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Pathophysiology of Bruises

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by

Nadine Najjar

on 17 September 2014

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Transcript of Pathophysiology of Bruises

Hemostasis=the process of blood clot formation at site of vessel injury
3 phases:
1. Vasoconstriction
2. Primary hemostasis: initiation and formation of platelet plug
3. Secondary hemostasis: coagulation cascade
4. Termination of clotting
5. Removal of clot by fibrinolysis

Primary Hemostasis
Goal=to form platelet plug via four reactions:
1. Adhesion
2. Aggregation
3. Secretion
4. Procoagulant activity
Vasoconstriction
Occurs immediately after injury to vessel
Mediated by endothelin and reflex mechanism (poorly understood)
4 steps
Pathways to Coagulation
Intrinsic and Extrinsic pathways activated
Both converge at factor X
Factor X converts inactive prothrombin to active thrombin
Thrombin converts fibrinogen to fibrin
Fibrin enmeshes and reinforces platelet plug to form stable clot
Coagulation Pathways
Extrinsic pathway vs. Intrinsic pathway
Breakdown of Hemoglobin
Hemoglobin in the extracellular space causes red-blue color
Phagocytes break down hemoglobin, which causes change in color on exterior
Hemoglobin(red-blue)--> biliverdin (green)--> bilirubin (yellow)--> hemosiderin (golden-brown)
Phagocytosis of RBCs
Red blood cells escape the capillaries and enter the extracellular space as a result of breakage in the endothelial lining
Hemoglobin broken down by macrophages

Hemostasis
Coagulation Cascade
Activity outside of the vessel
Pathophysiology of Bruises
Increased Bruising
Hemophilia: lowers levels of coagulation factors, which prevents fibrin formation
von Willebrand disease: deficiency of von Willebrand factor, which causes decreased platelet adhesion
Thrombocytopenia: decrease of platelets in blood
Full transcript