when a blood vessel is injured the first phase in hemostasis to occur is
coagulation
Hemostasis Hemostasis or haemostasis is a process which causes bleeding to stop, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing. This involves coagulation, blood changing from a liquid to a gel. Intact blood vessels are central to moderating blood's tendency to form clots. The endothelial cells of intact vessels prevent blood clotting with a heparin-like molecule and thrombomodulin and prevent platelet aggregation with nitric oxide and prostacyclin. When endothelial injury occurs, the endothelial cells stop secretion of coagulation and aggregation inhibitors and instead secrete von
Hemostasis
the body to stop bleeding and loss of blood. During hemostasis three steps occur in a rapid sequence. Vascular spasm is the first response as the blood vessels constrict to allow less blood to be lost. In the second step, platelet plug formation, platelets stick together to form a temporary seal to cover the break in the vessel wall. The third and last step is called coagulation or blood clotting. Coagulation reinforces the platelet plug with fibrin threads that act as a "molecular glue". Platelets are a large factor in the hemostatic process. They allow for the creation of the
Hemostasis
Hemostasis Hemostasis or haemostasis is a process which causes bleeding to stop, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing. This involves coagulation, blood changing from a liquid to a gel. Intact blood vessels are central to moderating blood's tendency to form clots. The endothelial cells of intact vessels prevent blood clotting with a heparin-like molecule and thrombomodulin and prevent platelet aggregation with nitric oxide and prostacyclin. When endothelial injury occurs, the endothelial cells stop secretion of coagulation and aggregation inhibitors and instead secrete von
Hemostasis
Thrombus A thrombus, colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of cross-linked fibrin protein. The substance making up a thrombus is sometimes called cruor. A thrombus is a healthy response to injury intended to prevent bleeding, but can be harmful in thrombosis, when clots obstruct blood flow through healthy blood vessels. Mural thrombi are thrombi that adhere to the wall of a blood vessel. They occur in large vessels such as
Thrombus
Willebrand factor which initiate the maintenance of hemostasis after injury. Hemostasis has three major steps: 1) vasoconstriction, 2) temporary blockage of a break by a platelet plug, and 3) blood coagulation, or formation of a fibrin clot. These processes seal the hole until tissues are repaired. The word "hemostasis" (, "sometimes" ) uses the combining forms "hemo-" and "-stasis", New Latin from Ancient Greek αἱμο- "haimo-" (akin to αἷμα "haîma"), "blood", and στάσις stásis, "stasis", yielding "motionlessness or stopping of blood". Hemostasis occurs when blood is present outside of the body or blood vessels. It is the innate response for
Hemostasis
Coagulation Coagulation (also known as clotting) is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The mechanism of coagulation involves activation, adhesion, and aggregation of platelets along with deposition and maturation of fibrin. Disorders of coagulation are disease states which can result in bleeding (hemorrhage or bruising) or obstructive clotting (thrombosis). Coagulation begins almost instantly after an injury to the blood vessel has damaged the endothelium lining the vessel. Exposure of blood to the subendothelial
Coagulation
and accelerin was found to be activated Factor V. All mammals have an extremely closely related blood coagulation process, using a combined cellular and serine protease process. In fact, it is possible for any mammalian coagulation factor to "cleave" its equivalent target in any other mammal. The only non-mammalian animal known to use serine proteases for blood coagulation is the horseshoe crab. Coagulation Coagulation (also known as clotting) is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed
Coagulation
Coagulation testing Blood clotting tests are the tests used for diagnostics of the hemostasis system. Coagulometer is the medical laboratory analyzer used for testing of the hemostasis system. Modern coagulometers realize different methods of activation and observation of development of blood clots in blood or in blood plasma. Substantially all coagulometers used in laboratory diagnostics are based on the methods of testing of the hemostasis system created more than fifty years ago. The majority of these methods are good to detect defects in one of the hemostasis components, without diagnosing other possible defects. Another problem of the actual hemostasis system
