HEMATOPOIETIC SYSTEM

Introduction and common

thrombo embolic disorders
NUR FADZLINA BINTI ZABRI
082013100006
SERIAL NO. 4

Introduction
Thrombosis is the formation of a blood clot
inside a blood vessel, obstructing the flow
of blood through the circulatory system
Embolus is a clot that breaks free and begins to
travel around the body
Thromboembolism is the combination of
thrombosis and its main complication,
embolism

VIRCHOWS TRIAD

Thrombus
Gray white, tangled-strand of fibrin and platelets
Mural thrombi are attached to one wall of an
underlying structure
Arterial thrombi are usually occlusive, rarely
mural
Venous thrombi are invariably occlusive, contain
large RBC component due to static environment

Features

Arterial thrombi

Venous thrombi

Sites

Common in coronary ,
cerebral, iliac

Superficial varicose vein

and deep vein in leg

Pathogenesis

Due to endothelial injury

Venous stasis

Microscopy

More platelet

More fibrin

Complications

Ischemia/infarction of
vital organs

Embolism, edema,
ulceration

Fate of thrombus

Embolism

Arterial emboli - Systemic thromboembolism

Venous emboli - Pulmonary thromboembolism
Fat embolism
Air embolism
Amniotic fluid embolism

Venous emboli - Pulmonary thromboembolism

Venous thrombi originate from the deep leg vein
thrombi above the level of the knee

Carried through large channel

Pass through the right side of the heart

Enter the pulmonary vascular

 Deep vein thrombus (DVT) and pulmonary

embolism (PE)
79% of PE arise from propagation of lower limb
DVT
Complications.

May occlude the main pulmonary artery (saddle embolus)

Sudden death or right ventricular failure ( cor pulmonale)
Obstruction of medium-size artery cause pulmonary
hemorrhage

Management
Oxygen
Opiates - morphine
Anticoagulations (LMW heparins,fondaparinux,
warfarin)
Thrombolytic therapy ( in patients with acute
massive PE accompanied with cardiogenic
shock)

Systemic thromboembolism
Emboli of the arterial circulation
80% arise from intracardiac mural thrombi
Small fraction may arise in vein but end up in
arterial circulation paradoxical emboli
Site of arrest depends on blood flow through the
dowsntream tissue
Common site : lower extremities, brain, intestine,
kidney

Arterial embolization causes infarction of

the affected tissue

Brain
Stroke
Transient
ischemic
attack

Heart
myocardial
infarction

Management
Stroke and myocardial infarction

Opiates morphine
Anticoagulants LMW heparin, fondaparinux
Fibrinolytics streptokinase, alteplase, reteplase
Anti-thrombotic drugs low dose aspirin,
abciximab, eptifibatide, tirofiban, orbofiban,
ticlopidine, clopidogrel

Amniotic fluid embolism

Uncommon complication of labor
Pulmonary microcirculation with epithelial
squamous cells shed from fetal skin, lanugo hair,
fat from vernix
Mortality rate is high
If patient survives, symptoms may occur :
Pulmonary edema
Disseminated intravascular coagulation

Disseminated Intravascular coagulation

Widespread formation of blood clots in the small
blood vessels
Coagulation process consumes clotting factors
and platelets
Normal clotting is disrupted and
severe bleeding can occur from various sites.

Clinical features :

Bleeding
Renal dysfunction
Hepatic dysfunction
Respiratory dysfunction
Shock
Central nervous system dysfunction

Management
Blood component therapy fresh frozen plasma,
cryoprecipitate
Anticoagulants low dose heparin
Recombinant human activated protein C drotrecogin alfa

References
Harrisons Principle of Internal Medicine, 18th
Edition, Volume 2
Robbins Basic Pathology 8th edition by Kumar
and Abbas
Davidsons Principles of Practice of Medicine 21st
Edition