Primary Hemostasis

acpj
Topic Outline
• Overview of Hemostasis
• Cellular Elements of Hemostasis
• Blood Vessels
– Components
– Response
• Platelet Response
– Adhesion
– Aggregation
– Secretion
Hemostasis

• Series of complex processes by which the

body spontaneously stops bleeding and
maintains blood on its fluid state within the
blood vessel compartment.
CONCEPT OF NORMAL COAGULATION

Platelets

Coagulation
Fibrinolysis

Body

“The formation and dissolution of thrombi is

maintained in a delicate balance.”

THROMBOSIS BLEEDING
 Blood vessel damage

Vascular Fibrinolysis
Response

Platelet Coagulation
Response System
 Cellular Elements of Hemostasis
1.Extravascular Tissue Factor/ TF- tissue
surrounding the vessel

2. Vascular Intima- blood vessel through

which the blood flows

3.Intrvascular Component- platelets and plasma

proteins
Image source: Rodak’s Hematology 5th edition
Primary Hemostasis
• Refers to the role of blood vessels and
platelets in response to a vascular injury

• Vessel constriction

• Platelet activation
Blood Vessels
• Tunica intima

• Tunica media

• Tunica adventitia
Vascular Intima
• Provides the interface between circulating
blood and the body tissues
• Endothelial cells
• Immune response, vascular permeability, proliferation
and HEMOSTSASIS
• Form a smooth, unbroken surface that eases the fluid
passage of blood

• In all blood vessels, fibroblasts occupy the

connective tissue layer and produce collagen
Image source: Rodak’s Hematology 5th edition
Anticoagulant Properties of Intact
Vascular Intima

Image source: Rodak’s Hematology 5th edition

Procoagulant Properties of Damaged
Vascular Intima

Image source: Rodak’s Hematology 5th edition

Image source: Rodak’s Hematology 5th edition
Fibrinolytic Properties of Vascular
Intima
• Endothelial cells
• Secretion of TPA
• Provide inhibitors to prevent excessive plasmin
generation
• PAI-1
• TAFI
Platelet Response
• Formation of a Platelet Plug

• Adhesion
• Shape change
• Aggregation

• Release reaction and Stabilization

Platelet adhesion
• The property by which platelets bind
nonplatelet surfaces

• vWF links platelets to collagen

Platelet shape change

• From discoid to irregular shape

• Facilitates the release of platelet internal

components
Platelet aggregation
• The property by which platelets bind to one
another

• Platelet to platelet interaction is made

possible by the presence of membrane bound
calcium, fibrinogen, and gp IIb/IIIa
Platelet secretion
• Secretion of procoagulants
• Factor V
• vWF
• ADP

Image source: Rodak’s Hematology 5th edition

Thromboxane A2 (TxA2)
• Stimulates platelet aggregation
• Vasoconstrictor
• Mediator of platelet release reaction

Image source: Rodak’s Hematology 5th edition

Platelet plug stabilization
• Supply of:
• Calcium
• Phosph
atidylse
rine
• Procoag
ulant
factors
• recepto
rs
Platelet Activation
• G Proteins
• Control cellular activation for all cells at the inner
membrane surface
• For eicosanoid synthesis or the IP3-DAG
pathway

• Eicosanoid synthesis: prostaglandin,

cyclooxygenase, or thromboxane pathway
• IP3-DAG Pathway: promotes release of ionic
calcium from the DTS
 Endothelial cells

Arac hidonic Acid Linoeic Acid

Endoperoxide Monohydroperoxide

Deacreases Inhibits
Prostacyclin 13 HODE platelet
aggregatio adhesio
n n

Promotes
Increases
Thromboxane A2 12 HETE platelet
aggregatio adhesion
n

Endoperoxide Monodyroperoxide

Arac hidonic Acid Arac hidonic Acid

Platelet Membrane Platelet Cytosol

Platelets
Inhibitors of platelet activity
• Prostacyclin and Nitric Oxide
• CD39
• Aspirin and other NSAID
References
• Rodak’s Hematology: Clinical Principles and
Applications, 5th Edition
• Clinical Hematology: Theory and Procedures, 5th
Edition, Turgeon, M.L.
• Steininger, Cheryl et al. Clinical Hematology:
Principles, Procedures and Correlations.