Hemostasis and bleeding disorders

Hemostasis is a complex physiological process that entails preventing blood loss from damaged vessels. It is a dynamic balance of anti-coagulation and pro-coagulation molecules and consists of three sequential processes.

Primary hemostasis

The interaction between the damaged endothelium, von Willebrand factor (VWF), and platelets is a vital process for the development of a platelet plug at the injury site.

Secondary hemostasis

The coagulation cascade is initiated on the surfaces of injured endothelium and activated platelets, where clotting factors are being activated. This leads to the formation of a fibrin mesh which provides stability to the formed platelet plug to allow wound healing.

Tertiary hemostasis

Fibrinolysis breaks down the platelet plug that allows normal structure of the endothelium, smooth endothelial lining, and normal lumen size.

Disorders of hemostasis, or an imbalance in the blood's clotting process, can both result in either hypocoagulation (bleeding) or hypercoagulation (thromboembolic disorders). Hereditary bleeding disorders are caused by the absence or deficiency of specific clotting proteins. The most common hereditary bleeding disorders are hemophilia A, hemophilia B, von Willebrand disease and immune thrombocytopenia (ITP).

Hemostasis has now been widely studied for more than a century. Life science research has generated a very detailed picture of the molecular and cellular events that play roles in normal and pathological hemostasis. Novel medication for treatment of hemostatic disorders is still a significant area of interest, taking hemophilia treatment as an example.

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