&uh 'arah(

'%ma"a a!*%,%*a$ !#a+u&a$%"a a!a" '%mu&a% )%&a em)u&uh 'arah

me"+a&am% !eru$a!a" damaged)( 'a" T; 'aa* '%%"'u!$% a'a $e&

m#"#$%* 'a" $e&-$e& e"'#*he&%um em)u&uh 'arah #&eh )er)a+a% cytokine(

'%ma"a T; a"+ '%e!$re$%!a" #&eh $e&-$e& %"% 'aa* me"%m)u&!a" re$#"$

!#a+u&a$% a'a em)u&uh 'arah a"+ intact.

T; ma"u$%a *er'%r% 'ar% 2=3 a$am am%"#( 'a" )era* m#&e!u&"a

)er9ar%a$% 'ar% 53.000-25.000. &issue factor a"+ *er'aa* 'a&am

ar%"+a" #*a!( aru-aru 'a" &a$e"*a( me"u"u!a" a!*%,%*a$ $e$%,%! a"+

&e)%h *%"++% '%)a"'%"+!a" a"+ a'a a'a ar%"+a" +%"a& 'a" &%ma( 'a"

)e)eraa '%a"++a *%'a! memu"a% a!*%,%*a$( m%$a&"a *r#m)#$%* 'a"

#*#*. Da" r#*e%" %"% )e&a!a"+a" $e4ara e!$*e"$%, '%mur"%!a" 'ar% ar%"+a"-

ar%"+a" *er$e)u* u"*u! em)ua*a" rea+e" *r#m)#&a$*%" a"+ '%+u"a!a"

u"*u! *e$* !#a+u&a$% '% !&%"%!.

&issue factor )er,u"+$% $e)a+a% !#,a!*#r u"*u! ,a!*#r BIIa 'a&am

me"+a!*%,a$% ,a!*#r 'a" u+a ,a!*#r I 'a&am r#$e$ em)e!ua" 'arah.

A!*%9a$% a&ur %"% a'a 'a$ar"a ha$%& 'ar% 'ua !ea'aa"( aa)%&a !#"*%"u%*a$

&a%$a" e"'#*he&%um *er+a"++u 'a" 'arah *eraar !e $e&-$e&

e!$*ra9a$!u&er a*au aa)%&a e"'#*e& a*au "eu*r#,%& 'a" m#"#$%* '%%4u

u"*u! e4pose T; a'a mem)ra""a.

A1616 MEKANISME PEMBEKUAN DARAH

Pa'a em)u&uh 'arah a"+ ru$a!( !a$!a'e !#a+u&a$% $e4ara 4ea*'%a!*%,a$% u"*u! me"+ha$%&!a" *r#m)%" 'a" a!h%r"a u"*u! mem)e"*u!

$#&%' ,%)r%" 'ar% $#&u)&e ,%)r%"#+e"( memer!ua* &a! *r#m)#$%* r%mer.

K#a+u&a$% '%mu&a% 'e"+a" 'ua me!a"%$me a"+ )er)e'a( a%*u r#$e$

a!*%,a$% !#"*a! 'a" !era 'ar% tissue factor . A!*%,a$% !#"*a! me"+a/a&%

$ua*u ra"+!a%a" 'ar% rea!$%-rea!$% a"+ me&%)a*!a" ,a!*#r II( ,a!*#r I(

,a!*#r I( ,a!*#r BIII( prekalikrein" igh $olecular 7eight -ininogen

HMK( 'a" platelet factor : P;-3. Rea!$%-rea!$% %"% )erera" u"*u!

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em)e"*u!a" $ua*u e"C%m a"+ me"+a!*%,a$% ,a!*#r ( '%ma"a rea!$%-

rea!$% *er$e)u* '%"ama!a" a&ur %"$*r%"$%! intrinsic pathway).

Se'a"+!a" !#a+u&a$% a"+ '%mu&a% 'e"+a" tissue factor" '%ma"a

$ua*u %"*era!$% a"*ara tissue facktor %"% 'e"+a" ,a!*#r BII( a!a"

me"+ha$%&!a" $ua*u e"C%m a"+ u+a me"+a!*%,a$% ,a!*#r . I"% '%"ama!a"

a&ur e!$*r%"$%! e4trinsic pathway . La"+!ah $e&a"u*"a 'a&am r#$e$

!#a+u&a$% me&%)a*!a" ,a!*#r 'a" B( P;-3( r#*r#m)%"( 'a" ,%)r%"#+e".

Rea!$%-rea!$% %"% '%"ama!a" a&ur )er$ama common pathway).

@a&ur e!$*r%"$%! '%mu&a% 'e"+a" emaara" 'arah !e ar%"+a" a"+

&u!a. D%$e)u* e!$*r%"$%! !are"a *r#m)#&a$*%" ar%"+a" tissue factor)

)era$a& 'ar% &uar 'arah. Pemer%!$aa" Protrom'in &ime PT '%+u"a!a"

u"*u! $!r%"%"+ a&ur %"%.

