THROMBOSIS

CHANDAN DEBBARMA
1ST YEAR PGT,DEPT. OF PATHOLOGY
AGMC
INTRODUCTION:
 Thrombosis refers to the formation of a thrombus,
defined as an aggregate of coagulated blood containing
platelets,fibrin and entrapped cellular elements,within a
vascular lumen.
 Blood clotting(hemostasis) Vs Thrombosis.
 Blood clotting(hemostasis) ->physiological protective
process.
 Thrombosis ->pathological process.
 ->one of the important causes for
cardiovascular disease in modern era.
PATHOGENESIS OF THROMBOSIS
 VIRCHOW TRIAD:
ENDOTHELIAL INJURY
A) Physical endothelial injury:
Causes: 1) MI
2) Myocarditis
3) Ulcerated atherosclerotic plaques
4) Cardiac surgery
5) Prosthetic valve
B) Endothelial dysfunction:
Causes: 1) Turbulent blood flow
2) Toxins( cigarette smoke,bacterial endotoxins)
3) Hypercholesterolemia
4) Homocysteinemia
ALTERNATIONS IN NORMAL BLOOD FLOW
 Turbulence: Arteries and heart
 Stasis: Venous thrombosis
Clinical disorders:
a) Ulcerated atherosclerotic plaques
b) Aneurysms
c) Acute MI
d) MS in RHD
e) Polycythemia vera
f) Sickle cell anemia
 HYPERCOAGULABILITY
Causess:A) Primary(Genetic)
a) Factor V mutation
b) Prothrombin mutation
c) Antithrombin III deficiency
d) Protein C deficiency
e) Protein S deficiency
f) Increased levels of factors VIII,IX,XI or
fibrinogen
B) Secondary(Acquired)
a) Prolonged bed rest/immobilization
b) MI,AF,Prosthetic cardiac valves
c) Cancer
d) DIC
e) HIT
f) Antiphospholipid antibody syndrome
g) OCP
MORPHOLOGY OF THROMBUS
 Varies in size and shape—site and underlying cause.
 Colour- gray white or dark red
 Lines of Zahn
TYPES OF THROMBUS- According to site: 2 Types
Features Arterial thrombus Venous thrombus
1) Cause Endothelial injury Stasis
2) Blood Rapid Slow
flow
3) Occlusion Partial/Complete Occlusive
4) Common Aorta,coronary,heart Superficial and deep
sites chambers,cerebral,femoral veins of legs
5) Colour Gray white Dark red
6) Lines of Prominent Less prominent
Zahn
7) Compositi Friable meshwork of More trapped RBCs
on platelets,fibrin,RBCsand and relatively few
degenerating leukocytes. platelets.
THROMBUS Vs POST MORTEM CLOT
Features Venous Thrombus Post mortem clot
1) Attachment to Focally and firmly attached Not attached
vessel wall
2) Consistency Dry,granular,firm and friable Gelatinous,soft and rubbery
3) Appearance White and dark areas Upper layer-Chicken fat
Lower layer-Currant jelly
4) Lines of Zahn Present Absent
5) Mechanism Stasis and hypercoagulabilty Sedimentation of blood
components due to gravity.

FATE OF THROMBUS
1) Propagation
2) Embolization
3) Dissolution
4) Organization and recanalization
Laboratory Investigations
1) CBC
2) Prothrombin time
3) Activated Partial thromboplastin time
4) Thrombin time
5) Coagulation factors assay
6) Activated PC resistance assay, FV Leiden mutation
analysis
7) Prothrombin G20210A mutation DNA analysis
8) ELISA(Lupus anticoagulant,anticardiolipin
antibodies,anti β2 glycoprotein I antibodies)
9) Homocystein measurement.
Reference
1. Robbins and Cotran Pathologic
Basis of Pathology