HEMOSTASIS

By
Prof. Dr.H.Gusbakti

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 HEMOSTASIS: INTRODUCTION
Hemo: Blood
Stasis: Keep in the same state.
Hemostasis refers to the various
mechanisms existing to keep blood in
the liquid state and within the
intravascular compartment.
They include:
The intact endothelium.
In vivo anticoagulants.
Procoagulant mechanisms.

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 HEMOSTASIS: SEQUENCE
OF EVENTS
VASCULAR SPASM.
PLATELET PLUG FORMATION.
BLOOD CLOT FORMATION:
COAGULATION.
CLOT RETRACTION.
FIBRINOLYSIS.
REORGANISATION.
REPAIR & REGENERATION.
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 VASCULAR SPASM

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 VASCULAR SPASM
Also called Vasoconstriction.
Is spontaneous.
Immediate but temporary.
Lasts for a maximum of 30
minutes.
Cause:
Myogenic: from the smooth muscles
Neurogenic: from the nerves

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 VASCULAR SPASM

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 PLATELET PLUG FORMATION
Caused by exposure of blood to:
Broken endothelium
Underlying collagen.
Steps in PP Formation: Platelet
Activation
Adhesion
Aggregation
Cohesion
Temporary & permanent plug

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 COAGULATION OF BLOOD

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 COAGULATION: BASIC
THREE STEPS
FORMATION OF PROTHROMBIN
ACTIVATOR.

FORMATION OF THROMBIN.

CONVERSION OF FIBRINOGEN TO
FIBRIN.

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 PROTHROMBIN ACTIVATOR FORMATION

Begins in response to:

Rupture of a vessel.
Damage to blood.
A series of reactions result in the
formation of a chemical complex.
This complex activates Prothrombin.
This can be formed either by an
extrinsic or intrinsic pathway.
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 CONVERSION OF PROTHROMBIN TO
THROMBIN

Prothrombin Activator is the

catalyst.
Usually it is the Activated Factor X,
along with the Factor V &
Phospholipids, which forms the
Activator.
It helps convert Prothrombin.
Results in the formation of
Thrombin.
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 FIBRIN FORMATION
Thrombin acts now as the catalyst.
It converts the plasma protein
Fibrinogen into Fibrin.
Fibrin monomer is converted to a
polymer by Factor XIII or FSF.
These fibrin threads form a
meshwork.
Blood cells get entangled in it to
form the Clot or Coagulum.
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04/09/17 gusbakti 13
C
O PROTHROMBIN
A
G
U
L
A
THROMBIN
T
I
O FIBRINOGEN FIBRIN MONOMER
N:
B
A
S
I FIBRIN POLYMER(THREA
C COAGULUM FORMEDCELLS ENTANGLED
S
T
E
P
S 04/09/17 gusbakti 14
 HEMOSTATIC HOMEOSTASIS

P
R
O A
C N
O T
A I
G C
U O
L A
A G
N U
T L
S A
N
T
S

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 COAGULATION FACTORS: PROCOAGULANTS

I FIBRINOGEN MW:3,50,000

II PROTHROMBIN MW: 69,000

III TISSUE THROMBOPLASTIN

IV FREE CALCIUM IONS Ca++

V PROACCELERIN, LABILE
FACTOR,ACCELERATOR GLOBULIN
ABSENT IN SERUM
VI NO SUCH FACTOR
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 COAGULATION FACTORS: PROCOAGULANTS

VII SERUM PROTHROMBIN

CONVERSION ACCELERATOR
(SPCA)
VIII ANTI HEMOPHILIC FACTOR A
IX CHRISTMAS FACTOR
X STUART-PROWER FACTOR
XI PLASMA THROMBOPLASTIN
ANTECEDENT (PTA)
XII HAGEMAN FACTOR, GLASS
CONTACT FACTOR
XIII
04/09/17
FIBRIN STABILIZING
gusbakti
FACTOR 17
 EXTRINSIC PATHWAY: A FLOW CHART
TISSUE TRAUMA

TISSUE THROMBOPLASTIN (III)

