Hemostasis

• Hemostasis is stoppage of bleeding in a quick & localized fashion when

blood vessels are damaged.
• Main goal of Hemostasis is to prevent hemorrhage (hemorrhage is loss of a
large amount of blood)
Opposite of hemorrhage  stops bleeding
Too little hemostasis  too much bleeding
Too much hemostasis  thrombi / emboli
Three major steps:
1. Vasoconstriction/vasospasm
2. Platelet plug formation Temporarily blocks the hole
1. Platelet-derived cytokines further the process
3. Coagulation cascade /blood clotting(= clot formation seals hole until
tissues repaired)
1. Two pathways: Extrinsic and Intrinsic
4. After vessel repair, plasmin dissolves the clot
Steps of Hemostasis
1)Vascular Spasm/vasoconstriction
Damage to blood vessel

stimulates pain receptors

And release serotonin which is a vasoconstrictor

That causes constriction/contraction of smooth muscle of small blood

vessels.

Vascular Spasm can reduce blood loss for several hours until other
mechanisms can take over.

Vascular Spasm is effective only for small blood vessel or arteriole.

2) Platelet plug formation
• Platelets store a lot of chemicals in granules
needed for platelet plug formation
–ADP, Ca+2, serotonin, fibrin-stabilizing
factor, & enzymes that produce
thromboxane A2
• There are three steps in the process of
Platelet plug formation
– (i) platelet adhesion
– (ii) platelet release reaction
– (iii) platelet aggregation
Platelet plug formation: Steps
i. Platelet Adhesion
• Platelets stick to exposed collagen underlying damaged endothelial
cells in vessel wall
ii. Platelet Release Reaction
• Platelets activated by adhesion
• Extend projections to make contact with each other
• Release thromboxane A2, serotonin & ADP activating other platelets
• Serotonin & thromboxane A2 are vasoconstrictors decreasing blood
flow through the injured vessel. ADP causes stickiness
iii. Platelet Aggregation
• Activated platelets stick together and activate new platelets to form
a mass called a platelet plug
• Plug reinforced by fibrin threads formed during clotting process
 Platelet Plug Formation

Von Willebrand Factor : A large blood protein that plays an important role in platelet gathering at the site of a wound
3)Blood Clotting
Blood clotting – It is a process in which liquid blood is changed
into a semisolid mass (a blood clot).

• Clotting is activated by tissue damage or when blood come in

contact with collagen.

• Clotting is a cascade of reactions in which each clotting factor

activates the next in a fixed sequence resulting in the
formation of fibrin threads
 Blood Coagulation

• Coagulation is a complex process by which blood forms clots.

• It is an important part of hemostasis (the cessation of blood
loss from a damaged vessel), wherein a damaged blood vessel
wall is covered by a platelet and fibrin-containing clot to stop
bleeding and begin repair of the damaged vessel
• So A blood clot consists of
-a plug of platelets
-enmeshed in a network of insoluble fibrin molecules.
Overview of the Clotting Cascade
Extrinsic Pathway:
-Chemical outside the blood triggers blood coagulation.
-This pathway is initiated by damaged tissues.
-Damaged tissues leak tissue factor (thromboplastin) into bloodstream.
• Prothrombinase forms in seconds

Intrinsic Pathway: Activation occurs when

– endothelium is damaged & platelets come in contact with collagen of blood
vessel wall
– Triggered by Hageman factor (found inside blood)
– platelets damaged & release phospholipids
• Requires several minutes for reaction to occur
 Clotting Factors
• Factor I = Fibrinogen
• Factor II = Prothrombin
• Factor III = Tissue factor /tissue thromboplastin
• Factor IV = Calcium
• Factor V = Labile factor
• Factor VI - Does not exist as it was named initially but later on discovered
not to play a part in blood coagulation.
• Factor VII = Stable factor
• Factor VIII = Antihemophilic factor A
• Factor IX = Antihemophilic factor B or Christmas factor (named after the
first patient in whom the factor deficiency was documented)
• Factor X = Stuart Prower factor
• Factor XI = Antihemophilic factor C
• Factor XII = Hageman factor
• Factor XIII = Fibrin stabilising factor
** Why blood does not clot inside the unbroken blood
vessel?
• Blood does not clot inside the blood vessel
because-
– Endothelium of blood vessels are quite smooth
and non water wettable. A rough and water
wettable substance is required for clotting.
– Presence of natural anticoagulants like heparin,
antithrombin, etc.