Introduction to

Hemostasis
By: Tom Anthony A. Tonguia, RMT
Historical background of hemostasis

• Hemostasis is derived from Greek meaning “the stoppage of

blood flow”.
• Study of hemostasis dates back to the time of Aristotle and
Plato.
• The bleeding disorder “hemophilia” was the first coagulation
disorder to be recognized.
• Moses Maimonides described two male children who had died
from excessive bleeding after circumcision.
• The disorder was given the name hemophilia which means
“love of hemorrhage” by Schonlein.
Historical development of Clinical Hemostasis

• Lee-White whole blood coagulation (1913)- in vitro, visual,

qualitative assessment of blood clotting capability.
• Qualitative- sensitive only to severe factor deficiencies and it is subjective &
time consuming
• Prolonged WBCT indicates a bleeding disorder
• 1940
• Platelet count
• Bleeding time
• WBCT
• Prothrombin Time (1930s)
Historical development of Clinical Hemostasis

• Today
• PT (Prothrombin time)
• APTT (Activated Partial Thromboplastin Time)
• Used to assess the activity of the reactants involved in the coagulation
mechanism
Overview of hemostasis

• Functionally, several processes are involved in hemostasis

following injury to a small blood vessel:
1. Blood vessel spasm
2. Formation of platelet plug
3. Contact among damaged blood vessel, blood platelet, and coagulation
proteins
4. Development of a blood clot around the injury
5. Fibrinolytic removal of excess hemostatic material to reestablish vascular
injury
Role of blood vessels in hemostasis

• Capillaries- where the metabolic exchange between the blood and

tissues takes place through openings called junction.
• Arteries and Veins – larger than capillaries and is composed of
three layers:
• Tunica intima (inner endothelial lining), which comes in contact with blood
cells and separates them from a subendothelium.
• Tunica media, composed of smooth muscle cells and connective tissue
(including collagen fibers and occasional fibroblasts).
• Tunica adventitia (outer part), which consists of connective-tissue
fibroblasts and collagen fibers.
The three hemostatic components

• Extravascular component- involves the tissue surrounding the

vessel, which become involved in hemostasis when a local vessel is
injured.
• Vascular component- involves the vessels through which blood
flows.
• Intravascular component- involves in coagulation such as platelets
& biochemical (procoagulants) in the plasma.
Hemostatic Mechanism

• Primary Hemostasis- involves the vascular and platelet response to

vessel injury.
• Secondary Hemostasis- includes the response of the coagulation
process to such injury .
• Ultimately lead to the formation of a stable fibrin-platelet plug at the site
of injury which permits healing.
• Fibrinolysis is initiated
• Gradual clot dissolution.
Basic Sequence of Events in Primary and
Secondary Hemostasis After Vessel Injury

Events Comments
Step 1 Vasoconstriction
Step 2 Platelet Adhesion
Step 3 Platelet Aggregation
Step 4 Fibrin-Platelet Plug Formation
Step 5 Fibrin Stabilization
Role of coagulation in hemostasis

• Coagulation is the process whereby plasma proteins, tissue

factors, and calcium interact on the surface of platelets to form a
fibrin clot.
• There are three interrelated pathways of coagulation involved:
extrinsic, intrinsic, and common pathways.
Role of platelets in hemostasis

• Platelets normally move freely through the lumen of blood vessels

as components of the circular system.
• Following damage to the endothelium of a blood vessel, a series of
events occur, including adhesion to the injured vessel, shape
change, aggregation, and secretion.
Concepts of Normal Hemostasis,
Hypocoagulation, and Hypercoagulation

• Normal hemostatic balance

• Under normal conditions, the formation and dissolution of thrombi is
maintained in a delicate balance.
• Without this balance, an individual may experience either excessive
bleeding (a result of poor clot formation or excessive fibrinolysis) or
vasooclussion (result of uncontrolled formation of thrombi in the vascular
system, occluding vessels and depriving organs of blood).
Concepts of Normal Hemostasis,
Hypocoagulation, and Hypercoagulation

• Hypocoagulation
• Hemophilia is a well-known example of an inherited hypocoagulable
disorder.
• Patients with hemophilia have a defective coagulation mechanism that is
unable to form adequate clots, resulting in excessive bleeding from cuts.
• Hypercoagulation (thrombosis)
• Associated with the inappropriate formation of thrombi in the vasculature
that occludes normal blood flow.
• It is caused by a defect in or lack the fibrinolytic system.