HEMATOLOGICAL SYSTEM

PART I
FLORIDA INTERNATIONAL UNIVERSITY
ADVANCED BIOSCIENCE IN ANESTHESIOLOGY II
NGR 6145
HEMATOLOGICAL SYSTEM
OBJECTIVES
Describe the various components of the blood vessel wall
and their role in the modulation of hemostasis.
Explain the coagulation cascade including important
reactions for both pathways and the final phase of blood
clotting.
Discuss common coagulation studies and their respective
normal values used for evaluating the hemostasis system.
Explain clinical instances specifically associated with
thrombus formation.
HEMATOLOGICAL SYSTEM
HEMOSTASIS
Process that stops bleeding and prevents the loss of
blood from vessels

Process is complex, involving the combined activity of
many factors

Hemostatic abnormalities can lead to excessive
bleeding or thrombosis
HEMATOLOGICAL SYSTEM
BLOOD VESSEL WALL
Blood vessel wall composed of four layers:
Endothelial lining:
Endothelial cells have an important role in the
modulation of hemostasis, thrombosis, and vascular
permeability
Endothelial cells synthesize and secrete prostaglandins
Able to promote procoagulant as well as anticoagulant
activity
Endothelial cell inhibits platelet aggregation
HEMATOLOGICAL SYSTEM
BLOOD VESSEL WALL
Subendothelial connective tissue layer:
Consists of a basement membrane, elastin, and
microfibrils
Collagen and fibronectin are found throughout this
layer
Damage to the endothelial cell barrier exposes a
highly thrombogenic subendothelium, which
activates hemostasis
HEMATOLOGICAL SYSTEM
BLOOD VESSEL WALL
Muscular layer:
Flow of blood through a vessel is primarily determined
by the degree of contraction of the third layer of the
vessel wall
Injury to a vessel causes acute vascular contraction
Decrease in diameter of the blood vessel diminishes
blood loss and facilitates the formation of a primary
hemostatic plug
Adventitia:
Outermost covering of blood vessel
HEMATOLOGICAL SYSTEM
PLATELETS
Play a primary role in hemostasis
Located in the platelet membrane are receptors for
substances that activate platelet activity or inhibit platelet
activity
Damage to a blood vessel causes the rapid activation and
attachment of platelets to the injured surface
Morphologic transformation occurs that results in complete
coverage of the damaged area
Substances secreted; intrinsic coagulation pathway activated
First hemostatic plug formed
HEMATOLOGICAL SYSTEM
BLOOD COAGULATION SYSTEM
Complex system with more than 20 substances with either
procoagulant or anticoagulant activity
Coagulation cascade is divided into the intrinsic and extrinsic
pathways
Intrinsic pathway is initiated with the activation of factor XII
Extrinsic pathway activated with the release of tissue
thromboplastin
Important reaction for both pathways is the conversion of
prothrombin to thrombin
Final phase of blood clotting; interaction of thrombin with
fibrinogen
HEMATOLOGICAL SYSTEM
BLOOD COAGULATION FACTORS
HEMATOLOGICAL SYSTEM
COAGULATION
CASCADE
HEMATOLOGICAL SYSTEM
FIBRINOLYTIC SYSTEM
Specialized system of checks and balances maintains
the blood in a fluid state and localizes clotting
Control mechanisms include:
Inhibition of activated proteases
Depletion of clotting factors
Fibrinolysis
Fibrinolytic process normally triggered by and confined
to fibrin
Thrombus formation or a tendency for bleeding may
occur
HEMATOLOGICAL SYSTEM
FIBRINOLYTIC SYSTEM
Thrombus likely to form when:
Vessel wall endothelium injured
Blood flow is decreased
Alterations in blood foster state of hypercoagulability
Hemostasis system normally is in a state of dynamic
equilibrium that maintains vascular integrity and prevents
pathologic thrombus formation
Alterations in various components can predispose to
bleeding or thrombosis
Disorders caused by a variety of abnormal conditions or
drugs
Clinical manifestations!
HEMATOLOGICAL SYSTEM
REFERENCES

Morgan, G.E., Mikhail, M.S., and Murray, M.J. (2006).
Clinical Anesthesiology. (4
th
Ed.) New York, NY:
McGraw-Hill.

Nagelhout, J.J. and Zaglaniczny, K.L. (2005). Nurse
Anesthesia. (3
rd
Ed.) St. Louis, MO: Elsevier-
Saunders.