Coagulation testing
of hemostasis and works by stopping blood loss from damaged blood vessels. At the site of injury, where there is an exposure of blood under the endothelium, the platelets gather and immediately form a plug. That process is called primary hemostasis. Simultaneously, a secondary hemostasis occurs. It is defined as the formation of insoluble fibrin by activated coagulation factors, specifically thrombin. These factors activate each other in a blood coagulation cascade that occurs through two separate pathways that interact, the intrinsic and extrinsic pathway. After activating various proenzymes, thrombin is formed in the last steps of the cascade, it then
Discovery and development of direct Xa inhibitors
which manifest as bleeding. Some medical conditions can also make patients susceptible to bleeding. These are conditions that affect the normal hemostatic (bleeding-control) functions of the body. Such conditions either are, or cause, bleeding diatheses. Hemostasis involves several components. The main components of the hemostatic system include platelets and the coagulation system. Platelets are small blood components that form a plug in the blood vessel wall that stops bleeding. Platelets also produce a variety of substances that stimulate the production of a blood clot. One of the most common causes of increased bleeding risk is exposure to nonsteroidal anti-inflammatory drugs
Bleeding
aren’t initially programmed to accumulate by themselves because this could cause an undesirable thrombosis. However, during hemostasis, coagulation is desired. As such, the platelets in the plasma must be alerted to the need for a plug formation. Any discontinuity detected in the vascular endothelium triggers an automatic response in the clotting system, which in turns stimulates thrombin production. Thrombin also causes platelet aggregation. As such, more often times than not, platelet adhesion and activation occur in overlapping steps, where one directly influences and contributes to the other. Once platelets are activated, when they come across injured endothelium cells, the von
Platelet plug
necessary. According to the type of the investigated object, the following complementary groups of methods can be specified: Coagulation testing Blood clotting tests are the tests used for diagnostics of the hemostasis system. Coagulometer is the medical laboratory analyzer used for testing of the hemostasis system. Modern coagulometers realize different methods of activation and observation of development of blood clots in blood or in blood plasma. Substantially all coagulometers used in laboratory diagnostics are based on the methods of testing of the hemostasis system created more than fifty years ago. The majority of these methods are good to detect defects
Coagulation testing
and 370 per 100,000 in female individuals), whereas the highest incidence ratios compared to those without affected siblings occurred at much younger ages (ratio of 4.3 among male individuals 20 to 29 years of age and 5.5 among female individuals 10 to 19 years of age). In contrast to the understanding for how arterial thromboses occur, as with heart attacks, venous thrombosis formation is not well understood. With arterial thrombosis, blood vessel wall damage is required for thrombosis formation, as it initiates coagulation, but the majority of venous thrombi form without any injured epithelium. Red blood cells and fibrin are
Venous thrombosis
orifice, such as the rectum, nose, or ears may signal internal bleeding, but cannot be relied upon. Bleeding from a medical procedure also falls into this category. "Medical bleeding" denotes hemorrhage as a result of an underlying medical condition (i.e. causes of bleeding that are not directly due to trauma). Blood can escape from blood vessels as a result of 3 basic patterns of injury: The underlying scientific basis for blood clotting and hemostasis is discussed in detail in the articles, coagulation, hemostasis and related articles. The discussion here is limited to the common practical aspects of blood clot formation
Bleeding
between thrombocytes and immune cells "sensu stricto". As hemostasis is a basic function of thrombocytes in mammals, it also has its uses in possible infection confinement. In case of injury, platelets, together with the coagulation cascade, form the first line of defense by forming a blood clot. Thus, hemostasis and host defense were intertwined in evolution. For example, in the Atlantic horseshoe crab (living fossil estimated to be over 400 million years old), the only blood cell type, the amebocyte, facilitates both the hemostatic function and the encapsulation and phagocytosis of pathogens by means of exocytosis of intracellular granules containing
