Coagulation of the blood is the process whereby bleeding (or haemorrhage) is normally arrested in the body. Blood starts to clot as soon as the skin (or other tissue) has been cut. Coagulation is part of the process of HAEMOSTASIS which is the arrest of bleeding from an injured or diseased blood vessel. Haemostasis depends on the combined activities of vascular, platelet (see PLATELETS) and PLASMA elements which are o?set by processes to restrict the accumulation of platelets and FIBRIN to the damaged area.
The three-stage process of coagulation is complex, involving many di?erent substances. There are two cascading pathways of biochemical reactions for activating coagulation of blood. The extrinsic pathway is the main physiological mechanism, which is triggered when blood vessels are damaged, usually by trauma or surgery. The intrinsic pathway is activated by internal disruption of the wall of a blood vessel. The basic pattern is broadly the same for both and is summarised simply as follows:
prothrombin + calcium + thromboplastin
thrombin + ?brinogen
?brin
Prothrombin and calcium are normally present in the blood. Thromboplastin is an enzyme which is normally found in the blood platelets and in tissue cells. When bleeding occurs from a blood vessel, there is always some damage to tissue cells and to the blood platelets. As a result of this damage, thromboplastin is released and comes into contact with the prothrombin and calcium in the blood. In the presence of thromboplastin and calcium, prothrombin is converted into thrombin, which in turn interacts with ?brinogen – a protein always present in the blood – to form ?brin. Fibrin consists of needle-shaped crystals which, with the assistance of the blood platelets, form a ?ne network in which the blood corpuscles become enmeshed. This meshwork, or CLOT as it is known, gradually retracts until it forms a tight mass which, unless the tissue injury is very severe or a major artery has been damaged, prevents any further bleeding. It will thus be seen that clotting, or coagulation, does not occur in the healthy blood vessel because there is no thromboplastin present. There is now evidence suggesting that there is an anti-thrombin substance present in the blood in small amounts, and that this substance antagonises any small amounts of thrombin that may be formed as a result of small amounts of thromboplastin being released.
The clotting or coagulation time is the time taken for blood to clot and can be measured under controlled conditions to ensure that it is normal (3–8 minutes). In certain diseases – HAEMOPHILIA, for example – clotting time is greatly extended and the danger of serious haemorrhage enhanced.
n. the process by which a colloidal liquid changes to a jelly-like mass. See blood coagulation.
(blood clotting) the process whereby blood is converted from a liquid to a solid state. The process may be initiated by contact of blood with a foreign surface (intrinsic system) or with damaged tissue (extrinsic system). These systems involve the interaction of a variety of substances (*coagulation factors) and lead to the production of the enzyme thrombin, which converts the soluble blood protein *fibrinogen to the insoluble protein *fibrin, forming the blood clot. Finally, fibrin is broken down by the action of *plasmin. Anticoagulants and tissue plasminogen activators act by inhibiting or activating various pathways in this cascade (see illustration). Blood coagulation is an essential mechanism for the arrest of bleeding (*haemostasis). See also platelet activation.... blood coagulation
(clotting factors) a group of substances present in blood plasma that, under certain circumstances, undergo a series of chemical reactions leading to the conversion of blood from a liquid to a solid state (see blood coagulation). Although they have specific names, most coagulation factors are referred to by an agreed set of Roman numerals (e.g. *Factor VIII, *Factor IX). Lack of any of these factors in the blood results in the inability of the blood to clot. See also haemophilia.... coagulation factors
(clotting time) the time taken for blood or blood plasma to coagulate (see blood coagulation). When measured under controlled conditions and using appropriate techniques, coagulation times may be used to test the function of the various stages of the blood coagulation process.... coagulation time
a type of *electrocoagulation used to arrest haemorrhage or destroy abnormal tissue. A stream of inert gas, such as argon or helium, is ionized, thereby carrying electrical energy to adjacent tissue; there is no physical contact between the plasma coagulation apparatus and the tissue.... plasma coagulation
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