Aa)%&a 'arah '%am)%& $e4ara ha*%-ha*% $eh%"++a *%'a! *er!#"*am%"a$%

4a%ra" ar%"+a"( 'arah *er$e)u* ma$%h mem)e!u '%'a&am *a)u"+ +e&a$.

@a&ur %"% '%$e)u* a&ur %"*r%"$%!( !are"a $u)$*a"$% a"+ '%er&u!a" u"*u!

em)e!ua" a'a 'a&am 'arah. @a&ur %"*r%"$%! '%4e*u$!a" #&eh !#"*a! ,a!*#r

II 'e"+a" ermu!aa" a$%"+. Partial throm'oplastin time PTT 'a"

activated P&& aPTT a'a&ah m#"%*#r a"+ )a%! u"*u! a&ur %"%. Ke'ua a&ur

a!h%r"a $ama -$ama me"+a!*%,a$% ,a!*#r ( 'a" '%$e)u* a&ur )er$ama.

K#"$e 'ar% 'ua a&ur a"+ *er%$ah ra!*%$ u"*u! memaham% !#a+u&a$%

'arah in vitro. Ha$%& 'ar% emer%!$aa" PT 'a" PTT a*au aPTT )%a$a"a

me"#"+ !a$% $ua*u !e&a%"a" 'a&am $!ema !#a+u&a$% u"*u! '%a+"#$%$

!e&a%"a"-!e&a%"a" !#a+u&a$%.

,au2 Int2'n&'4

@a&ur %"*r%"$%!( memer&u!a" ,a!*#r BIII( ,a!*#r I( ,a!*#r ( ,a!*#r I('a" ,a!*#r II. @u+a memer&u!a" re!a&%!re%" 'a" HMK( )e+%*u u+a %#"

!a&$%um 'a" ,#$,#&%%' a"+ '%$e!re$% 'ar% *r#m)#$%*. Mu&a- mu&a a&ur

%"*r%"$%! *era'% aa)%&a re!a&%!re%"( HMK( ,a!*#r I 'a" ,a!*#r II

*eraar !e ermu!aa" em)u&uh 'arah a'a&ah $*%mu&u$ r%mer u"*u!

,a$e !#"*a!. Kumu&a" !#m#"e"-!#m#"e" ,a$e !#"*a! meru)ah

re!a&&%!re%" me"a'% !a&&%!re%"( a"+ $e&a"u*"a me"+a!*%,a$% ,a!*#r II

me"a'% ,a!*#r IIa. ;a!*#r IIa !emu'%a" 'aa* me"+h%'r#&%$a

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re!a&&%!re%" &a+% me"a'% !a&&%!re%"( mem)e"*u! !a$!a'e a"+ $a&%"+

me"+a!*%,a$%. ;a!*#r IIa u+a me"+a!*%,a$% ,a!*#r I me"a'% ,a!*#r Ia

'a" me"e)a)!a" e&ea$a" )ra'%!%"%"( $ua*u 9a$#'%&a*#r a"+ #*e" 'ar%

HMK. De"+a" a'a"a a2( ,a!*#r Ia me"+a!*%,a$% ,a!*#r I me"a'%

,a!*#r Ia( 'a" ,a!*#r Ia me"+a!*%,a$% ,a!*#r me"a'% ,a!*#r a.2(((

,au2 E4&t2'n&'4

@a&ur e!$*r%"$%!( '%mu&a% a'a *ema* a"+ *rauma 'a&am re$#"$

*erha'a e&ea$a" tissue factor ,a!*#r III. Ka$!a'e !#a+u&a$% '%a!*%,a$%

aa)%&a tissue factor '%e!$re$%!a" a'a $e&-$e& a"+ ru$a! a*au '%$*%mu&a$%

$e&-$e& 9a$!u&er a*au m#"#$%*( $eh%"++a !#"*a! 'e"+a" ,a!*#r BIIa

$%r!u&a$% 'a" mem)e"*u! !#m&e!$ 'e"+a" a'a"a %#" !a&$%um. &issue

factor a'a&ah $ua*u !#,a!*#r 'a&am a!*%,a$% ,a!*#r a"+ '%!a*a&%$a ,a!*#r

BIIa. ;a!*#r BIIa( $ua*u re$%'u +&a a"+ me"+a"'u"+ $er%"e r#*ea$e(

meme4ah ,a!*#r me"a'% ,a!*#r a( %'e"*%! 'e"+a" ,a!*#r Ia 'ar% a&ur

%"$*r%"$%!. A!*%,a$% ,a!*#r BII *era'% me&a&u% !era *r#m)%" a*au ,a!*#r a.

&issue factor )a"a! *er'aa* 'a&am ar%"+a" *erma$u! a'9e"*%*%a

em)u&uh 'arah( e%'erm%$( mu!#$a u$u$ 'a" respiratory" !#r*e!$

$ere)ra&( m%#!ar'%um 'a" +meru&u$ +%"a&. A!*%,a$% tissue factor u+a

'%uma% a'a $u)e"'#*e&%um. Se&-$e& e"'#*e&%um 'a" m#"#$%* u+a 'aa*

me"+ha$%&!a" 'a" me"+e!$re$%!a" a!*%,%*a$ tissue factor a*a$ $*%mu&a$%

'e"+a" %"*er&eu!%"-1 a*au e"'#*#!$%"( '%ma"a me"u"u!a" )ah/a

cytokine 'aa* me"+a*ur e!$re$% tissue factor 'a" 'e#$%$% ,%)r%" a'a

*ema* %",&ama$%.

