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Related Concept Videos

Introduction to Hemostasis01:05

Introduction to Hemostasis

11.9K
Hemostasis is a complex physiological process that prevents excessive bleeding when a blood vessel is injured. It's crucial for maintaining the integrity of the circulatory system, as it ensures that our blood remains fluid while still within the vascular network and yet clots to prevent blood loss upon vessel injury.
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
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Extrinsic and Intrinsic Pathways of Hemostasis01:20

Extrinsic and Intrinsic Pathways of Hemostasis

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Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
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Disorders of Hemostasis01:24

Disorders of Hemostasis

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Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
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Blood Pressure Imbalances and Circulatory Shock01:24

Blood Pressure Imbalances and Circulatory Shock

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Disorders affecting blood volume, vascular tone, or vascular function can disrupt vascular homeostasis, including conditions like hypertension, hemorrhage, and shock.
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
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Coagulation01:09

Coagulation

8.9K
The coagulation phase is a critical part of the body's process to prevent blood loss following injury to blood vessels. It involves chemical reactions that form a clot to seal the injured area. The clotting process begins shortly after injury, within 15-20 seconds for severe damage and 1-2 minutes for minor injuries.
During the coagulation phase, clotting factors, or procoagulants, play a vital role in initiating and progressing the coagulation cascade. This cascade is a series of reactions...
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Vascular Spasm01:16

Vascular Spasm

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The vascular phase, also known as vasospasm, is the initial stage of hemostasis, crucial for preventing excessive bleeding when a blood vessel is injured. After a vessel is cut, nerves in the damaged area trigger pain and other sensory impulses. Simultaneously, the smooth muscles in the vessel wall contract, resulting in a vascular spasm. This contraction reduces the vessel's diameter at the injury site, slowing or stopping blood loss through the vessel wall. Vascular spasms typically last...
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Integrated Compensatory Responses in a Human Model of Hemorrhage
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Hemostatic Balance in Severe Trauma.

Thorsten Haas1, Melissa M Cushing2

  • 1Department of Pediatric Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland.

Frontiers in Pediatrics
|December 2, 2020
PubMed
Summary

Trauma-induced coagulopathy affects children and adults, impacting survival. Early detection and goal-directed treatment, including fibrinogen replacement, are crucial for improving outcomes in pediatric trauma patients.

Keywords:
coagulation factor concentratesmassive bleedingpediatricsthrombosistransfusiontraumaviscoelastic testing

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Area of Science:

  • Trauma and Emergency Medicine
  • Hematology
  • Pediatric Critical Care

Background:

  • Acute coagulopathy is common in pediatric trauma, increasing mortality.
  • Mechanisms of adult trauma coagulopathy are not fully understood in children.
  • Severe hypofibrinogenemia is frequent in pediatric trauma patients.

Purpose of the Study:

  • To review current understanding of trauma-induced coagulopathy in pediatric patients.
  • To highlight diagnostic and treatment challenges in pediatric trauma.
  • To emphasize the need for further research in pediatric trauma coagulopathy.

Main Methods:

  • Literature review of studies on pediatric trauma-induced coagulopathy.
  • Analysis of diagnostic tools, including viscoelastic measurements.
  • Evaluation of treatment strategies, such as blood product ratios and goal-directed protocols.

Main Results:

  • Standard laboratory tests are insufficient for rapid diagnosis of coagulopathy.
  • Viscoelastic measurements are established in adults but need pediatric studies.
  • Higher plasma/platelet to RBC ratios did not consistently improve survival in pediatric trauma.

Conclusions:

  • Goal-directed transfusion protocols with viscoelastic tests and early fibrinogen replacement show promise.
  • Early detection and treatment of hypofibrinogenemia are vital.
  • Pediatric trauma patients face risks of both bleeding and venous thromboembolism, lacking specific preventative guidelines.