Platelet
but before the creation of the fibrin mesh clot, which is the more permanent solution to the injury. The result of the platelet plug formation is the coagulation of blood. It can also be referred to as primary hemostasis. For many years, the critical role that platelets (also known as thrombocytes) played in hemostasis and blood coagulation went unnoticed by scientists. Even though the existence of platelets as a cell fragment was initially discovered in 1882, it took scientists until the 1960s before they moved their interest from the interaction of platelets with blood coagulation to the interaction of platelets
Platelet plug
reaction to horse proteins or human blood products are not good candidates for use of TachoSil. TachoSil TachoSil is a collagen sponge coated with the human coagulation factors fibrinogen and thrombin. It is used during surgery to stop local bleeding on internal organs (hemostasis). The sponge is manufactured from horse tendons. TachoSil reacts upon contact with blood, other body fluids or saline to form a clot that glues it to the tissue surface. Hemostasis is reached in a few minutes, and the sponge is absorbed by the body within several weeks. Some patients experience hypersensitivity or allergic reactions. In rare
TachoSil
complications and liver toxicity, and their long-term effects were in doubt. When a blood vessel ruptures or gets injured, factor VII comes into contact with tissue factors which starts a process called the blood coagulation cascade. Its purpose is to stop bleeding and repair tissue damage. When this process is too active due to various problems the risk of blood clots or embolisms increases. As the name indicates the cascade is a multi-step procedure where the main product thrombin is made by activating various proenzymes (mainly serine proteases) in each step of the cascade. Thrombin has multiple purposes, but mainly
Discovery and development of direct thrombin inhibitors
may occur as a result of trauma, certain phases of disseminated intravascular coagulation, and sepsis. It may also occur as a result of hemodilution as a result of blood losses and/or transfusions with packed red blood cells or other fibrinogen-poor whole blood replacements. Clinical analyses of the fibrinogen disorders typically measure blood clotting using the following successive steps: Higher levels are, amongst others, associated with cardiovascular disease (>3.43 g/L). It may be elevated in any form of inflammation, as it is an acute-phase protein; for example, it is especially apparent in human gingival tissue during the initial phase of periodontal
Fibrinogen
TachoSil TachoSil is a collagen sponge coated with the human coagulation factors fibrinogen and thrombin. It is used during surgery to stop local bleeding on internal organs (hemostasis). The sponge is manufactured from horse tendons. TachoSil reacts upon contact with blood, other body fluids or saline to form a clot that glues it to the tissue surface. Hemostasis is reached in a few minutes, and the sponge is absorbed by the body within several weeks. Some patients experience hypersensitivity or allergic reactions. In rare cases, it could turn into severe hypersensitive reaction. Those who are prone to having a systemic
TachoSil
spherical to stellate, and the fibrinogen cross-links with glycoprotein IIb/IIIa aid in aggregation of adjacent platelets (completing primary hemostasis). The coagulation cascade of secondary hemostasis has two initial pathways which lead to "fibrin" formation. These are the "contact activation pathway" (also known as the intrinsic pathway), and the "tissue factor pathway" (also known as the extrinsic pathway), which both lead to the same fundamental reactions that produce fibrin. It was previously thought that the two pathways of coagulation cascade were of equal importance, but it is now known that the primary pathway for the initiation of blood coagulation is the
Coagulation
Thromboelastometry Thromboelastometry (TEM), previously named rotational thromboelastography (ROTEG) or rotational thromboelastometry (ROTEM), is an established viscoelastic method for hemostasis testing in whole blood. It is a modification of traditional thromboelastography (TEG). TEM investigates the interaction of coagulation factors, their inhibitors, anticoagulant drugs, blood cells, specifically platelets, during clotting and subsequent fibrinolysis. The rheological conditions mimic the sluggish flow of blood in veins. TEM is performed with the ROTEM whole blood analyzer (Tem Innovations GmbH, Munich) and is an enhancement of thrombelastography, originally described by H. Hartert in 1948. While traditional thromboelastography is a global assay for blood clotting disorders and
