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HAEMODYNAMIC
DISORDERS
 HAEMOSTASIS
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 It is a mechanism through which the body control

bleeding and prevent thrombosis.
 Various mechanisms and pathways that act together
in a synergistic way maintain haemostasis
 HAEMOSTASIS
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 Mechanisms of Haemostasis include

 Intact Blood Vessel
 Intact blood vessels prevents both bleeding and thrombosis
 Additionalyblood vessels when are injured they constrict and prevent
bleedings.

 Normal Platelets
 platelets should be normal in count and function.
 Normal Coagulation Factors
 These are circulating proteins in an inactive form, but when trauma
occurs it will be activated in a cascade manner (each one activate the
other ) factor I to factor XIII
 HAEMOSTASIS
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 Normal Fibrinolytic System

 Fibrinolytic factors are proteins that prevent
propagation of thrombus formation (localizations
of thrombus in one site).

 Plasminogen is the main fibrinolytic factor.

 HAEMOSTASIS
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 Natural Inhibitors
 LikeProtein S, C, antithrombin III, which inactivate
active coagulation factor, so prevent further
thrombosis, lack of these inhibitors result in
thrombosis.
 THROMBOSIS

 Definition
 Thrombus is a coagulated solid mass, composed of
blood constituents (platelets, fibrin, WBS and RBCs)
which develops in an artery, vein, capillary or heart
champers
 THROMBOSIS

 Pathogenesis of thrombosis
 According to Virchow’s triad theory, there are three
factors responsible for this process.

 Damage to the endothelial lining of a blood vessel.

 Abnormal blood flow (Stasis or turbulence).
 Increased coagulablity of blood, i.e., increased coagulation
factors or decrease natural inhibitors.
 THROMBOSIS

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 THROMBOSIS

 Endothelial Injury and Thrombosis:

 Damaged endothelial cells release
 procoagulant substances (e.g., thromboplastin,
VonWillebrand factor), and

 reduce secretion of anticoagulant substances

(e.g.antithrombin III, NO, and plasminogen activator ).
 cont…
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 Loss of endothelial cells exposes the underlying

basement membrane or collagen of the blood
vessels, allowing the binding of platelets mediated
by a Von Willebrand factor (initiates the formation
of
thrombi).
 Causes of Endothelial Injury:

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 Causes of Endothelial Injury:

 Hemodynamic injury in high blood pressure.
 Atherosclerosis.
 Infection, vasculitis and thrombophlebitis.
 Metabolic disorders e.g., hyperlipidaemia
 Severe trauma or surgery.
 Predisposing Factors for venous Thrombosis
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 Varicose Veins

 Prolonged Immobility

 Tissue Damage

 Pregnancy and Obstetrical Complications:

 Predisposing Factors for venous Thrombosis
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 Circulatory Disturbances
 Major circulatory disturbances such as myocardial
infarction and stroke, are important risk factors.
 Tumors
 Thrombosis in tumours is related to the release of
thromboplastin, which promotes coagulation.
 Arterial Thrombosis
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 Arterial Thrombosis
 Common sites are coronary, cerebral, mesenteric, and
renal artery.
 Clinical Features
 The main clinical features are due to obstruction of
blood supply resulting in infarction according to the
location, e.g., myocardial, brain intestines and kidneys.
 Venous Thrombosis
 Commonly develop in deep veins so called deep venous
thrombosis
 Predisposing Factors
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 Predisposing Factors: Include

 stasis of the circulation, injury (trauma,
surgery),
 hypercoagulability,
 oral contraceptives,
 late pregnancy,
 cancer,
 advanced age, and
 sickle cell disease.
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 Comparison, venous and arterial thrombi

 Outcomes of Thrombosis

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 Resolution
 Fibrinolysis mediated by plasmin accounts for the
dissolution of most thrombi.
 Propagation
 Thrombi that do not resolve by fibrinolysis activities
tend to grow because of the deposition of additional
platelets, fibrin, and red blood cells.
 Outcomes of Thrombosis

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 Embolization
 Thrombi may detach from the vessel wall and give rise to emboli
carried downstream by the circulating blood

 Organization
 Ingrowths of granulation tissue from the vessel wall form a firm link
between the thrombus and the vessel wall.

 Recanalization
 The blood vessels in the granulation tissue, organizing the thrombus
may fuse into larger channels that bridge the thrombus, allowing the
resumption of blood flow
 HEMORRHAGE
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 Definition
 Hemorrhage (bleeding) is an escape of blood from the
blood vessels (artery, vein, capillary or heart) because
of trauma, inflammation, neoplasia or abnormal
haemostasis.
 Classification of Bleeding:

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 1- According to the Affected Organs

 2-According to the Site Bleeding

 Important terminology of bleeding:

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 Petechiae, Purpura, and Ecchymoses

 All the three terms refer to hemorrhages into the skin
and mucosae.
 Pinpoint hemorrhages smaller than 1mm are called
petechiae
 those measuring 1mm to 1cm in diameter are called
purpura
 those larger than 1cm are called ecchymoses.
 Cont…
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 Hematoma
 Hematoma is a grossly visible extravasated blood in
the tissue
 Hemorrhages into Body Cavities
 Hematopericardium
 hematothorax, and
 hemarthrosis
 Cont…
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 Hematuria
 Hematuria is appearance of blood in urine,
 it may be classified as microscopic or macroscopic
 Hematemesis
 Hematemesis is vomiting of blood
 Hemoptysis
 bloody stained sputum and associated with cough
 EDEMA
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 It is an abnormal accumulation of fluid in the

interstitial spaces of organs, or body cavities.
 Clinically, edema manifests as swellings.
 The amount of interstitial fluid is determined by the
mechanism of fluid balance, (the increased
secretion of fluid into the interstitium, or the
impaired removal of the fluid)
 EDEMA
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 Pathophysiology of edema
 Several factors can contribute to the formation of
edema include the followings
 Increased hydrostatic pressure
 Reduced colloidal (oncotic) pressure within blood
vessels.
 Increased tissue colloid pressure.
 Increased blood vessel permeability e.g., due to
inflammation.
 Obstruction of fluid clearance in the lymphatic system.
 Clinical classification of Edema:
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 Pitting Edema
 Edema is referred to as "pitting" when, pressure is
applied to a small area and the indentation persists
after the release of the pressure.
 None pitting Edema
 This type of edema is observed when the indentation
does not persist; it is associated with such conditions as
lymphedema, and myxedema.
 EDEMA
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 Causes of generalized edema

 Nephrotic syndrome
 Liver cirrhosis
 Malnutrition
 Heart failure
 Renal failure
 Localized edema
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 Localized edema can take the form of organ

specific edema

 Organ-specific Edema: Edema may occur in

specific organs as part of
inflammations or other condition.
 Examples of organ-specific edema:
 Cerebral Edema

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 Cerebral Edema
 This is extracellular fluid accumulation in the
brain,it can occur in toxic or abnormal metabolic
states and conditions such
as reduced oxygen at high altitudes.

 It causes drowsiness or loss of

consciousness.
 Cont…
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 Pulmonary Edema: This type occurs when the

pressure in blood
vessels in the lung is raised because of obstruction
of blood in the
pulmonary veins, this is usually due to failure of
the left ventricle of the
heart
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 Corneal Edema
 Periorbital Edema
 Cutaneous Edema
 Lymphedema
 Laryngeal edem
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