Hemostasis

What is hemostasis?

Hemostasis (hee-muh-stay-sis) is your body’s normal reaction to an injury that causes bleeding. This reaction stops bleeding and allows your body to start repairs on the injury. You need this ability to stay alive, especially with significant injuries.

When all goes well, hemostasis is a good thing. But in uncommon cases, the processes that control hemostasis can malfunction. This can cause potentially serious — or even dangerous — problems with bleeding or clotting.

How does hemostasis work?

Hemostasis combines the terms “hemo” (meaning “blood”) and “stasis” (meaning “standing still”). In this context, it’s the term for how your body stops bleeding. The process starts just seconds after an injury. It’s normal for a wound to bleed for two to seven minutes.

The hemostasis process isn’t a single one, but a collection of several processes.

Four stages of hemostasis

The steps of hemostasis include:

1. Your blood vessel tightens or constricts in the damaged area to help reduce the blood loss from that spot.
2. Platelets circulating in your blood stick to the damaged tissue to form a temporary plug (primary hemostasis). That clot works like a bottle cork, keeping blood in and debris or germs out.
3. The “coagulation cascade” sequence starts (secondary hemostasis). Coagulation factors in your blood amplify the clotting effects to stabilize the plug.
4. The platelet plug and a substance called fibrin form a solid, stable clot like bricks and mortar. During healing, normal tissue replaces this fibrin clot.

What triggers hemostasis?

An injury triggers hemostasis. Your body naturally monitors itself for injuries. Any break in your skin is a risk for germs to enter your body. Clots help reduce that risk by sealing the injury. When your body detects an injury, it reacts quickly to take control of the situation. Without normal hemostasis, even minor injuries could cause dangerous blood loss. An example of this is hemophilia, a condition where hemostasis doesn’t work properly and blood can’t clot effectively.

What potential health problems can happen with hemostasis?

Hemostasis refers to normal blood clotting in response to an injury. But your body can clot too little (hypocoagulability, in which you bleed or bruise too much in response to an injury). Or you can clot too much (hypercoagulability, in which you clot even without injury). Hypercoagulability can cause many blood clots to form spontaneously and block normal blood flow. When blood clots form inside your blood vessels, healthcare providers call it a thrombosis. If thrombosis happens repeatedly, you may have a condition called thrombophilia.

Thrombophilia (hypercoagulability or too much clotting)

Hypercoagulability is when your blood clots too much or too easily. This is dangerous because those clots can get stuck in different places in your body and cause severe, life-threatening problems. Examples of these problems include:

• Stroke, a blood clot in your brain
• Deep vein thrombosis (DVT), a blood clot in your leg or arm that can then travel to your lungs (pulmonary embolism)
• Heart attack, a blood clot in the blood vessels of your heart

Many types of cancer can cause hypercoagulability, as can some rare genetic conditions. That means you either inherit them from your parents or they happen because of a random variation in your DNA. People with these conditions have thrombophilia. A few examples of conditions like this include:

• Protein C deficiency
• Prothrombin gene variation
• Factor 5 Leiden variation

Inherited disorders that can cause thrombophilia aren’t as common as “acquired” conditions, which you usually develop later in life. Examples of acquired conditions include:

• Antiphospholipid syndrome
• Inflammatory bowel disease
• Severe reactions to infections, like sepsis
• Severe bone fractures with prolonged periods of not moving

Most medications that treat thrombophilia make it harder for your blood to clot in some way. Examples of these include:

• Antiplatelets
• Anticoagulants
• Fibrinolytic (fibrin-breaking or clot-busting) drugs

Hypocoagulability (not enough clotting)

When your blood doesn’t clot well, any injury becomes a much more dangerous event. Without proper clotting, even minor injuries can cause you to lose a lot of blood. It also means you’re at a greater risk for injuries to organs and blood vessels inside your body, which can then cause internal bleeding.

Certain types of cancer, like leukemia, can cause you to bleed too easily. That’s because they often involve a lack of platelets in your body or anti-clotting activity. Conditions that keep your blood from clotting are often genetic, too. Some examples of genetic conditions include:

• Hemophilia
• von Willebrand disease
• Inherited thrombocytopenia (low platelet count)

Treating conditions that keep your blood from clotting usually involves medications that slow down or block your body’s anti-clotting processes, boost your body’s ability to make platelets or add more of certain clotting factors to your blood. You can also receive transfusions of platelets to add more if your body needs them.

How are hemostasis problems diagnosed?

A healthcare provider — like a hematologist — can diagnose hemostasis problems based on your symptoms and blood tests that analyze the clotting-related components in your blood.

Blood tests may include:

• Complete blood count (CBC)
• Platelet count
• Blood smear
• Bleeding time
• Prothrombin time (PT)
• Activated partial thromboplastin time (aPTT)
• Fibrinogen level
• Thrombin clotting time

When should I contact a healthcare provider about problems with hemostasis?

Hypercoagulability can happen with a variety of different symptoms depending on where and when an abnormal clot develops. Examples of this include:

• Brain: Stroke symptoms, including weakness or paralysis on one or both sides of your body, slurring speech, inability to move one side of your face and headache
• Heart: Heart attack symptoms, including chest pain, shortness of breath, weakness, fast or irregular heartbeat, heart palpitations (feeling your own heartbeat) and passing out
• Lungs: Pulmonary embolism symptoms, including wheezing or sudden problems breathing, pain in your chest, coughing blood, fingertips or lips that are pale or blue-tinted and passing out
• Deep vein thrombosis (DVT) in your leg: This can often lead to pulmonary embolism — symptoms include pain in your calf or elsewhere in your leg, as well as swelling or redness
• Kidneys: Blockages in your kidney can cause blood in your urine (pee), needing to pee less often and pain in your lower back on either side of your spine

Hypocoagulability will cause you to bleed more easily. Most often, this causes the following symptoms:

• Nosebleeds that are hard to stop
• Bleeding around your gums when you brush your teeth
• Wounds that may seep or ooze blood for a long time and take much longer to heal (cuts in areas with many blood vessels, like your face, fingertips or scalp, can bleed a long time)
• Finding bruises that you can’t remember how you got or bruising much more easily and visibly (bruises are bigger and more colorful)