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) whereby a damaged
blood vessel wall is covered by a platelet and fibrin
containing clot to stop bleeding and begin repair of the
damaged vessel.
Disorders of coagulation can lead to an increased risk of
bleeding (hemorrhage) and/or clotting (thrombosis).

Coagulation begins almost instantly after an injury to the

blood vessel has damaged the endothelium (lining of the
vessel).
Platelets immediately form a plug at the site of injury; this is
called primary hemostasis.
Secondary hemostasis occurs simultaneously: proteins in
the blood plasma, called coagulation factors or clotting
factors, respond in a complex cascade to form fibrin
strands which strengthen the platelet plug.

Platelet activation
Damage to blood vessel walls exposes subendothelium
proteins, most notably collagen, present under the
endothelium.
Circulating platelets bind collagen with surface collagenspecific glycoprotein Ia/IIa receptors.
The adhesion is strengthened further by the large,
multimeric circulating proteins von Willebrand factor (vWF),
which forms links between the platelets glycoprotein Ib/IX/V
and the collagen fibrils.
This adhesion activates the platelets.

The coagulation cascade

The coagulation cascade of secondary hemostasis has
two pathways,
the contact activation pathway (known as the intrinsic
pathway) and
the tissue factor pathway (known as the extrinsic
pathway)
that lead to fibrin formation.

Coagulation Pathway

Intrinsic
pathway
(Contact)

Prothrom
bin

Fibrinog
en

Extrinsic
pathway
(Tissue
factor)
Xa
Xa

Thrombin
Thromb
in

Fibri
n

Intrinsic Pathway
Contact (Eg: with glass)

XII

XIIa

XIa

XI

IXa

IX

VIIIa
PL
Ca++

Xa

Extrinsic Pathway
Tissue factor (TF)

VIIa- TF

VII

XIa
IX

IXa
VIIIa
X

Xa

Site of Action of Drugs

Tissue factor (TF)

VII

Warfarin

VIIa- TF

IXa
VIIIa

IX

Heparin

Xa

Va

Prothromb
in
Fibrinog

Thrombin

Fibri

Blood type

ABO blood group system

Rhesus blood group system

The Rhesus system is the second most significant blood group
system in human blood transfusion.
The most significant Rhesus antigen is the RhD antigen because it
is the most immunogenic of the five main rhesus antigens.

Red blood cell compatibility