Kemamua" ,a!*#r a u"*u! me"+a!*%,a$% ,a!*#r BII me"4%*a!a"

$ua*u hu)u"+a" a"*ara a&ur %"$*r%"$%! 'a" e!$*r%"$%!. Se&a%" %*u hu)u"+a"'ua a&ur %*u a'a me&a&u% !emamua" 'ar% tissue factor 'a" ,a!*#r BIIa

u"*u! me"+a!*%,a$% ,a!*#r I me"a'% Ia. Ha& %"% *er)u!*% )ah/a a'a

a$%e"-a$%e" 'e"+a" 'e,%$%e"$% ,a!*#r BII *e*a% *%'a! 'e,%$%e"$% ,a!*#r I(

*era'% e"uru"a" !a'ar 'ar% a!*%,a$% ,a!*#r I( $e'a"+!a" a$%e"-a$%e"

'e"+a" 'e,%$%e"$% ,a!*#r BIII a*au ,a!*#r I( memu"a% !a'ar a"+ "#rma&

'ar% a!*%,a$% ,a!*#r 'a" r#*hr#m)%". Da" a'a infusion recom'inant

factor 9a 'e"+a" '#$%$ a"+ re&a*%, !e4%& 10-20 m+!+ a'a a$%e"-

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a$%e" 'e"+a" 'e,%$%e"$% ,a!*#r BII me"+ha$%&!a" $ua*u e"%"+!a*a" a"+

)e$ar a'a !#"$e"*ra$% a!*%,a$% ,a!*#r . ;a!*#r Ia a"+ )aru '%)e"*u! %*u

mem)e"*u! !#m&e!$ 'e"+a" ,a!*#r BIIIa 'e"+a" a'a"a mem)ra"

!a&$%um 'a" ,#$,#&%%'( 'a" $e&a"u*"a u+a me"+a!*%,a$% ,a!*#r me"a'%

a. K#m&e!$ %"% '%$e)u* *e"a$e. Da" *er"a*a )u!*%-)u!*% me"u"u!a"

)ah/a a&ur e!$*r%"$%! )erera" u*ama 'a&am memu&a% em)e!ua" 'arah

in vitro 'a" em)e"*u!a" ,%)r%".

ctivated factor 6a a'a&ah *ema* '%ma"a !a$!a'e !#a+u&a$% a&ur

%"*r%"$%4 'a" e!$*r%"$%! )er*emu. ;a!*#r a )er%!a*a" 'e"+a" ,a!*#r Ba

'%a!*%,a$% #&eh *r#m)%"(a"+ ma"a 'e"+a" !a&$%um 'a" ,#$,#&%%' '%$e)u*

!#m&e!$ r#*hr#m)%"a$e( a"+ $e4ara 4ea* meru)ah r#*r#m)%"

me"a'% *r#m)%".

S*u'%-$*u'% a"+ )aru *e&ah meru)ah !#"$e a&ur em)e!ua"

'arah 'a" $%$*%m a"*%!#a+u&a$%. T%'a! $eer*% $%$*em &ama( '%ma"a

)er'a$ar!a" a&ur %"*r%"$%! 'a" e!$*r%"$%!( !#"$e )aru em)e!ua" 'arah

)er,#!u$ a'a tissue factor. T; )er%!a*a" 'e"+a"


38/47

Mu&a-mu&a !#m&e!$ T;-BIIa '%er)e$ar #&eh a!*%,a$% feed'ack

,a!*#r BII #&eh ,a!*#r a 'a" ,a!*#r Ia( a!a" *e*a% !#m&e!$ %*u $e4ara

4ea* '%ham)a* #&eh &issue %actorPathway nhi'itor T;PI. Pa'a /a!*u

%*u *r#m)%" a"+ '%ha$%&!a" me"+a!*%,a$% ,a!*#r I( )e+%*u u+a ,a!*#r B(

,a!*#r BIII( 'a" !are"a %*u me"am)ah em)e"*u!a" tenase 'a" a!h%r"a

me"+ha$%&!a" &e)%h )a"a! *r#m)%". ;a!*#r I 'aa* u+a '%a!*%,a$% #&eh

,a!*#r IIa( a!a" *e*a% era"a""a u"*u! ,%$%#+% hem#$*a$%$ m%"%ma&(

$eer*% '%*u"u!a" #&eh *%'a! a'a"a +ea&a er'araha" a'a %"'%9%'u-

%"'%9%'u 'e"+a" 'e,%$%e"$% )era* ,a!*#r II( re!a&&%!re%"( a*au HMK.

