HEMOSTASIS

Written by: Fayzah Alshammari

Date: 06-11-2021

Hemostasis
Hemostasis is a complex physiologic process that keeps circulating blood
in a fluid state and then, when an injury occurs, produces a clot to stop
the bleeding, confines the clot to the site of injury, and finally dissolves
the clot as the wound heals.

Major Components of Hemostasis

1. Vascular system 2. Platelets (thrombocyte)
3. blood coagulation factors 4. fibrinolysis

Mechanisms involved in hemostasis:

The process has four steps, which immediately engage following tissue
injury.
Step 1. Vascular spasm
The body’s immediate reaction to injury is to reduce blood loss by
narrowing the damaged vessel. Smooth muscle within the vessel’s wall
contracts in response to the injury.

Step 2. Platelet activation to form a platelet plug (primary hemostasis)

In primary hemostasis, platelets rush to the site of injury and activate.
The activated platelets stick to each other and collagen fibers to make a
platelet plug. This mechanism blocks blood flow from the wound. The
platelets also release chemicals to stimulate more vasoconstriction and
attract more platelets to the injured site.

Role of Platelets in Hemostasis

1. Maintenance of vascular integrity

 2. initial arrest of bleeding by platelet plug formation
3. stabilization of the hemostatic plug

Step 3: Coagulation to form a clot (secondary hemostasis)

The blood clotting cascade is complex system composed of coagulation
factors. These coagulation factors become activated in a sequence
ending in the formation of a strong fibrin clot. Damage to a vessel wall
exposes endothelial collagen, activating the intrinsic coagulation
pathway. This pathway contains factors I (fibrinogen), II (prothrombin),
IX (Christmas factor), X (Stuart Prower factor), XI (plasma
thromboplastin), and XII (Hageman factor). An extrinsic pathway
activates with trauma to extravascular cells and consists of factors I, II,
VII (stable factor), and X. The intrinsic and extrinsic pathways meet at the
common pathway where fibrinogen is converted to fibrin. The common
pathway contains factors I, II, V, VIII (antihemophilic factor), and X.

Step 4. Fibrinolysis
Fibrinolysis is a highly regulated enzymatic process preventing the
unnecessary buildup of intravascular fibrin and enabling clot lysis.
Fibrin plays an essential role in hemostasis:
(1) primary product of the coagulation cascade and (2) substrate for
fibrinolysis.
In fibrinolysis, a fibrin clot, the product of coagulation, is broken down.
Its main enzyme plasmin cuts the fibrin mesh at various places, leading
to the production of circulating fragments that are cleared by other
proteases or by the kidney and liver.