1. Endothelium
2. Platelets
3. Plasma coagulation factors & their inhibitors
4. Fibrinolytic system
Components of Normal Hemostasis:
Site of injury
1. Vasoconstriction:
Subendothelial collagen—is highly “thrombogenic”
2. Primary hemostasis
3. Secondary hemostasis
Platelet Adhesion
Fibrin deposition
Granule
release &
shape
change
Tissue factor—activates the coagulation cascade—Thrombin is formed
Platelet Granules
Fibrinogen
Fibronectin
Factor V
Factor VIII
TGF
Platelet Granules
ADP
ATP
Ca
Histamine
Serotonin
Epinephrine
Thrombus formation
4. Thrombus formation
Trapped Neutrophils
& RBC’s
Is Endothelium
Prothrombotic ???
or
Antithrombotic ???
Has both Prothrombotic & Antithrombotic properties
Balance between Procoagulation & Anti coagulation
determines Fate of thrombus
Activated by Infectious agents, Hemodynamic forces, Plasma
mediators- Cytokines.
ANTI- THROMBOTICS
•PGI 2
•NO
•ADP
•Heparin like molecule
•t-PA
•Thrombomodulin
•Protein C & S
PRO-THROMBOTIC
•vWF
•Tissue factor
•PAI
ATIIIClotting Factors
Tissue factor*
PAI-1
Antiplasmin
TFPI
Prot. C
Prot. S
Procoagulants Anticoagulant
Fibrinolytic System
Platelet
Platelet
Edema
“Increased fluid in interstitial tissue space”
Pathophysiology:
1. Increased Hydrostatic pressure
2. Reduced plasma Osmotic pressure
3. Lymphatic obstruction
EDEMA
Plasma Colloid
Pressure
Hydrostatic
Pressure
Increased
Interstitial
Fluid
Pressure
Arterial
End
Venous
End
Capillary Bed
Lymphatics
Impaired Venous return:
- CHF
- Constrictive pericarditis
- Ascites
- Venous compression
Nephrotic syndrome
Cirrhosis of Liver
Malnutrition
Protein loosing Enteropathy
Inflammatory
Neoplastic
Post surgical
Post Radiation
Periorbital edema: Severe renal ds.
Pitting edema: finger pressure.
Pulmonary edema: seen in left ventricular failure, renal
failure, ARDS, pulmonary infections, and hypersensitivity
rn. Lungs on cross section –reveals frothy, blood tinged
fluid.
Brain edema: seen in encephalitis, hypertensive crisis,
and obstruction to cerebral venous outflow.