HEMOSTASIS

• Hemostasis is a sequence of responses that stops bleeding

• Three mechanisms reduce blood loss:
(1) Vascular spasm
(2) Platelet plug formation
(3) Blood clotting (coagulation)

Vascular Spasm
• When arteries or arterioles are damaged, the circularly arranged smooth
muscle in their walls contracts immediately, a reaction called vascular spasm.
• This reduces blood loss for several minutes to several hours, during which
time the other hemostatic mechanisms go into operation
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Platelet Plug Formation
• Platelet release granules containing :
oClotting factors, ADP, ATP, Ca2+, and serotonin.

oEnzymes that produce thromboxane A2, a prostaglandin.

oFibrin-stabilizing factor, which helps to strengthen a blood clot.

oLysosomes; some mitochondria.

oPlatelet-derived growth factor (PDGF)

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 Platelet plug formation occurs as follows:
• Initially, platelets contact and stick to parts of a damaged blood vessel, such as collagen fibers
of the connective tissue underlying the damaged endothelial cells. This process is called
platelet adhesion.

• Due to adhesion, the platelets become activated.

 They extend many projections that enable them to contact and interact with one another,
and they begin to liberate ADP, TXA2, serotonin.
 This phase is called the platelet release reaction.
 Liberated ADP and thromboxane A2 activates nearby platelets.
 Serotonin and thromboxane A2 function as vasoconstrictors, which decreases blood flow
through the injured vessel.

• The release of ADP makes other platelets in the area sticky, and the stickiness of the newly
recruited and activated platelets causes them to adhere to the originally activated platelets.
 This gathering of platelets is called platelet aggregation.
Eventually, the accumulation and attachment of large numbers of platelets form a mass called a
platelet plug.
 A platelet plug is very effective in preventing blood loss in a small vessel.
 Although initially the platelet plug is loose, it becomes quite tight when reinforced by fibrin
threads formed during clotting
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 Blood clotting

 Normally, blood remains in its liquid form as long as it stays within its vessels.
 If it is drawn from the body, it thickens and forms a gel.
 Eventually, the gel separates from the liquid.
 The straw-colored liquid, called serum (blood plasma minus the clotting proteins).
 The gel is called a blood clot. It consists of a network of insoluble protein fibers called fibrin in which the
formed elements of blood are trapped.
 The process of gel formation, called clotting or coagulation is a series of chemical reactions that results
in formation of fibrin threads.
 If blood clots too easily, the result can be thrombosis—clotting in an undamaged blood vessel.
 If the blood takes too long to clot, hemorrhage can occur.
 Clotting involves several substances known as clotting (coagulation) factors. These factors include
calcium ions (Ca2+), several inactive enzymes synthesized by liver cells and released into the bloodstream,
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and various molecules associated with platelets or released by damaged tissues.
Clotting factors

Clotting factors are identified by

Roman numerals that indicate the
order of their discovery

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 Clotting can be divided into three stages :

• Two pathways, called the extrinsic pathway and the intrinsic pathway, lead to the
formation of prothrombinase.

(Steps involved in the next two stages of clotting are the same for both the extrinsic
and intrinsic pathways, and together these two stages are referred to as the common
pathway)

• Prothrombinase converts prothrombin into the enzyme thrombin.

• Thrombin converts soluble fibrinogen into insoluble fibrin. Fibrin forms the
threads of the clot.

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