Siemens Healthineers - What is hemostasis

What is hemostasis?

Why your body relies on a healthy balance of clotting and bleeding

Blood is a fluid that is circulated around the body through blood vessels. It performs many vital functions within the body, including defense and protection mechanisms, supplying oxygen and nutrients and regulating body temperature. Injuries such as a cut or bruise can damage blood vessels, which causes bleeding. In a healthy person, bleeding will automatically stop after a short time to prevent extensive blood loss. This function is called hemostasis.

Thrombosis and COVID-19

Hemostasis

Platelets adhering to the wound.
Platelets adhering to the wound.

As a first action to stop bleeding, the body sends proteins called collagen, which makes blood platelets travel to the wound and stick to each other.

Platelets also cause the vessels to contract, causing lower blood circulation around the injured area.

Platelets release various compounds that make even more platelets aggregate to help close the wound. Typically, within a few minutes, a seal is formed. This seal is a first reaction to stop the bleeding.

How is a clot formed?

To stabilize the seal, substances released through the injury start another interlinked chain reaction, which is called secondary hemostasis.

This sequence of reactions can happen via two pathways. Both pathways lead to the production of cross-linked fibrin.

As a result, a clot made of platelets, fibrin, and blood cells is formed in the blood.

D-dimer molecule
D-dimer molecule.

Once the wound has healed underneath its stable seal and the clot is no longer needed, the clot is broken down by a process called fibrinolysis.

This process elevates a protein in the blood called D-dimer.

In a healthy person, clotting and fibrinolysis are balanced, meaning the blood appropriately develops clots and breaks them down only when needed in response to a wound or contusion.

Thrombosis

Imbalanced scale showing how a clotting tendency relates to a risk of thrombosis.
A clotting tendency might lead to thrombotic complications.

A thrombotic disorder refers to conditions in which blood clots form in the blood vessels. This happens due to elevated clotting in the blood.

There are several conditions that may trigger elevated clotting activity in the blood. If the blood clots too much, a person could experience thrombosis.

If a clot becomes too large, it can block normal blood flow in arteries and veins, causing:

  • Ischemic stroke or heart attack
  • Deep vein thrombosis (DVT)
  • Pulmonary embolism (PE)

A clot can also wander through the body and may block blood vessels in the brain (stroke) or the lung (PE).

Learn more about DVT and PE, and the role of D-dimer testing.

Diagram: Blood flow in case of thrombosis.
Blood flow in case of thrombosis.

If a patient is at high risk for thrombosis, a physician will attempt to prevent excessive clot formation with medication, such as heparin or oral anticoagulants.

Acute thrombosis, like a heart attack or a stroke, requires immediate treatment. One of the standard therapeutic measures is treatment with fibrinolytic medications to dissolve the blocking clot (or thrombus) and reestablish blood flow to prevent damage or death.

COVID-19

COVID-19 in relation to hemostatic disorders.

COVID-19 patients are experiencing serious—and sometimes fatal—clotting abnormalities.

Studies show that many critically ill COVID-19 patients develop thrombotic complications such as confirmed venous thromboembolism (VTE) or pulmonary embolism (PE), sometimes despite medical treatment, e.g., heparin therapy.1-5

The risk of thrombosis in COVID-19 patients increases with disease severity and length of the hospital stay.4

Thrombosis and fibrin found as clots and/or microclots in the small blood vessels of the lung and other organs have been found to be a major cause of death in COVID-19 patients.5

Bleeding

Imbalanced scale showing how a bleeding tendency relates to bleeding disorders.
An imbalance can cause bleeding.

When the clotting rate in a person’s blood is too low, the patient may experience excessive bleeding.

Bleeding disorders are often inherited but can also be acquired via different diseases and conditions. Main inherited dysfunctions and acquired causes for bleeding disorders are:

Inherited:

  • Hemophilia A
  • Hemophilia B
  • Von Willebrand disease
  • Platelet dysfunction

Acquired:

  • Liver disorders
  • Disseminated intravascular coagulopathy (DIC)
  • Anticoagulant therapy
  • Platelet dysfunction

Bleeding disorders can be treated with medications that replace missing proteins to close the gaps in the hemostasis reaction cascade.

Lab Tests

Patient and physician talking about blood health
Are you talking to your doctor about blood health?

Hemostasis lab tests can help your doctor to identify hereditary or acquired blood clotting disorders and the effectiveness of therapy used to manage them.

These tests are used to determine how long it takes for your blood to clot, identifying any delay or amplification of time that may cause an imbalance between clotting or fibrinolysis.

Are you talking to your doctor about blood health? If you are at risk for a thrombotic complication or suspect a bleeding disorder, ask your physician about lab testing to check your coagulation status so he or she can identify appropriate therapy or refer you to a specialist.


We stand behind you

 

Stay safe and healthy!

1

2

3

4

5