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Blood Coagulation

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Introduction of Blood Coagulation

The process of Blood Coagulation (Coagulation) is the formation of a Blood clot. It is an important part of hemostasis, which refers to any process that stops bleeding by clot formation in injured vessels. This includes physiological processes in the body and also pathological processes resulting in uncontrolled bleeding.


Coagulation begins almost immediately after an injury to the Blood vessel has damaged the endothelium lining of the vessel. Platelets that are normally kept in an inactive state by circulating plasma begin to change shape, turning into spherical shapes (called "platelet plug formation"). This begins with Von Willebrand factor (vWF) binding to exposed subendothelium collagen fibres. vWF changes shape to bind to collagen, and other platelets change shape as well, forming a small plug that stops the bleeding. 


The granules in the platelet then release chemicals called Coagulation factors which are responsible for the widening of Blood vessels (vasoconstriction), clotting at the site of injury. Platelet activation is also seen in the endothelial cells lining the Blood vessel, which releases many small packages called platelet alpha granules. These granules contain more Coagulation factors that continue to aid in clotting. Additionally, they secrete epinephrine that causes even more vasoconstriction at the site of injury.


Next, Fibrinogen and larger Coagulation protein fibres form a mesh on the platelet plug, locking it in place for clot stabilization. This is called cross-linking of fibrin. Activated factor XIII forms covalent bonds with lysine amino acids of prekallikrein and high-molecular-weight kininogen, converting them to bradykinin. Bradykinin is a strong vasodilator that opens up Blood vessels even more, which brings more platelets and other clotting factors to the site of injury. These all work together to form a mesh-like structure that stabilizes the clot.


The entire process of Coagulation is a cascade of events, with each step triggering the next. It is a complex process that can be easily disrupted if any of the factors are abnormal. This can lead to uncontrolled bleeding, which is a life-threatening condition.


Blood is a very important fluid in the human body that flows under high pressure through our veins and is essential for the proper functioning of the body. The Blood is 90 percent water, inorganic salt and protein. Traces of other substances such as organic acids, pigments, enzymes, platelets, WBC, RBC and other enzymes are also present in the Blood. Owing to how vital Blood is, a significant loss of this fluid may lead to death. To prevent this, our body has an inbuilt Blood clotting mechanism. Through this Blood clotting process called Blood Coagulation, the excess loss of Blood from our body is prevented. 


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Blood Clotting Mechanism 

The Blood Coagulation definition states that the Blood clotting mechanism is the process through which a thrombus or clot is formed, which restricts excess Blood from flowing out. This gel-like mass is created from fibrin and platelets. The Blood clotting mechanism has various steps that finally result in Blood Coagulation. Haemostasis (the opposite being haemorrhage) refers to a process that brings about cessation to bleeding and helps the damaged Blood vessel to heal with the loss of the Blood stopped. The mechanism of Blood Coagulation is given below:


The First Stage

The mechanism of Blood Coagulation is known as haemostasis. The first step follows an injury or cut that results in the loss of Blood. This initiates the process of vasoconstriction, which causes the walls of the vessels to react immediately and reduce the amount of Blood that flows to the infected region. The first stage is essentially healing the wound, where the Blood starts forming a gel-like substance that would prevent further loss of Blood from taking place.


The Second Stage

In the second stage of the Blood Coagulation process, the platelets play a significant role in stopping the bleeding in the injured region. This is started by a process called secondary homeostasis that causes a fibrin clot to be formed. The granule contents which are stored include ADP along with thromboxane, which causes the platelets which are within the Blood plasma to get activated. However, the platelets by themselves are insufficient in completely securing the injured region and forming a Blood clot. Here, various other factors come into play that finally activate and assist each other during the clotting cascade. 


The Third Stage

The clotting cascade gives way to the development of fibrinogen, a soluble plasma protein. The fibrin proteins coagulate and form a Blood clot. If the protein is composed of only platelets, then it is called white thrombosis, and if the red Blood cells are also present, they are termed red thrombosis. This is the final step in the mechanism of Blood Coagulation.


Deep Vein Thrombosis

The Blood clotting process may not always proceed smoothly, as in the case of deep vein thrombosis. Deep Vein Thrombosis or DVT is caused when the Blood clot takes place in one or multiple deeply located veins in the body. Generally, after the Blood clotting process, these clots dissolve, as is natural in the process of Blood clotting. However, after dissolving, the clots travel through the bloodstream and affect other organs such as the lungs or the chest, where they block the flow of the Bloodstream. The typical symptom of DVT is pain in the muscles, particularly in the legs, along with swelling. Most of the time, the clots occur without any perceptible symptoms. DVT takes place due to medical reasons or the lack of frequency in the body movements. 


