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.