Anatomy & Physiology

Anatomy & Physiology Study Guide which is a period called the vascular phase of hemostasis. During the vascular phase, changes occur in the endothelium of the vessel at the injury site: • The endothelial cells contract and expose the underlying basal lamina to the bloodstream. • The endothelial cells begin releasing chemical factors and local hormones. Endothelial cells also release endothelins. These are peptide hormones that stimulate smooth muscle contraction and promote vascular spasms, while also stimulating the division of endothelial cells, smooth muscle cells, and fibrocytes to accelerate the repair process. • The endothelial plasma membranes become “sticky.” A hole in the wall of a small artery or vein may be partially sealed off by the attachment of endothelial cells on either side of the break. In small capillaries, endothelial cells on opposite sides of the vessel may stick together and prevent blood flow along the damaged vessel. The stickiness is also essential because it facilitates the attachment of platelets as the platelet phase gets under way. • The platelet phase of hemostasis begins with the attachment of platelets to sticky endothelial surfaces, to the basal lamina, and to exposed collagen fibers. The attachment of platelets to exposed surfaces is called platelet adhesion . As more and more platelets arrive, they stick to one another as well. This process, called platelet aggregation, forms a platelet plug that may close the break in the vessel wall if the damage is not severe or the vessel is relatively small. No more than 15 seconds after an injury occurs, platelet aggregation begins. As they arrive at the injury site, platelets become activated. The first sign of activation is that they become more spherical and develop cytoplasmic processes that extend toward adjacent platelets. At this time, the platelets begin releasing a wide variety of compounds, including: adenosine diphosphate (ADP), which stimulates platelet aggregation and secretion; thromboxane A2 and serotonin, which stimulate vascular spasms; clotting factors, proteins that play a role in coagulation; platelet-derived growth factor (PDGF), a peptide that promotes vessel repair; and calcium ions, which are required for platelet aggregation and are used in several steps in the clotting process. The platelet phase proceeds rapidly because ADP, thromboxane, and calcium ions released from each arriving platelet stimulate further aggregation. The platelet plug produced will be reinforced through a positive feedback loop as clotting occurs. The Coagulation Phase No more than a few seconds after the injury, the vascular and platelet phases begin. The coagulation phase does not start until 30 seconds or more after the vessel has been damaged. Coagulation, or blood clotting, involves a complex sequence of steps leading to the conversion of circulating fibrinogen into the insoluble protein fibrin. A fibrin network covers the surface of the platelet plug. Passing blood cells and additional platelets are trapped in the fibrous tangle, forming a blood clot that effectively seals off the damaged portion of the vessel. Normal blood clotting depends on the presence of clotting factors , or procoagulants, in the plasma. Important clotting factors include Ca2+ and 11 different proteins. Several of the proteins are proenzymes , which, when converted to active enzymes, direct essential reactions in the clotting response. The activation of one proenzyme commonly creates an enzyme

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