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THROMBOSIS. Dr. Afsar Saeed Shaikh M.B.B.S, M.Phil. Assistant Professor of Chemical Pathology Pathology Department, KEMU, Lahore. INTRODUCTION. NORMAL HEMOSTASIS 1) Maintain blood in fluid form in normal blood vessels

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Dr. Afsar Saeed Shaikh

M.B.B.S, M.Phil.

Assistant Professor of Chemical Pathology

Pathology Department, KEMU, Lahore.


1) Maintain blood in fluid form in normal blood vessels

2) induce a rapid & localized hemostatic plug formation at the site of vascular injury


‘Pathologic opposite to hemostasis’


‘An inappropriate activation of normal hemostatic processes, such as the formation of a blood clot in uninjured vasculature or thrombotic occlusion of a vessel after relatively minor injury.’

    • Endothelial Injury
    • Abnormal Blood Flow
    • Hypercoagubality
1 endothelial injury
1. Endothelial Injury
  • General:
    • A dominant influence
    • Can act without combination with other factors
    • Important factor where normally high flow rates hampers thrombus formation e.g. arterial circulation & heart chambers
endothelial injury
Endothelial Injury
  • Sites :
    • Within cardiac chamber (e.g. following M.I)
    • Over ulcerative atherosclerotic plaques
    • At the site of inflammatory or traumatic vascular injury
mechanism of endothelial injury
Mechanism of Endothelial Injury
  • 1: Direct endothelial injury; physical loss of endothelium
  • 2: Dysfunctional endothelium (Imbalance of anticoagulant and pro-coagulant properties of endothelium)


dysfunctional endothelium
Dysfunctional Endothelium
  • Stress of hypertension
  • Bacterial endotoxins
  • Turbulent flow over scarred valves
  • Hypercholesterolemia
  • Products absorbed from cigarette smoke
  • Irradiation.
1 abnormal blood flow
1. Abnormal Blood Flow
  • Turbulence:
    • Arterial & cardiac thrombosis
    • A cause of endothelial injury
    • Also causes countercurrents and local pockets of stasis
  • Stasis:
    • Venous thrombi
    • Acts by disturbing normal blood flow
mechanism of abnormal blood flow
Mechanism of Abnormal Blood Flow
  • Normal blood flow; laminar
  • Turbulence & stasis disrupt normal laminar blood flow
  • Bring platelets in contact with endothelium
  • Prevent dilution of clotting factors
  • Retard the inflow of inhibitors
  • Promote endothelial cell activation
clinical settings of abnormal blood flow
Clinical Settings of Abnormal Blood Flow
  • Ulcerative atherosclerotic plaques
  • Aortic & arterial aneurysms
  • MI
  • Mitral valve stenosis
  • Hyperviscosity syndrome
  • Sickle cell anemia
3 hypercoagubility
3. Hypercoagubility
  • Important but less frequent contributor
  • ‘Any alteration of the coagulation pathways that predisposes to thrombosis’
causes of hypercoagubality
Causes of Hypercoagubality
  • PRIMARY (Genetic)
  • Common:

Mutation in factor V gene

Mutation in prothrombin gene

  • Rare:

Antithrombin III deficiency

Protein C def.

Protein S def.

causes of hypercoagubality1
Causes of Hypercoagubality
  • Secondary (Acquired)
  • High Risk:

Prolonged bed rest

MI, Cancer, DIC

Atrial fibrillation

Tissue damage

Prosthetic cardiac valve

Antiphospholipid antibody syndrome

causes of hypercoagubality2
Causes of Hypercoagubality
  • Secondary (Acquired)
  • Low Risk:


Nephrotic syndrome

Pregnancy, Oral contraceptives

Sickle cell anemia


types of thrombi
Types of Thrombi
  • Types:
  • Arterial Thrombi
  • Venous Thrombi
  • Mural Thrombi
  • Red Thrombi (Stasis thrombi)
  • White Thrombi (Gray-white)
morphology of thrombi
Morphology of Thrombi
  • Arterial:
  • Usually occlusive
  • Firmly attached to the injured artery wall
  • Gray-white and friable
  • Composed of a meshwork of platelets, fibrin, erythrocytes, and degenerating leukocytes
morphology of thrombi1
Morphology of Thrombi
  • Venous:
  • Invariably occlusive
  • Not firmly attached to the artery wall
  • Red in color and not friable but wet like a in-vitro clot
  • Contain more erythrocytes as compare to arterial thrombi
fate of thrombi
Fate of Thrombi
  • Propagation
  • Embolization
  • Dissolution
  • Organization and recanalization