;u"+$% u*ama *r#m)%" ;IIa a'a&ah u"*u! meme4ah ,%)r%"#+e" me"a'%

,%)r%" 'a" me"+a!*%,a$% ,a!*#r III a"+ me"+ha$%&!a" crosslinked )e!ua"

a"+ $*a)%&.

er%!u* $!ema r#$e$ em)e!ua" 'arah :

A10 INHIBITOR

Seum&ah r#*e%" &a$ma mamu me"+ham)a* $er%"e r#*ea$e

*er&%)a* 'a&am !#a+u&a$%( ,%)r%"#&%$%$( 'a" em)e"*u!a" !%"%". I"% *erma$u!

antitrom'in " heparin cofactor " a5macroglo'ulin" a1antitrypsin" tissue

38


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factor pathway inhi'itor ( &%P)" activator inhi'itor1(P1)" dan C1

inhi'itor.

ntitrom'in (& ) a'a&ah $ua*u r#*e%" &a$ma 'e"+a" M

5.000 '%ha$%&!a" '% hear( *er'%r% 'ar% #&%e*%'a ra"*a% *u"++a& 'e"+a"

32 a$am am%"#. AT-III me"e*ra&%$a$%me"+ham)a* *r#m)%" 'e"+a"

mem)e"*u! !#m&e!$ $*a)%& 1:1 a"*ara $a*u re$%'u ar+%"%" 'ar% AT-III 'a"

activesite serine 'ar% *r#m)%". AT-III u+a me"+ham)a* ,a!*#r IIa( ,a!*#r

Ia( ,a!*#r a( ,a!*#r BII-T;( !a&&%!re%" &a$ma 'a" &a$m%". Kera"a

$a"+a* '%er4ea* #&eh hear%". AT-III $e)a+a% a"*%!#a+u&a" 'a" hear%"

$e)a+a% !#,a!*#r.

eparin cofactor H;-II( $e4ara $e&e!*%, me"+ham)a* *r#m)%"

'e"+a" mem)e"*u! $ua*u !#m&e!$. Seer*% AT-III( a!*%,%*a$ %"h%)%*#r %"%

$e4ara "a*a '%$*%mu&a$% 'e"+a" a'a"a hear%". er)e'a 'e"+a" AT-III(

H;-II *%'a! me"+ham)a* a!*%,%*a$ ,a!*#r-,a!*#r !#a+u&a$% &a%""a( 'a"

H;-II '%a!*%,a$% #&eh dermatan sulfate" $e'a"+!a" AT-III *%'a!. Ma!a H;-

II merua!a" %"h%)%*#r e"*%"+ 'ar% *r#m)%" 'e"+a" a'a"a dermatan

sulfate.

a5Plasmin inhi'itor (a5antiplasmin)" a'a&ah %"h%)%*#r &a$m%" a"+

)erea!$% 4ea*( '%ma"a me"+ham)a* &a$m%" 'e"+a" $e+era 'e"+a"

mem)e"*u! !#m&e!$ 1:1. Plasminogen activator inhi'itor1 (P1)"

a'a&ah $ua*u r#*e%" &a$ma 'e"+a" M 52.000( '%ha$%&!a" #&eh )er)a+a%

$e&( $eer*% $e&-$e& e"'#*he&%um( hea*#$%*( 'a" ,%)r#)&a$*. K#"$e"*ra$%

'%'a&am &a$ma $a"+a* re"'ah 0.005 m+'& 'a" u+a '%$%ma" 'a&am a

granul *r#m)#$%*. PAI-1 me"+ham)a* tissue plasminogen activator *-PA

'a" ur#!%"a$e 'e"+a" mem)e"*u! $ua*u !#m&e!$ 'e"+a" e"C%m( 'a"PAI-1 )erera" e"*%"+ 'a&am e"+a*ura" a!*%,%*a$ $%$*%m ,%)r%"#&%$%$.

a1Proteinase nhi'itor" u+a '%!e"a& $e)a+a% a1antitripsin" atau a1

antiproteinase" u+a me"+%"a!*%,a$% &a$m%" 'a" ur#!%"a$e( *e*a% $e)a+a%

%"h%)%*#r *r%$%" re&a*%, &emah. a1proteinase inhi'itor a'a&ah aglo'ulin"

'%uma% '% 'a&am &a$ma 'a" a'a mem)ra"e *r#m)#$%*. Me!a"%$me

!era a"*%-e"C%m"a )e&um '%!e*ahu%.

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Activated protein C inhi'itor ( AP %"h%)%*#r( me"+ham)a* a!*%,%*a$

r#*e%" a!*%, 'e"+a" mem)e"*u! !#m&e!$ 'e"+a" e"C%m %"%. Pr#*e%" %"%

u+a '%!e"a& $e)a+a% plasminogen activator inhi'itor.

&issue factor pathway inhi'itor T;PI( u+a '%$e)u* e4trinsic

pathway inhi'itor EPI a*au lipoproteinassociated coagulation inhi'itor

LAI( a'a&ah r#*e%" &a$ma a"+ )aru '%*emu!a" M 3.000 a"+

me"+ham)a* a/a& !#a+u&a$% 'arah 'e"+a" !#m&e!$ %9atissue factor.

