Week 6 Discussion-Blood Clotting

Disseminated Intravascular Coagulation

Blood clotting is a process of clot formation with the help of coagulation factors to stop bleeding. Three steps are involved in the process of blood coagulation (Smith et al., 2015). These are primary hemostasis, secondary hemostasis, and clot factor. These clotting factors help to form a clot at the site of injury. In the primary hemostasis, there is a formation of a weak plug of platelet cells, while in the secondary hemostasis, the weak platelet plug is strengthened by fibrin. Two processes are involved in primary hemostasis, blood vasoconstriction following an injury, resulting in reduced blood flow to the injured area. The second process is the aggregation of platelet cells, activating fibrin clot formation from fibrinogen. The clotting stage happens in two pathways, the extrinsic and intrinsic pathways. Since our patient’s case is caused by acute trauma, then the extrinsic pathway cascade is activated. Factor VII is triggered in this pathway and meets the intrinsic pathway at the common pathway. This is where factor 10 triggers the thrombin; thrombin then triggers the formation of fibrinogen which is responsible for fibrin clot formation.

Partial thromboplastin time and Active partial thromboplastin time values are used to evaluate the rate of blood clotting. When the values of these tests are prolonged, then its shows that the clotting rate is slow, and one is likely to have a continuous bleeding problem (Niederdöckl et al., 2016). Fibrin degradation and split products are seen in patients with disseminated intravascular coagulation (DIC) because of the release of plasminogen factors in the endothelium responsible for the fibrinolytic activity.

Sepsis may lead to DIC, an inflammatory process in the body system, leading to the release of cytokines and the activation of the coagulation process. Cancer can cause DIC by triggering the release of procoagulant substances into the bloodstream.

References

Niederdöckl, J., Dempfle, C. E., Schönherr, H. R., Bartsch, A., Miles, G., Laggner, A., & Pathil, A. (2016). Point‐of‐care PT and aPTT in patients with suspected deficiencies of coagulation factors. International journal of laboratory hematology, 38(4), 426-434. https://doi.org/10.1111/ijlh.12519

Smith, S. A., Travers, R. J., & Morrissey, J. H. (2015). How it all starts: Initiation of the clotting cascade. Critical reviews in biochemistry and molecular biology, 50(4), 326-336. https://doi.org/10.3109/10409238.2015.1050550

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