hemorragia y trombosis

Universidad Autónoma de Nuevo LeónFacultad de Medicina Veterinaria y

Zootecnia

Patología GeneralRafael Ramírez Romero

Trastornos Circulatorios

Hemorrhage, the escape of blood from the vascular system, is commonly due to trauma. Hemorrhage may be external or internal and in either case may deprive the animal of blood (exsanguination)

Hemorragia, la salida de sangre del sistema vascular, se debe comúnmente a trauma. La hemorragia puede ser externa o interna y en cualquier caso puede privar de sangre al animal (exanguinaciòn)

Trastornos Circulatorios

When hemorrhage occurs as the result of rupture or tear in the blood vessel the hemorrhage is by rhexis. If there is not defect in the blood vessel and the red blood cells merely pass through the vascular structures it is by diapedesis

Cuando la hemorragia es el resultado de una ruptura o desgarre del vaso sanguíneo la hemorragia es por rexis. Si no hay defecto en el vaso sanguíneo y los glóbulos rojos simplemente atraviesan la estructura vascular esta es por diapédesis

Trastornos Circulatorios

rhexis

diapedesis

hemorrhage

Microscopic image of an hemorrhage

Trastornos Circulatorios

Accumulation of blood in the thoracic cavity, pericardial space, peritoneral space (abdominal cavity), and joints are called hemothorax, hemopericardium, hemoperitoneum, o hemarthrosis, respectively

La acumulación de sangre en la cavidad torácica, espacio pericárdico, espacio peritoneal (cavidad abdominal) y articulaciones se denomina, hemotórax, hemopericardio, hemoperitoneo, o hemartrosis, respectivamente

Trastornos Circulatorios

Hemothorax sheep and Hemopericardium dog

Trastornos Circulatorios

When blood escapes into tissue (rather than through broken surfaces), it accumulates as a blood-filled space called hematoma (hematocyst)

Cuando la sangre escapa hacia los tejidos (mas que a través de superficies rotas), se acumula como un espacio lleno de sangre y se llama hematoma (hematoquiste)

Tra

sto

rno

s C

ircu

lato

rio

s Horse

Subdural hematoma

Trastornos Circulatorios

Subcutaneous hematoma

Trastornos Circulatorios

Petechiae refers to very tiny hemorrhages into the skin, mucous membranes and serosal surfaces. Their presence indicates a generalized process with severe endothelial damage such as septicemia and viral infections

Petequias se refiere a hemorragias muy pequeñas en la piel, membranas mucosas y superficies serosas. Su presencia indica un proceso generalizado con daño endothelial severo como ocurre en septicemias e infecciones virales

Trastornos Circulatorios

Petechiae

Trastornos Circulatorios

Ecchymoses are larger hemorrhages (greater than 1 cm diameter). The term purpura is emloyed loosely to mean hemorrhages larger than petechiae or petechial and ecchymotic hemorrhages generalized

Equimosis son hemorragias mas grandes (mayores que 1 cm de diámetro). El termino púrpura se emplea de manera amplia para referirse a hemorragias mas grandes que petequias o hemorragias petequiales y equimoticas generalizadas

Trastornos Circulatorios

Ecchymoses

Trastornos Circulatorios

Pig, purpura associated to hemorrhagic dermatitis/nephritic syndrome

Trastornos Circulatorios

Sheep, adult Paintbrush hemorrhages

Sufusiones Suffusions

Trastornos Circulatorios

Horse, Hemomelasma ilei hemorrhagic lesions probably associated to parasites

Trastornos Circulatorios

Guanaco, newborn

Hyphema

Trastornos Circulatorios

Hemoptisis and Epistaxis

Trastornos Circulatorios

Gastric ulcer in pigs provoking melena Melena in a puppy due to Ancylostoma caninum

Trastornos Circulatorios

Causes of hemorrhage:

Trauma

Vascular lesions

Toxins

Coagulation disorders

Allergies

Agonal

Causas de hemorragia:

Trauma

Lesiones vasculares

Toxinas

Desórdenes de la Coagulación

Alergias

Agónicas

Trastornos Circulatorios

Horse, fractured rib and traumatic hemorrhage

Trastornos Circulatorios

Horse, aneurysm and thrombosis in mesenteric artery due to Strongylus vulgaris, also, aneurism in aorta due to abnormal migration of Spirocerca lupi

Trastornos Circulatorios

Hemorrhages

Vit. K deficiency in cattle feeding lush sweet clover (containing dicumarol a compound related to warfarin)

Trastornos Circulatorios

Cow, heart; agonal hemorrhages Pig, lung; blood bronchoaspiration during euthanasia

Trastornos Circulatorios

Thrombus: Solid mass of coagulated blood formed within the circulation

Clot (blood): Blood coagulated outside the blood vessel or after death

Trombo: masa solida de sangre coagulada que se forma dentro de la circulación

Coágulo (sangre): sangre coagulada fuera de los vasos sanguíneos o después de la muerte

Trastornos Circulatorios

Thrombosis (antemortem coagulated blood) versus chicken fat clots (post mortem coagulated blood)

Trastornos Circulatorios

It is difficult to make a clear distinction between a thrombus and a blood clot because their obvious relationship based on blood coagulation. A thrombus is essentially a pathological type of blood clot formed intravascularly