K#"$e"*ra$% T;PI 'a&am &a$ma re"'ah( *e*a% pool a"+ &e)%h )e$ar 'ar%

T;PI *er'aa* 'a&am e"'#*e&%um em)u&uh 'arah 'a" 'aa* '%&ea$!a" !e

'a&am 'arah #&eh hear%". Ka'ar T;PI &a$ma me"%"+!a* 'ua m%"++u

h%"++a ema* !a&% &%a* 'e"+a" %",u$ hear%". T;PI me"+a*ur a!*%,a$% ;

me&a&u% %"h%)%$% !#m&e!$ ;BIIa -T; 'a" ,a!*#r a. Me!a"%$me !era"a

u"%!( mu&a- mu&a T;PI )er%"*era!$% 'e"+a" ,a!*#r a 'e"+a" mem)e"*u!

!#m&e!$ a-T;PI( a"+ !emu'%a" mem)e"*u! !#m&e!$ ;uartenary 6a

&%P9atissue factor 'e"+a" a!%)a* h%&a"+"a a!*%,%*a$ !#m&e!$ BIIa-

*%$$ue ,a4*#r. T;PI '%$%"*e$%$ #&eh $e&-$e& e"'#*e&%um em)u&uh 'arah( u+a

#&eh hea*#$%*.

A1? PENGATURAN PEMBEKUAN DARAH

Me!a"%$me a"*%!#a+u&a" a&am%ah me"+a*ur 'a" me!a&%$er

em)e"*u!a" &a! hem#$*a$%$ a*au *r#m)u$ !e *ema* em)u&uh 'arah

a"+ ru$a!. I"h%)%*#r ,a!*#r !#a+u&a$% u*ama a*au a"*%!#a+u&a" a&am%ah

a"+ )er&a"+$u"+ *erha'a em)e"*u!a" a*au !era *r#m)%"( *erma$u!

$%$*%m a"*%*r# m)%" 'a" r#*e%" .

A"*%*r#m)%" me"+%"a!*%,a$% *r#m)%" 'ar% $er%"e r#*ea$e a"+ &a%"

;-BIIa( ;-IIa( ;Ia( ;-Ia 'e"+a" )er%!a*a" $e4ara %rre9er$%)e& me&a&u%re$%'u ar+%"%" !e *ema* $er%"e a!*%, 'ar% r#*ea$e $er%"e r#*ea$e

%"h%)%*#r a*au $er%". Da&am !ea'aa" *%'a! a'a hear%"( *%"+!a*

%"a!*%,a$%"a re&a*%, &am)a*( *e*a% aa)%&a hear%" a*au heara" $u&,a*

'%"'%"+ em)u&uh 'arah )er%!a*a" !e re$%'u &$%"e a'a m#&e!u& AT( a!a"

me"+ha$%&!a" %"a!*%,a$% *r#m)%" $e!e*%!a %*u u+a. O&eh !are"a %*u AT

'%$e)u* heparin cofactor 1. Hear%" 4#,a4*#r II( 'aa* u+a '%a!*%,a$% #&eh

hear%" /a&auu" '%)u*uh!a" um&ah a"+ &e)%h )e$ar(

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glycosaminoglycan" dermatan sulphate u"*u! %"a!*%,a$% *r#m)%". Tr#m)%"

'aa* u+a )er%!a*a" !e e"'#*e&%um a*au ermu!aa" *r#m)#$%* me&a&u%

re$e*#r *r#m)#m#'u&%" 'a" '%$%"+!%r!a" 'ar% $%r!u&a$%. Ser%"-$er%" &a%"

$eer*% J -1 antitrypsin dan J-2 macroglo'ulin )erera" mem)a"*u

%"a!*%,a$% *r#m)%". Pr#*e%" 8 P8( $ua*u r#*e%" a"+ *er+a"*u"+ r#*e%"

a"+ '%$e)u* P@dependent protease inhi'itor (P@).

@a&ur r#*e%" P merua!a" me!a"%$me u*ama u"*u!

mem)a*a$% re$#"$ !#a+u&a$% *erha'a *rauma. @a&ur %"% '%mu&a% aa)%&a

*r#m)%" )er%!a*a" 'e"+a" throm'omodulin (&$). K#m&e!$ *r#m)%"-TM

a'a&ah $ua*u a!*%,a*#r #*e" 'ar% P 'a" memu"a% $e'%!%* !emamua"

u"*u! a!*%,a$% *r#m)#$%* a*au )e!ua" ,%)r%"#+e". ctivated PC (PC)

'%er)e$ar #&eh endothelial cell PC receptor (*PCA) a"+ me"%"+!a*!a"

a,%"%*a$ !#m&e!$ *r#m)%"-TM u"*u! P. AP me"%"a!*%,a$% $e4ara

r#*e#&%*%! ,a!*#r Ba 'a" ,a!*#r BIIIa 'e"+a" )a"*ua" !#,a!*#r r#*e%" S

PS. K#m&e!$ *r#m)%"-TM $e4ara 4ea* '% %"a!*%,a$% #&eh P %"h%)%*#r

PI 'a" AT.

