Hemorragia y Trombosis

Universidad Autónoma de Nuevo León
Facultad de Medicina Veterinaria y

Zootecnia
Patología General
Rafael Ramírez Romero
Trastornos Circulatorios
Hemorrhage, the Hemorragia, la salida de

escape of blood from sangre del sistema
the vascular system, vascular, se debe
is commonly due to comúnmente a trauma.
trauma. Hemorrhage La hemorragia puede
may be external or ser externa o interna y
internal and in either en cualquier caso puede
case may deprive the privar de sangre al
animal of blood animal (exanguinaciòn)
(exsanguination)
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
rhexis
hemorrhage
diapedesis
Microscopic image of an hemorrhage
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
Hemothorax sheep and

Hemopericardium dog
When blood escapes Cuando la sangre

into tissue (rather than escapa hacia los
through broken tejidos (mas que a
surfaces), it través de superficies
accumulates as a rotas), se acumula
blood-filled space como un espacio lleno
called hematoma de sangre y se llama
(hematocyst) hematoma
(hematoquiste)
Trastornos Circulatorios Horse
Subdural hematoma
Subcutaneous hematoma
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
Petechiae
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
Ecchymoses
Pig, purpura associated to

hemorrhagic
dermatitis/nephritic
syndrome
Sheep, adult
Paintbrush
hemorrhages
Sufusiones
Suffusions
Horse,
Hemomelasma ilei
hemorrhagic lesions
probably associated
to parasites
Guanaco, newborn
Hyphema
Hemoptisis and Epistaxis

Gastric ulcer in pigs

provoking melena
Melena in a puppy due to
Ancylostoma caninum
Causes of hemorrhage: Causas de hemorragia:

Trauma Trauma
Vascular lesions Lesiones vasculares
Toxins Toxinas
Coagulation disorders Desórdenes de la
Allergies Coagulación
Agonal Alergias
Agónicas
Horse, fractured rib and

traumatic hemorrhage
Horse, aneurysm and
thrombosis in mesenteric
artery due to Strongylus
vulgaris, also, aneurism in
aorta due to abnormal
migration of Spirocerca lupi
Hemorrhages
Vit. K deficiency in cattle
feeding lush sweet clover
(containing dicumarol a
compound related to
warfarin)
Cow, heart; agonal hemorrhages

Pig, lung; blood bronchoaspiration
during euthanasia
Thrombus: Solid mass of Trombo: masa solida de

coagulated blood formed sangre coagulada que se
within the circulation forma dentro de la
Clot (blood): Blood circulación
coagulated outside the Coágulo (sangre): sangre
blood vessel or after coagulada fuera de los
death vasos sanguíneos o
después de la muerte
Thrombosis (antemortem coagulated

blood) versus chicken fat clots (post
mortem coagulated blood)
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
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
To understand the Para entender lo
intrincacies of blood intrincado de la
coagulation during the coagulación durante los
physiological or procesos fisiológicos y
pathological processes patológicos de
of hemostasis and hemostasis y trombosis,
thrombosis, it would be puede ser apropiado
appropiate to separate separar los componentes
the components in: a) en: a) proteínas
plasma proteins, b) plasmáticas, b)
blood platelets and c) plaquetas y, c) endotelio
endothelium
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
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-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
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 2-
plasmin 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 Conforme un émbolo se
downstream, it eventually mueve a favor de la corriente
encounters a small blood sanguínea, este encuentra
vessel smaller than its eventualmente un vaso
diameter, provoking a sanguíneo pequeño mas
partial or complete pequeño que el mismo,
occlusion. The provocando una oclusión
consequences could be parcial o completa. Las
ischaemia (an inadequate consecuencias podrían ser
blood supply to an organ isquemia (un aporte sanguíneo
causing cell damage) or inadecuado a un órgano
infarction (death of tissue causando daño celular) o
“an infarct” due to infarto (muerte del tejido “un
insufficient blood supply). 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)

Hemorragia y Trombosis

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Hemorragia y Trombosis

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Universidad Autónoma de Nuevo León

Facultad de Medicina Veterinaria y

Hemorrhage, the Hemorragia, la salida de

Hemothorax sheep and

When blood escapes Cuando la sangre

Petechiae refers to very Petequias se refiere a

Pig, purpura associated to

Hemoptisis and Epistaxis

Gastric ulcer in pigs

Causes of hemorrhage: Causas de hemorragia:

Horse, fractured rib and

Cow, heart; agonal hemorrhages

Thrombus: Solid mass of Trombo: masa solida de

Thrombosis (antemortem coagulated

It is difficult to make a Es difícil hacer una clara

Endothelium modulates opposing aspects of blood coagulation:

The fibrinolytic system illustrating the plasminogen activators and inhibitors:

myocardium infarct with

Parasitic Emboli due

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