Coagulation Hemostasis & Fibrinolysis

Hemostasis retains blood in vascular system if with injury; localizes rxs involved to the site of injury, repairs & reestablishes blood flow through injured blood vessel Hemorrhage lack of procogulant; excess of fibrinolysis Thrombosis (clot) lack of fibrinolysis; excess procoagulant

Primary hemostasis
Vasoconstriction of damaged blood vessels platelet plug (platelet adhesion, secretion, aggregation) Involves platelets and endothelium Platelet adhesion w/ vascular injury platelet adheres to subendothelium (collagen, fibronectin), due to vWF and glycoprotein Ib, IIb & IIIa

Primary hemostasis
Platelet secretion shape change due to microtubules; disk spherical w/ pseudopods; granules go out Platelet aggregation PG formation causes platelet aggregation & plt release; arachidonic acid + cyclooxygenase TXA2 (vasoconstrictor; plt stimulator) & PGI2 (inhibitor of platelet function) Clot retraction

Primary hemostasis
Endothelium Endothelial injury vasoconstriction; Factor XII activation smooth muscle contraction Normal intact endothelium produces PGI2 to prevent platelet aggregation w/o coagulant properties

Endothelial cells
Assist in platelet activation Limits coagulation mechanism Clot dissolution

Secondary Hemostasis
Clotting factors Platelets provides surface, plays part in contact system, XXa, PTT, Vit K dependent factors in surface of activated platelet, thrombasthenin (platelet protein) promotes clot retraction

Limiting Mechanisms of Hemostasis

Normal blood circulation Inhibitors (naturally occurring) Fibrinolysis

Platelets
60% proteins, 30% lipids, 8% CHO Minerals, water, nucleotide, glycogen Glucose main energy source Function hemostasis, maintenance of capillary integrity 2/3 in blood; 1/3 in spleen (young)

Platelets
Cytoplasm: Chromomere central granular Hyalomere peripheral non granular Parts:
Peripheral zone Sol gel zone Organelle zone Membranous system

Peripheral zone DMS; plt adhesion and aggregation

Glycocalyx made of glycoproteins; reacts w/ vWF Plasma membrane bilayer, arachidonic acid Sub-membranous zone receives message from outside

Sol-gel zone shape, contractile

Microfilaments (actin, myosin, thrombasthenin for clot retraction) Microtubules (tubulin shape)

Organelle zone
Alpha granules - most numerous, PDGF Dense bodies ADP, ATP, Ca, serotonin, pyrophosphate platelet aggregation Mitochondria ATP synthesis for platelet metabolism Lysosomal granules ACP, hydrolytic enzymes

Membranous System
Dense tubular system from SER holds calcium, makes PG Surface connecting system open canalicular system system for release of granule constituents to the outside