De,%$%e"$% here'%*er 'ar% r#*e%" ( r#*e%" S( 'a" re$%$*e"$%

*erha'a activated protein C" !e$emua"a )erhu)u"+a" 'e"+a"

hypercogula'le state" 'a" a!*%,a$% !#a+u&a$% *e&ah *er)u!*% a'a a$%e"-

a$%e" 'e"+a" 'e,e$%e"$% 'ar% ma$%"+ ma$%"+ r#*e%" a"*%!#a+u&a" %"%.

A1@ SISTIM FIBRINOLISIS

S%$*%m ,%)r%"#&%$%$ e"*%"+ u"*u! me"%"+!%r!a" 'e#$%* ,%)r%" a"+

)er&e)%ha". S%$*%m ,%)r%"#&%$%$ u+a merua!a" $ua*u $%$*%m mu&*%!#m#"e"

a"+ *er'%r% 'ar% r#e"C%m( a!*%,a*#r &a$m%"#+e" 'a" %"h%)%*#r-%"h%)%*#r.

P&a$m%"#+e"( a'a&ah $ua*u +&%!#r#*e%" ra"*a% *u"++a& 'e"+a" am%"#*erm%"a& glutamic acid glutamic acid a"+ mu'ah '%e4ah #&eh r#*e#&%$%$

me"a'% )e"*u! m#'%,%!a$% 'e"+a" $ua*u *erm%"a& lysine" valine a*au

methionin.

Pa'a *ema* ar%"+a" a"+ ru$a! tissue in,ury)" ,%)r%"#&%$%$ '%mu&a%

'e"+a" eru)aha" &a$m%"#+e" me"a'% &a$m%". P&a$m%" memu"a%

)a"a! ,u"+$% $eer*% 'e+ra'a$% 'ar% ,%)r%"( %"a!*%,a$% ,a!*#r B 'a" ,a!*#r

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BIII 'a" a!*%,a$% 'ar% me*ar#*e%"a$e a"+ )erera" e"*%"+ 'a&am

r#$e$ e"em)uha" &u!a 'a" er)a%!a" ar%"+a" tissueremodeling).

A!*%,a*#r-a!*%,a*#r &a$m%"#+e" meme4ah e*%'e 'ar% &a$m%"#+e"

'a" mem)e"*u! &a$m%" ra"*a% 'ua. A!*%,a$% me"a'% &a$m%" 'aa* *era'%

me&a&u% *%+a a&ur a%*u :

1. @a&ur %"*r%"$%!( me&%)a*a" a!*%,a$% 'ar% r#a!*%,a*#r $%r!u&a$% me&a&u% ,a!*#r

IIa.

2. @a&ur e!$*r%"$%!( '%ma"a a!*%,a*#r-a!*%,a*#r '%&ea$!a" !e a&%ra" 'arah 'ar%

ar%"+a" a"+ ru$a!( $e&-$e& a*au '%"'%"+ em)u&uh 'arah $emua a!*%,a*#r

u+a r#*ea$e.

3. @a&ur e!$#+e"( '%ma"a &a$m%"#+e" '%a!*%,a$% 'e"+a" a'a"a #)a*

*r#m)#&%*%!( $eer*% $*re*#!%"a$e.

Da&am !ea'aa" ,%$%#+%!( a!*%,a$% &a$m%"#+e" *eru*ama #&eh

tissue plasminogen activator a"+ '%$%"*e$%$ 'a" '%&ea$ 'ar% $e&-$e&

e"'#*e&%um em)u&uh 'arah 'a&am re$#"$ *erha'a *r#m)%" 'a" a'a

!eru$a!a" $e&. Se*e&ah '%$*%mu&a$% *-PA release #&eh e4ercise" statis" a*au

desmopressin DDABP( ma$a aruh"a 'a&am $%r!u&a$% $a"+a* e"'e!

$e!%*ar 5 me"%*( )erhu)u"+a" 'e"+a" %"h%)%$% #&eh PAI-1 'a" clearance

'%ha*%. A!*%,a*#r &a%"( urokinasetype plasminogen avtivator u-PA(

'%r#'u!$% '%+%"a& 'a" '%*emu!a" *eru*ama 'a&am ur%"e. A!a" *e*a%

$eum&ah !e4%& r#ur#!%"a$e &a$ma a*au singlechain uP ( $4uPA 'aa*

'%r#)ah me"a'% )e"*u! a!*%, me&a&u% $%$*%m !#"*a! #&eh !a&&%!re%".

Pr#$e$ ,%)r%"#&%*%! '%a*ur a'a *%a-*%a *aha e"C%ma*%! #&eh

%"h%)%*#r-%"h%)%*#r r#*ea$e $e$%,%!. A!*%,%*a$ &a$m%"#+e" '%a*ur #&eh

%"h%)%*#r-%"h%)%*#r &a$m%" $eer*% a-2 antiplasmin" a2- ma!r#+)u&%"( 'a" u+a #&eh plasminogen activator inhi'itor 1 ( PAI-1( a"+ merua!a"

%"h%)%*#r ,%$%#+% 'ar% *PA 'a" uPA.

P&a$m%" memu"a% ,%)r%"#+e" 'a" ,%)r%" $e)a+a% $u)$*ra*

u*ama"a a"+ *ere"*%"+ u"*u! r#'u!$% ,ra+me"-,ra+me" $e$%,%! a"+

$e4ara !#&e!*%, '%$e)u* fi'rinogenfi'rin degradation product ;DP.

