Hemostasis: Vasoconstriction Platelet Plug Formation Coagulation Cascade Fibrinolysis

Hemostasis
 When blood vessels are damaged then healing of blood

vessels and cessation of bleeding occurs in a following
steps.
 Platelets plays an important role in this process.
 Following events occurs during this.
 Vasoconstriction
 Platelet plug formation
 Coagulation cascade
 fibrinolysis
VASOCONSTRICTION
 When platelets come in contact with a damaged blood vessels
 Then they adhere to the wall of the damaged blood vessel
 The surface of platelets becomes sticky
 Platelets release serotonin
 Serotonin constrict the blood vessel and reduces or stop blood
flow from the damaged blood vessel (vasoconstriction)
 Vasoconstriction also done by thromboxane which is released
by damaged vessels.
Platelet Plug Formation
 The adherent platelets clump (thick cluster) to each
other.
 Then they release other substance that is adenosine
diphosphate (ADP)
 ADP attracts more platelets to the affected site
 The platelets rapidly arrive at the site of damage
and form a temporary seal.
 The seal is known as platelet plug
 Platelet plug formation complete within 6 minutes of
injury.
Coagulation
 Coagulation is also known as clotting

 This is a process by which blood changes from liquid
to a gel, forming a blood clot.
 Clotting involves several substances known as
clotting factors.
 Clotting factors are synthesized by hepatocytes.
Clotting factors
Clotting factors are proteins (except factor IV) within the
clotting cascade necessary to form cross‐linked fibrin. They
were numbered in the order they were discovered. Calcium is
factor IV, which is a critical cofactor in the activation of many of
the proteins.
The clotting factors are as follows:
Factor I - Fibrinogen.
Factor II - Prothrombin.
Factor III - Thromboplastin.
Factor IV - Calcium ions.
Factor V - Labile factor.
Factor VII - Stable factor.
Factor VIII - Antihemophilic factor A.
Factor IX - Christmas factor or Plasma Thromboplastin Component
(PTC).
Factor X - Stuart-Prower factor.
Factor XI - Plasma Thromboplastin Antecedent (PTA).
Factor XII - Hagemann factor.
Factor XIII - Fibrin stabilizing factor.
 Some other clotting factors also has a role in the clotting
mechanism, and they are:
 High Molecular Weight Kininogens (HMW-K).
 Pre-Ka (Fletcher factor).
 Ka (Kallikrein).
 Platelet phospholipids.
 Factors I, II, VII, VIII, IX, and X These are synthesized in the
liver and are secreted into plasma (Factors II, and VII have
complete vit-K dependent synthesis).
 All are protein in nature.
 The presence of factor VI has not been proven.
 Decreased synthesis of factor VIII may lead to hemophilia-A.
 Deficiency of factor IX may lead to hemophilia-B.
Coagulation cascade
STAGES OF CLOTTING
 There are three stages of clotting are present.
 STAGE I
 STAGE II
 STAGE III
 Stage I
 Extrinsic and intrinsic pathway leads to formation of
prothrombinase
 STAGE II
 Prothrombinase converts prothrombin (plasma protein
formed by liver)into enzyme thrombin.
CONT….
 STAGE III
 Thrombin in presence of Ca2+ converts soluble fibrinogen
(another plasma protein formed by liver )into insoluble fibrin
 Fibrin forms the clot
 The mature blood clot trap blood cells and other plasma
proteins that is plasminogen.
 Plasminogen are more stronger then platelet plug and they
destroy clot afterword.
EXTRINSIC PATHWAY
 Extrinsic pathway activates rapidly (within

few seconds) after tissue damage
 Damage tissue release chemicals called
thromboplastin or tissue factor
 These factors or chemicals starts
coagulation.
INTRINSIC PATHWAY
 Intrinsic pathway is slow process

 It takes about 3-6 minutes to initiate after injury
 It is initiated when blood comes in contact with
damaged blood vessel lining endothelium.
FIBRINOLYSIS
 After clot formation process of healing of damaged blood vessel begins

 The breakdown of clot is known as fibrinolysis.
 This process involves following steps:-
• Plasminogen which are trap inside the mature clot is converted into
enzyme plasmin.
• Plasmin forms because damaged endothelial cells release some
activators
Cont…
 Plasmin breaks down fibrin to soluble product
 This soluble product is considered as a waste
material and is removed by phagocytosis.
 As clot is removed the healing process continue to
restores the blood vessel wall.
activator
Plasminogen
Plasmin
Fibrin
Breakdown
CONTROL OF COAGULATION
 Control of coagulation is achieved by two factors

 Smoothness of normal blood vessels prevents
adhesion of platelets in healthy and undamaged
blood vessel.
 Activated clotting factors remain active only for short
period of time because of the presence of natural
anticoagulants that is heparin and antithrombin III.
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Hemostasis

 When blood vessels are damaged then healing of blood

 Coagulation is also known as clotting

 Extrinsic pathway activates rapidly (within

 Intrinsic pathway is slow process

 After clot formation process of healing of damaged blood vessel begins

 Control of coagulation is achieved by two factors

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