Thromboelastometry
replace laboratory assays such as prothrombin time (PT) or factor assays. However, due to the rapid availability of differential diagnostic information, TEM has become an established method in surgical procedures where blood losses can be expected. Thromboelastometry Thromboelastometry (TEM), previously named rotational thromboelastography (ROTEG) or rotational thromboelastometry (ROTEM), is an established viscoelastic method for hemostasis testing in whole blood. It is a modification of traditional thromboelastography (TEG). TEM investigates the interaction of coagulation factors, their inhibitors, anticoagulant drugs, blood cells, specifically platelets, during clotting and subsequent fibrinolysis. The rheological conditions mimic the sluggish flow of blood in veins. TEM is
Thromboelastometry
Visotek and tested by LTW so the surgeon can efficiently coagulate an albumin-ICG solder together with a solid transparent albumin scaffold and provide quick and accurate hemostasis and biliary sealing. Special areas of unmet clinical need are rapid hemostasis of solid visceral organs (liver/kidney/spleen) involved in trauma, tumors and transplantation and specifically in patients with coagulation failure or therapeutic anticoagulation. There are many advantages to the LTW method. It saves lives because it quickly repairs and controls hemorrhage in patients who cannot clot, and it conserves blood based on a lowered requirement for transfusions. The new method is capable of
Visotek
Causes of disturbed blood flow include stagnation of blood flow past the point of injury, or venous stasis which may occur in heart failure, or after long periods of sedentary behaviour, such as sitting on a long airplane flight. Also, atrial fibrillation, causes stagnant blood in the left atrium (LA), or left atrial appendage (LAA), and can lead to a thromboembolism. Cancers or malignancies such as leukemia may cause increased risk of thrombosis by possible activation of the coagulation system by cancer cells or secretion of procoagulant substances (paraneoplastic syndrome), by external compression on a blood vessel when a solid
Thrombosis
G. 54. The picture shows a room, the wall of which is almost filled by a high window with coats-of-arms on the right, and by the open house-door on the left. At the door stands a boy with long hair looking towards the spectator ; he wears a white cap, a grey jacket and frock adorned with coloured ribbons. He holds in his hand a basket of rolls or apples, which a young woman, leaning forward and seen in lost profile, is taking from him. She wears a black silk hood, a black velvet jacket, a red silk skirt, and
A Boy Bringing Bread
A year later, the Ichiwa-kai gang’s leader was shot to death. The war between Yamaguchi Gumi and the splinter group killed more than 30 gang members and a few bystanders. At one three-month period, 12 people were killed and 17 people were wounded. This war would be known as the Yama-Ichi War. In 1989, Yoshinori Watanabe took the position of 5th Generation Kumicho of Yamaguchi Gumi and ended nearly ten years of violent power struggle within the largest yakuza organization. Yoshinori Watanabe’s huge ceremony to commemorate accession was held at a local shrine and infused traditional and feudal aspects of
Yoshinori Watanabe
defeats. As with previous years, the Irish state broadcaster, Radio Telefís Éireann will provide both television and radio coverage for the event. As well as showing the senior game, RTÉ will also provide coverage of the All-Ireland Minor Hurling Championship Final on the day along with a suitable build up to the game in the preceding days. Irish satellite sports channel, Setanta Sports will provide coverage on the day for Australia, Canada, United Kingdom and United States of America. The British Broadcasting Corporation provides coverage in Northern Ireland, although viewers may also be able to watch the RTÉ coverage through
2008 All-Ireland Senior Hurling Championship Final
Pandiagonal magic cube In recreational mathematics, a pandiagonal magic cube is a magic cube with the additional property that all broken diagonals (parallel to exactly two of the three coordinate axes) have the same sum as each other. Pandiagonal magic cubes are extensions of diagonal magic cubes (in which only the unbroken diagonals need to have the same sum as the rows of the cube) and generalize pandiagonal magic squares to three dimensions. In a pandiagonal magic cube, all 3m planar arrays must be panmagic squares. The 6 oblique squares are always magic. Several of them may be panmagic squares.