P&a$m%" u+a meme4ah ,a!*#r B 'a" ,a!*#r BIII:. Le'a!a"

,%)r%"#&%$%$ '%ham)a* #&eh %"h%)%*#r #*e" a-2 a"*%&a$m%" 'a" #&eh a-2

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ma!r#+)u&%". P&a$m%" )e)a$ 'a&am &a$ma $e+era '% %"a!*%,!a" #&eh a- 2

antiplasmin( $e'a"+!a" &a$m%" a"+ *er%!a* ,%)r%" 'a&am &u+ hem#$*a$%$

!a& *er&%"'u"+% 'ar% a-2 a"*%&a$m%" 'a" 'aa* meme4ah ,%)r%" me"a'%

;DP. I"h%)%*#r 'ar% a!*%,a*#r &a$m%"#+e" u+a meme+a"+ era"a" e"*%"+

'a&am me"+a*ur ,%)r%"#&%$%$ 'a" mem)a*a$%"a a'a )a+%a" &u!a.

B1 GOLONGAN DARAH

#"+a" 'arah a'a&ah 4%rr% !hu$u$ 'ar% $ua*u %"'%9%'u !are"a

a'a"a er)e'aa" e"%$ !ar)#h%'ra* 'a" r#*e%" a'a ermu!aa"

mem)ra"e $e& 'arah merah.'ua e"%$ e"++#"+a" 'arah a"+ a&%"+

e"*%"+ a'a&ah e"++#"+a" 'arah AO 'a" Rhe$u$ ;a!*#r Rh.

B1/ S'&tem ABO

#"+a" 'arah ma"u$%a '%*e"*u!a" )er'a$ar!a" e"%$ a"*%+e" 'a"

a"*%)#' a"+ *er!a"'u"+ 'a&am 'arah"a( $e)a+a% )er%!u* :

• I"'%9%'u 'e"+a" +#"+a" 'arah A mem%&%!% $e& 'arah merah

'e"+a" a"*%+e" A '% ermu!aa" mem)ra"e $e&"a 'a"

me"+ha$%&!a" a"*#)#'% *erha'a a"*%+e" 'a&am $erum 'arah"a.

Seh%"++a( #ra"+ 'e"+a" +#"+a" 'arah A "e+a*%9e ha"a 'aa*

me"er%ma 'arah 'ar% #ra"+ 'e"+a" +#"+a" 'arah A "e+a*%9e a*au

O "e+a*%9e.

• I"'%9%'u 'e"+a" +#"+a" 'arah A mem%&%!% $e& 'arah merah

'e"+a" a"*%+e" A 'a" $er*a *%'a! me"+ha$%&!a" a"*%)#'

*erha'a a"*%+e" A mauu" . $eh%"++a #ra"+ 'e"+a" +#"+a"

'arah A #$%*%, 'aa* me"er%ma 'arah 'ar% #ra"+ 'e"+a"

+#"+a" 'arah AO aau 'a" '$e)u* re$%%e" u"%9er$a&. Namu"(

#ra"+ 'e"+a" +#"+a" 'arah A #$%*%, *%'a! 'aa* me"'#"#r!a"

'arah !e4ua&% a'a $e$ame A #$%*%,.

• I"'%9%'u 'e"+a" +#"+a" 'arah O mem%&%!% $e& 'arah *a"a

a"*%+e"( *a% memr#'u!$% a"*%)#' *erha'a a"*%+e" A 'a" .

$eh%"++a( #ra"+ 'e"+a" +#"+a" 'arah O "e+a*%9e 'aa*

me"'#"#r!a" 'arah"a !ea'a #ra"+ 'e"+a" +#"+a" 'arah

AO aau" 'a" '%$e)u* '#"#r u"%9er$a&. Namu" #ra"+ 'e"+a"

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+#"+a" 'arah O-"e+a*%, ha"a 'aa* me"er%ma 'arah 'ar% $emua

$e$ame O-"e+a*%,.

Se4ara umum +#"+a" 'arah O a'a&ah a"+ a&%"+ umum

'%uma% '% 'u"%a. Me$!%u" '% )e)eraa "e+ara $eer*% S/e'%a 'a"

N#r/e+%a( +#"+a" 'arah A &e)%h '#m%"a". A"*%+e" A &e)%h umum

'%uma% '%$)a"'%"+ a"*%+e" . !are"a +#"+a" 'arah A memer&u!a"

!e)era'aa" 'ua a"*%+e"( A 'a" ( +#"+a" 'arah %"% a'a&ah e"%$ a"+

a&%"+ ara"+ '%uma% '% 'u"%a. I&mu/a" Au$*r%a( Kar& La"'$*e%"er(

memer#&eh e"+har+aa" N#)e& 'a&am )%'a"+ ,%$%#+% 'a" Ke'#!*era"

a'a *ahu" 130 u"*u! a$a"a me"emu!a" 4ara e"++#"+a" 'arah

AO.

