Hemostasis

Not to be confused with homeostasis. Hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood
 within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing. This involves 
.clots coagulation, blood changing from a liquid to a gel. Intact blood vessels are central to moderating blood's tendency to form

The endothelial cells of intact vessels prevent blood clotting with a heparin-like molecule and thrombomodulin and prevent platelet
aggregation with nitric oxide and prostacyclin. When endothelial injury occurs, the endothelial cells stop secretion of coagulation and
.aggregation inhibitors and instead secrete von Willebrand factor which initiate the maintenance of hemostasis after injury

:Hemostasis has three major steps

Vasoconstriction )1

2) Temporary blockage of a break by a platelet plug

.Blood coagulation, or formation of a fibrin clot. These processes seal the hole until tissues are repaired )3
• When it comes to a differential diagnosis of platelet disorders it comes down to:
• Thrombocytopenia = too few
• Thrombocytosis = too many
• Thrombocytopathy = too broken

Some causes of Thrombocytopenia:

1. Decreased production:

a. Decreased megakaryocytes secondary to drugs, toxins, or infection i. Chemo drugs, thiazides, alcohol, digoxin, septra,
phenytoin, ASA

b. Normal megakaryocytes with megaloblastic hematopoiesis or hereditary origin

c. Malignant infiltration of bone marrow

2. Splenic Sequestration

d. Usually in the context of hematologic cancers (one of the few groups where platelet transfusions are helpful).

e. b. Portal HTN
Causes of Thrombocytosis:
This is a platelet count > 600,000 / mm3

Most common causes = infection or iron deficiency (platelets still work normally)
1. Autonomous (primary thrombocythemia)
2. Reactive (secondary thrombocythemia)
a. Iron deficiency
b. Infection or inflammation ex. Kawasaki’s disease
c. Trauma
d. Nonhematologic malignant disease
e. Postsplenectomy
f. Rebound from alcohol, cytotoxic drug therapy, folate or vitamin B12
deficiency
• How is thrombocytosis treated?
• Patients who have no symptoms may remain stable and only require routine check-ups by their
physician. Secondary forms of thrombocytosis rarely require treatment.
• For those with symptoms, a few treatment options are available. One is to treat the disease
that is causing thrombocytosis. In some cases, the patient can take aspirin to help prevent
blood clots. The low dose used for this purpose does not usually cause stomach upset or
bleeding.
• In essential thrombocythemia, drugs such as hydroxyurea or anagrelide are used to suppress
platelet production by the bone marrow. These drugs usually have to be taken indefinitely.
Treatment with interferon is sometimes necessary but is associated with a greater number of
side effects.
• Newer agents are now being developed in an effort to suppress the overproduction of
platelets. In cases of severe life-threatening thrombocytosis, a procedure called
plateletpheresis is performed to immediately lower the platelet count to safer levels. In this
procedure, a special instrument is used to remove blood from the patient, separate and
remove the platelets, and then return the other blood cells to the patient.
• Treatment for thrombocytopenia depends on its cause and severity. The main goal of treatment is to prevent death and disability caused by bleeding.

• If your condition is mild, you may not need treatment. A fully normal platelet count isn't necessary to prevent bleeding, even with severe cuts or
accidents.
• Thrombocytopenia often improves when its underlying cause is treated. People who inherit the condition usually don't need treatment.
• If a reaction to a medicine is causing a low platelet count, your doctor may prescribe another medicine. Most people recover after the initial medicine
has been stopped. For heparin-induced thrombocytopenia (HIT), stopping the heparin isn't enough. Often, you'll need another medicine to prevent
blood clotting.
• If your immune system is causing a low platelet count, your doctor may prescribe medicines to suppress the immune system.
• Severe Thrombocytopenia
• If your thrombocytopenia is severe, your doctor may prescribe treatments such as medicines, blood or platelet transfusions, or splenectomy.

• Medicines
• Your doctor may prescribe corticosteroids, also called steroids for short. Steroids may slow platelet destruction. These medicines can be given through a
vein or by mouth. One example of this type of medicine is prednisone.
• The steroids used to treat thrombocytopenia are different from illegal steroids taken by some athletes to enhance performance.
• Your doctor may prescribe immunoglobulins or medicines like rituximab to block your immune system. These medicines are given through a vein. He or
she also may prescribe other medicines, such as eltrombopag or romiplostim, to help your body make more platelets. The former comes as a tablet to
take by mouth and the latter is given as an injection under the skin.

• Blood or Platelet Transfusions

• Blood or platelet transfusions are used to treat people who have active bleeding or are at a high risk of bleeding. During this procedure, a needle is
used to insert an intravenous (IV) line into one of your blood vessels. Through this line, you receive healthy blood or platelets.

• Splenectomy
• A splenectomy is surgery to remove the spleen. This surgery may be used if treatment with medicines doesn't work. This surgery mostly is used for
adults who have immune thrombocytopenia (ITP). However, medicines often are the first course of treatment.
 Thank You For Listening

12