Pandiagonal magic cube
twice. In 2006, he transferred to Calcio Catania, who were just promoted to Serie A for the 2006–07 season. He played only 9 league matches in the first season. After played only once in the start of the second season, he was loaned to then Serie B club, Spezia. After failed to sell the player in 2008–09 season. At the mid of 2009 summer transfer windows, Catania announced the contract terminations under mutual consent for both Millesi and Babu. On 31 August 2009, he signed a 1+1 contract with Salernitana of Serie B. On 15 November, he returned to Avellino,
Francesco Millesi
turtles, birds, cats, dogs, and rabbits, whose vein is found in the center of the nail. Antihemorrhagic An antihemorrhagic (antihæmorrhagic) agent is a substance that promotes hemostasis (stops bleeding). It may also be known as a hemostatic (also spelled hæmostatic) agent. A styptic (also spelled stiptic) is a specific type of antihemorrhagic agent that works by contracting tissue to seal injured blood vessels. Styptic pencils contain astringents. Antihemorrhagic agents used in medicine have various mechanisms of action: Hemostatic agents are used during surgical procedures to achieve hemostasis and are categorized as hemostats, sealants and adhesives. They vary based on their
Antihemorrhagic
strokes are the result of blood clots that are preventing blood flow within a cerebral blood vessel. The goal of tPA treatment is to break up the clots that are occluding the vessel, and restore cerebral blood flow. Treatment with tPA has been shown to improve patient outcome in some studies and to be harmful in others. The effectiveness and risk of tPA is strongly correlated with the delay between stroke onset and tPA delivery. Current standards recommend for tPA to be delivered within 3 hours of onset, while best results occur when treatment is delivered within 90 minutes of
National Institutes of Health Stroke Scale
"must" be present, or else the condition is fatal due to a lack of systemic blood flow. In some cases, it can be detected prenatally. There are four variants: Supracardiac (50%): blood drains to one of the innominate veins (brachiocephalic veins) or the superior vena cava; Cardiac (20%), where blood drains into coronary sinus or directly into right atrium; Infradiaphragmatic (20%), where blood drains into portal or hepatic veins; and a mixed (10%) variant. TAPVC can occur with "obstruction", which occurs when the anomalous vein enters a vessel at an acute angle and can cause pulmonary venous hypertension and cyanosis
Anomalous pulmonary venous connection
a thrombosis or embolism resulting in ischaemia. Acute limb ischaemia Acute limb ischaemia (ALI) occurs when there is a sudden lack of blood flow to a limb. Acute limb ischaemia is caused by embolism or thrombosis, or rarely by dissection or trauma. Thrombosis is usually caused by peripheral vascular disease (atherosclerotic disease that leads to blood vessel blockage), while an embolism is usually of cardiac origin. In the United States, ALI is estimated to occur in 14 out of every 100,000 people per year. With proper surgical care, acute limb ischaemia is a highly treatable condition; however, delayed treatment (beyond
Acute limb ischaemia
until about 08:27 when she disappeared completely taking with her 15 officers and 123 men. After nearby ships picked up the survivors of the sunken destroyer, the injured were taken to the hospital at Sandy Hook, New Jersey. A United States Coast Guard Sikorsky HNS-1 flown by Lieutenant Commander Frank A. Erickson — the first use of a helicopter in a life-saving role — flew two cases of blood plasma, lashed to the helicopter's floats, from New York to Sandy Hook. The plasma saved the lives of many of "Turner"s injured crewmen. "Turner"s name was stricken from the Naval Vessel
USS Turner (DD-648)
coagulation
Title: Hemostasis. Content: Hemostasis Hemostasis or haemostasis is a process which causes bleeding to stop, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing. This involves coagulation, blood changing from a liquid to a gel. Intact blood vessels are central to moderating blood's tendency to form clots. The endothelial cells of intact vessels prevent blood clotting with a heparin-like molecule and thrombomodulin and prevent platelet aggregation with nitric oxide and prostacyclin. When endothelial injury occurs, the endothelial cells stop secretion of coagulation and aggregation inhibitors and instead secrete von
Vasoconstriction
Vasoconstriction
vasoconstriction
vasoconstriction
vasoconstriction
vasoconstriction