Su$u"a" +e"#*%, 'a" !emu"+!%"a" +ame* a"+ '%)e"*u! 'aa*

'%&%ha* a'a *a)e& )er%!u* :

#"+a" 'arah AO '%!e"'a&%!a" #&eh a&e&a +a"'a IA( I( 'a" IO(

IA 'a" I !#'#ma%"( 'a" !e'ua"a '#m%"a" *erha'a IO.

#"*#h : er!a/%"a" a"*ara r%a +#"+a" A he*er#C%+#* 'e"+a" /a"%*a

he*er#C%+#*.

P : IAIO IIO

: IA( IO I(IO

; :

IAI : +#"+a" 'arah A

IIO : +#"+a" 'arah

IOIO : +#"+a" 'arah O

Pea2'&an

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Ke7!7!4an !!nan da2a#

B1- S'&tem R#e&u&

@e"%$ e"++#"+a" 'arah &a%" a"+ 4u!u '%!e"a& a'a&ah

'e"+a"mema",aa*!a" ,a!*#r Rhe$u$ a*au ,a!*#r Rh. Nama %"% '%er#&eh

'ar% m#"e* e"%$ Rhe$u$ a"+ '%!e*ahu% mem%&%!% ,a!*#r %"% a'a

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*ahu"10#&eh Kar& La"'$*e%"er. Se$e#ra"+ a"+ *%'a! mem%&%!% ,a!*#r Rh

'% ermu!aa" $e& 'arah merah"a mem%&%!% +#"+a" 'arah Rh-. Mere!a

a"+ mem%&%!% ,a!*#r Rh a'a ermu!aa" $e& 'arah merah"a '%$e)u*

mem%&%!% +#"+a" 'arah Rh. @e"%$ e"++#"+a" %"% $er%"+!a&%

'%+a)u"+!a" 'e"+a" e"++#"+a" AO. #"+a" 'arah O a'a&ah

a"+ a&%"+umum '%uma%( me$!%u" a'a 'aerah *er*e"*u +#"+a" A

&e)%h '#m%"a"( 'a" a'a u&a )e)eraa 'aerah 'e"+a" 0 #u&a$%

'e"+a" +#"+a" 'arah .

Ke4#4#!a" ,a!*#r Rhe$u$ ama* e"*%"+ !are"a !e*%'a!4#4#!a"

+#"+a". M%$a&"a '#"#r 'e"+a" Rh $e'a"+!a" re$%%e""a Rh- 'aa*

me"e)a)!a" r#'u!$% a"*%)#'% *erha'a a"*%+e" RhD a"+

me"+a!%)a*!a" hem#&%$%$. Ha& %"% *eru*ama *era'% a'a eremua" a"+

a'a a*au '% )a/ah u$%a me&ah%r!a" !are"a ,a!*#r Rh 'aa*meme"+aruh%

a"%" a'a $aa* !eham%&a".

Su$u"a" +e"#*%, 'a" !emu"+!%"a" +ame* 'aa* '%&%ha* a'a *a)e&

)er%!u* :

#"+a" Rhe$u$ %"% mem%&%!% ar*% e"*%"+ a'a er!a/%"a". %&a

$e#ra"+ r%a Rhe$u$ me"%!ah 'e"+a" /a"%*a Rhe$u$ -( !emu"+!%"a"

a"a!"a me"'er%*a er%*r#)&a$*#$%$ ,e*a&%$ e"a!%* !u"%"+ )a%.

#"*#h: er!a/%"a" a"*ara r%a Rh 'e"+a" /a"%*a Rh <

P : r%a Rhe$u$ F /a"%*a Rhe$u$ < RhRh rhrh

: Rh rh

; : Rhrh Rhe$u$ er%*r#)&a$*#$%$ ,e*a&%$

B16 S'&tem MN

#"+a" %"% *%'a! mem%&%!% "%&a% me'%$ !are"a ha"a '%uma%

a"*%+e" e"e"*u +#"+a" 'a&am er%*r#$%* 'a" *%'a! '%uma% a"*%)#'%

'a&am &a$ma. #"+a" %"%'%!e"'a&%!a" #&eh +e" IM 'a" IN !#'#m%"a"

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$a*u $ama &a%". Su$u"a" +e"#*%, 'a"!emu"+!%"a" +ame* 'aa* '%&%ha*

a'a *a)e& )er%!u*.

#"*#h: er!a/%"a" a"*ara r%a +#"+a" M h#m#C%+#* 'e"+a" /a"%*a

+#"+a" Nh#m#C%+#*

P : r%a +#"+a" M F /a"%*a +#"+a" N

IMIM ININ

: IM IN

; : IMIN : +#"+a" MN

A'a )a"a! !&a$%,%!a$% +#"+a" 'arah( '%a"*ara"a a'a&ah +#"+a"

AO( Rhe$u$( 'a"MN. Dua a"+ er*ama mem%&%!% "%&a% me'%$( $e'a"+

a"+ *era!h%r *%'a!. Ke*%+a+#"+a" *er$e)u* '%*emu!a" #&eh K.

La"'$*e%"er.

tugas 1 hemopoeitic dan hemotasis

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