GLYCOPROTEIN + PHOSPHOLIPID
VII:SPCA

+v
FACTOR X Xa e
F
E
FACTOR IV: Ca++ FACTOR V E
D
PROTHROMBIN ACTIVATOR B
PROTHROMBIN A
THROMBIN
C
K
FACTOR IV: Ca++ ONTO
THE OTHER
TWO STEPS
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COAGULATION
 INTRINSIC PATHWAY: A FLOW CHART
TRAUMA TO BLOOD; EXPOSURE TO COLLAGEN
XII XIIa HMW KININOGEN
PREKALLIKREIN
XI XIa

IX IXa
VIII
Ca++
THROMBIN
X Xa

PLATELET
PHOSPHOLIPIDS Ca++
V

PROTHROMBIN ACTIVATOR

PROTHROMBIN THROMBIN
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Ca ++
 DIFFERENCES BETWEEN EXTRINSIC &
INTRINSIC PATHWAYS

EXTRINSIC INTRINSIC
The essential, The trigger is the
triggering step is exposure of Collagen in
Tissue trauma. the vascular wall to
Factor XII &
Thrombocytes.
Is explosive in
nature. Is slow to proceed.
Can be completed Can take 2 to 6
in 15 seconds. minutes.
No inhibitory Many inhibitory or
mechanisms to antagonistic
counter this mechanisms exist in
pathway. the blood.

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 IN VIVO ANTICOAGULANTS
IN VIVO:
Smooth and intact endothelium.
Heparin.
Thrombin Prostacyclin
Thrombaxane A2
AntiThrombin III
Thrombomodulin
Plasminogen System( Fibrinolysins)

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IN VITRO ANTICOAGULANTS
HEPARIN.
VITAMIN K ANTAGONISTS(MOA: VII, IX
&X)
Dicoumarol
Warfarin
Diphenadione.
CALCIUM CHELATORS
Potassium-Ammonium Oxalate.
Sodium/Potassium Oxalate
Sodium Citrate 3.8% solution.
Ethylene Diamine Tetra Acetic Acid. (EDTA)

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 HEMOSTASIS: APPLIED ASPECTS

STATES OF DECREASED CLOTTING:

VITAMIN K DEFICIENCY.

HEMOPHILIAS

THROMBOCYTOPENIA: ITP
THROMBESTHENIA
AFIBRINOGENEMIA: Absence of
Fibrinogen in the Plasma.Coagulation
not possible. Very rare.
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 HEMOSTASIS: APPLIED ASPECTS

STATES OF EXCESSIVE
COAGULATION:
Atherosclerosis, Thrombosis.
Disseminated Intravascular Clotting
(DIC)
Thromboembolism

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 HEMOPHILIAS
Bleeding Disorders.
Seen exclusively in Males.
Causes:
Factor VIII deficiency: Classical
Hemophilia 85% cases.
Factor IX deficiency: Christmas
Disease 15%.

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 HEMOPHILIAS
Genetically transmitted by a gene on
the recessive X chromosome.
Females can be carriers, making their
sons diseased!
Symptoms:
Unstoppable bleeding:
From wounds.
Into joints, etc.
Investigation: Prolonged Clotting Time.
Treatment: Now, Genetically engineered
Pure Factor VIII or IX as needed.

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 THROMBOCYTOPENIA: ITP
Normal Thrombocyte Count: 1.5 4.0
Lakhs/Cu.mm.
Critical Thrombocyte Count:
<50,000/Cu.mm.
Symptoms:
Bleeding tendency increases.
Small punctate hemorrhages under the
skin.
Called Purpura.
So it is called Thrombocytopenic
purpura
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P
U
R
P
U
R
A

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 THROMBOTIC DISORDERS

ATHEROSCLEROSIS: THROMBOSIS:
Coronary
Cerebral
Pulmonary
DISSEMINATED INTRAVASCULAR
CLOTTING: DIC: CONSUMPTION
COAGULOPATHY:
Toxins from Bacteria
Prostatic Cancer
Acute Myeloid Leukemia
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 THROMBOTIC DISORDERS
THROMBOEMBOLISM:
Thrombi are formed.
Bits of it may be detached.
They are called emboli.
Emboli move up in the circulating blood.
They obstruct some vessels.
Can cause embolism:
Coronary
Cerebral
Pulmonary

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