Es difícil hacer una clara distinción entre un trombo y un coágulo de sangre debido a su obvia relación basada en la coagulación sanguínea. Un trombo es esencialmente un coágulo de sangre e tipo patológico formado intravascularmente

Trastornos Circulatorios

Normal blood coagulation often takes place largely extravascularly, as in the arrest of an hemorrhage, and is often referred to as hemostasis to distinguish it from the pathological process of thrombosis, or thrombogenesis

La coagulación normal de la sangre se lleva a cabo mayormente fuera de los vasos sanguíneos, como en la detención de una hemorragia y se le llama comúnmente hemostasia para distinguirla del proceso patológico de trombosis o trombo génesis

Trastornos Circulatorios

To understand the intrincacies of blood coagulation during the physiological or pathological processes of hemostasis and thrombosis, it would be appropiate to separate the components in: a) plasma proteins, b) blood platelets and c) endothelium

Para entender lo intrincado de la coagulación durante los procesos fisiológicos y patológicos de hemostasis y trombosis, puede ser apropiado separar los componentes en: a) proteínas plasmáticas, b) plaquetas y, c) endotelio

A After vascular injury, local neurohumoral factors induce a transient vasoconstriction

B Platelets adhere to exposed estracellular matrix via von Willebrand factor and become activated, that is, undergo a shape change and release secretory granules to recruit additional platelets

Trastornos Circulatorios

C Tissue factor is exposed by endothelium resulting in fibrin polymerization and cementing of platelets into a definitive secondary hemostatic plug

D Counter-regulatory mechanisms includes release of tissue type plasminogen activator that promotes fibrinolysis and thrombomodulin that impedes coagulation cascade, to restrict the hemostatic process

Trastornos Circulatorios

Factor Name

I Fibrinogen

II Prothrombin

III Tissue thromboplastin

IV Divalent calcium

V Proaccelerin

VII Proconvertin

VIII Antihemophilic factor

IX Christmas factor

X Stuart-Prower factor

XI Plasma thromboplastin antecedent

XII Hageman factor

XIII Fibrin stabilizing factor

Preallikrein (Fletcher factor)

High-molecular-weight-kininogen (Fitzgerald factor)

Endothelium modulates opposing aspects of blood coagulation: a) Normally possesses antiplatelet, anticoagulant, and fibrynolitic properties b) After injury or activation endothelium exerts procoagulant activities

Trastornos Circulatorios

The fibrinolytic system illustrating the plasminogen activators and inhibitors: a) tPA activates plasminogen most effectively when bound to fibrin meshwork b) Free plasmin in circulation is rapidly bound and neutralized by 2-plasmin inhibitor, and tPA is blockd by PAI released by endothelium stimulated by thrombin

The balance is an overall procoagulant effect

Trastornos Circulatorios

Arterial thrombus

Venous thrombus

Fate of Thrombi: Progression, extension of the primary thrombus Embolization, thrombi may disloge and travel to other sites Organization (re-canalization), invasion by connective tissue and formation of new blood vessels Dissolution, removed by fibrinolytic activity

Desarrollo de los trombos: Progresión, extensión del trombo primario Embolización, los trombos pueden desprenderse y viajar a otros sitios Organización (recanalización), invasión por tejido conectivo con formación de nuevos vasos sanguíneos Disolución, removidos por actividad fibrinolítica

Potential outcome of venous thrombosis

Organized and recanalized thrombus

Embolus is a mass carried in the bloodstream from its site of origin to a more distant site. The process is called embolism. Although most emboli originate from thrombi, there are other less common types of emboli including, tumor cell clumps, air bubbles, aggregates of bacteria, and fat or bone marrow emboli after fractures

Embolo es una masa llevada por el torrente circulatorio desde su sitio de origen hacia otras partes mas distantes. Al proceso se le llama embolismo. Aunque la mayoría de los émbolos se originan de trombos, hay otros tipos de émbolos menos comunes incluyendo, conglomerados de células tumorales, burbujas de aire, agregados de bacterias y grasa o medula ósea después de fracturas

As an embolus moves downstream, it eventually encounters a small blood vessel smaller than its diameter, provoking a partial or complete occlusion. The consequences could be ischaemia (an inadequate blood supply to an organ causing cell damage) or infarction (death of tissue “an infarct” due to insufficient blood supply).

Conforme un émbolo se mueve a favor de la corriente sanguínea, este encuentra eventualmente un vaso sanguíneo pequeño mas pequeño que el mismo, provocando una oclusión parcial o completa. Las consecuencias podrían ser isquemia (un aporte sanguíneo inadecuado a un órgano causando daño celular) o infarto (muerte del tejido “un infarto” debido a un aporte sanguíneo insuficiente).

pulmonary thromboembolism

Angiogram - Embolism Infarction Kidney

Pathology, macro and micro Embolism Infarction Kidney

Development of Coronary Atherosclerosis

Coronary Atheorsclerosis and Infarction

Coronary Thrombosis With

Infarction

myocardium infarct first day

myocardium normal

myocardium infarct first to second day

myocardium infarct with hemorrhage first to second day

myocardium infarct third to fourth day

myocardium infarct first to second week

Coronary Angioplasty

Embolic Pneumonia

Embolic Nephritis

Parasitic Emboli due to Dirofilaria immitis

Metastasis from oral cavity soft palate; Embolic Malignant Melanoma

DIC (disseminated intravascular coagulation)