Did you Know? 

Various disorders obstruct Blood Coagulation. One of such disorders is Willebrand disease, in which a person is deficient in the VWF protein. When people with the Willebrand disease bleed, they are incapable of forming a platelet plug. Another disorder that affects Blood Coagulation is haemophilia. In haemophilia, the Blood vessels constrict, and the platelets form a plug. One of the essential clotting factor proteins is absent or damaged, and the clot is not made sturdy enough.

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FAQs on Blood Coagulation

1. Describe the Mechanism of Blood Clotting.

Coagulation is initiated immediately following an injury to a blood vessel that has suffered damage in the endothelium lining. The blood is exposed to the subendothelial space. It gives way to two different processes: the platelets undergo change, and the subendothelial tissue factor is exposed to plasma factor VII, resulting in cross-linked fibrin formation. A plug is formed at the site of injury resulting in primary hemostasis. Secondary hemostasis occurs at the same time. Blood coagulation occurs not only in humans but all other mammals and animals as well. In mammals, the blood clotting mechanism comprises both protein and cellular components.

2. What is Deep Vein Thrombosis?

Deep vein thrombosis refers to a severe condition that takes place when a blood clot occurs in a deep-seated vein within the body. Blood that has solidified into a lump is called a blood clot. Blood clots form in the deep-seated veins generally in the lower leg or thigh but can also be created in the other parts of the body. The symptoms of the disorder may include swelling in the ankle, leg or foot especially on one side, cramp in the calf, an area of skin feeling comparatively warmer, reddishness or bluishness of the skin in the affected region and severe pain in the foot or ankle region.

3. What is the difference between Haemostasis and Haemorrhage?

Haemostasis is the process that brings about the cessation of bleeding, while haemorrhage refers to the continuous flow of blood from an open wound. Haemostasis is a process in which a Blood vessel wall injury is repaired and returned to its normal function, and haemorrhage is the loss of blood from a damaged Blood vessel. A haemorrhage is a pathological condition that arises from an injury or disease of the Blood vessel, which leads to the escape of blood from the circulatory system into surrounding tissues. Haemostasis is the body's natural way of stopping bleeding. A haemorrhage is the amount of blood lost during surgery, childbirth or an injury.

4. What are the stages of Blood Coagulation?

The process of Blood Coagulation has three main stages, namely, Hemostasis or the formation of a gel-like substance at the site of injury to prevent further loss of Blood from taking place, thrombus formation as a result of platelets aggregation and the conversion of fibrinogen to fibrin, and clot retraction which is the contraction of the wound by smooth muscles to draw the edges closer together. Blood Coagulation is a process in which blood changes from a liquid to a semi-solid or solid state, which stops the bleeding from a wound.

5. What are the indications of deep vein thrombosis?

Symptoms of deep vein thrombosis include pain in the leg muscles that worsens when pressure is applied, swelling of the legs, redness or warmth near the affected site, and skin that appears bluish in colour. Deep vein thrombosis is the condition of a Blood clot inside one or more veins deep below the skin surface, such as in the leg. Deep vein thrombosis (DVT) can also occur in some other parts of the body, e.g., the arm and pelvis. Deep vein thrombosis is a Blood clot that forms inside a vein deep in the body.

6. What are the causes of Blood Coagulation?

The main cause of Blood Coagulation is damage to the inner lining of the Blood vessel. When the structure of the artery is damaged, it exposes subendothelial tissues, which activate platelets and bring about extensive thrombus formation. Other causes of Blood Coagulation include injuries, surgery, childbirth, cancer, obesity, and the use of oral contraceptives.

 

Blood clotting can also be caused by various medical conditions such as deep vein thrombosis, heart attack, stroke, and pulmonary embolism. The main cause of Blood clotting is when the inner lining of a Blood vessel is damaged.

7. What is the role of platelets in stopping the bleeding?

The platelets play a significant role in stopping the bleeding by secreting different factors that cause the Blood vessels to constrict and form a Blood clot. Platelets are a process called secondary homeostasis, which causes a fibrin clot to be formed. The platelets play a significant role in stopping the bleeding by secreting different factors that cause the Blood vessels to constrict and form a Blood clot. Platelet is a process called secondary homeostasis, which causes a fibrin clot to be formed. This is the final step in the mechanism of Blood Coagulation. 


The clotting cascade gives way to the development of fibrinogen, a soluble plasma protein that coagulates and forms a Blood clot. If the protein is composed of only platelets, then it is called white thrombosis, and if the red Blood cells are also present, they are termed red thrombosis. DVT takes place due to medical reasons or the lack of frequency in the body movements.