Hemorragia Y Trombosis

Universidad Autónoma de Nuevo León Facultad de Medicina Veterinaria y Zootecnia

Patología General Rafael 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 Cuando la hemorragia occurs as the result of es el resultado de una rupture or tear in the ruptura o desgarre del blood vessel the vaso sanguíneo la hemorrhage is by hemorragia es por rexis. rhexis. If there is not Si no hay defecto en el defect in the blood vaso sanguíneo y los vessel and the red glóbulos rojos blood cells merely simplemente atraviesan pass through the la estructura vascular vascular structures it esta es por diapédesis is by diapedesis

Trastornos Circulatorios

rhexis

hemorrhage

diapedesis

Microscopic image of an hemorrhage

Trastornos Circulatorios Accumulation of blood La acumulación de in the thoracic cavity, sangre en la cavidad pericardial space, torácica, espacio peritoneral space pericárdico, espacio (abdominal cavity), and peritoneal (cavidad joints are called abdominal) y hemothorax, articulaciones se hemopericardium, denomina, hemotórax, hemoperitoneum, o hemopericardio, hemarthrosis, hemoperitoneo, o respectively 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)

Trastornos Circulatorios

Horse

Subdural hematoma

Trastornos Circulatorios

Subcutaneous hematoma

Trastornos Circulatorios Petechiae refers to very Petequias se refiere a tiny hemorrhages into hemorragias muy the skin, mucous pequeñas en la piel, membranes and serosal membranas mucosas y surfaces. Their superficies serosas. Su presence indicates a presencia indica un generalized process proceso generalizado with severe endothelial con daño endothelial damage such as severo como ocurre en septicemia and viral septicemias e infections infecciones virales

Trastornos Circulatorios

Petechiae

Trastornos Circulatorios Ecchymoses are larger Equimosis son hemorrhages (greater hemorragias mas grandes than 1 cm diameter). (mayores que 1 cm de The term purpura is diámetro). El termino emloyed loosely to púrpura se emplea de mean hemorrhages manera amplia para larger than petechiae or referirse a hemorragias petechial and mas grandes que ecchymotic petequias o hemorragias hemorrhages petequiales y equimoticas generalized 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 Trombo: masa solida de coagulated blood formed sangre coagulada que se within the circulation forma dentro de la circulación Clot (blood): Blood coagulated outside the Coágulo (sangre): sangre blood vessel or after coagulada fuera de los death 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 Es difícil hacer una clara clear distinction between distinción entre un a thrombus and a blood trombo y un coágulo de clot because their sangre debido a su obvia obvious relationship relación basada en la based on blood coagulación sanguínea. coagulation. A thrombus Un trombo es is essentially a esencialmente un pathological type of coágulo de sangre e tipo blood clot formed patológico formado intravascularly intravascularmente

Trastornos Circulatorios Normal blood La coagulación normal coagulation often takes de la sangre se lleva a place largely cabo mayormente fuera extravascularly, as in the de los vasos sanguíneos, arrest of an hemorrhage, como en la detención de and is often referred to una hemorragia y se le as hemostasis to llama comúnmente distinguish it from the hemostasia para pathological process of distinguirla del proceso thrombosis, or patológico de trombosis thrombogenesis 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

Trastornos Circulatorios 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

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-weightkininogen (Fitzgerald factor)

Trastornos Circulatorios

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 α 2plasmin inhibitor, and tPA is blockd by PAI released by endothelium stimulated by thrombin The balance is an overall procoagulant effect

Arterial thrombus

Venous thrombus

Fate of Thrombi: Desarrollo de los trombos: Progression, extension of the Progresión, extensión del primary thrombus trombo primario Embolization, thrombi may Embolización, los trombos disloge and travel to other pueden desprenderse y viajar sites Organization a otros sitios (re-canalization), invasion by Organización connective tissue and (recanalización), invasión por formation of new blood tejido conectivo con vessels Dissolution, formación de nuevos vasos removed by fibrinolytic sanguíneos Disolución, activity removidos por actividad fibrinolítica

Potential outcome of venous thrombosis

Organized and recanalized thrombus

Embolus is a mass carried in Embolo es una masa llevada the bloodstream from its site por el torrente circulatorio of origin to a more distant desde su sitio de origen site. The process is called hacia otras partes mas embolism. Although most distantes. Al proceso se le emboli originate from llama embolismo. Aunque la thrombi, there are other less mayoría de los émbolos se common types of emboli originan de trombos, hay including, tumor cell clumps, otros tipos de émbolos air bubbles, aggregates of menos comunes incluyendo, bacteria, and fat or bone conglomerados de células marrow emboli after fractures 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 normal

myocardium infarct first day

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 Nephritis

Embolic Pneumonia

Metastasis from oral cavity soft palate; Embolic Malignant Melanoma

Parasitic Emboli due to Dirofilaria immitis

DIC (disseminated intravascular coagulation)