This document discusses surgical hemostasis. It begins by outlining the learning objectives, which are to understand what hemostasis is, the causes of excessive bleeding during or after surgery, and how to evaluate a patient's hemostasis before surgery. It then defines hemostasis as the arrest of blood escape through natural or artificial means. It describes the natural hemostasis process involving vasoconstriction, platelet plug formation, and blood clot formation. It lists the 12 clotting factors and the intrinsic and extrinsic clotting pathways. The document concludes by discussing causes of bleeding during or after surgery, including defects of hemostasis, and the steps of pre-operative evaluation of a patient's hemost

1. SURGICAL HEMOSTASIS
Prof. Faisal Ghani Siddiqui
MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE

2. LEARNING OUTCOMES
By the end of this lecture, the students
will learn;
• What is hemostasis and why blood doesn't
clot inside intact blood vessels
• What are different causes of excessive
bleeding during or after surgery
• How to evaluate your patient for
hemostasis before surgery?

3. HEMOSTASIS

4. Will this bleeding stop?

5. HEMOSTASIS
arrest of the escape of blood by
either;
• natural means (vessel spasm or
clot formation),or
• artificial means (compression or
ligation)

6. NATURAL HEMOSTASIS
Local vasoconstriction Formation of platelet plug Formation of blood clot

7. 12 CLOTTING FACTORS
NAME
VIII Antihaemophilic factor A
IX Antihaemophilic factor B
(Christmas factor)
X Staurt-Power factor
XI Antihaemophilic factor C
XII Hagemen factor
XIII Fibrin stabilizing factor
NAME
I Fibrinogen
II Prothrombin
III Tissue thromboplastin
IV Calcium
V Proaccelerin (Labile factor)
VII Proconvertin (Stable factor)

8. CLOTTING CASCADE
INTRINSIC PATHWAY
• All factors needed are present in the blood
• Triggered when ‘contact factors’ are exposed to collagen or basement membrane
at the site of injury
EXTRINSIC PATHWAY
• Requires tissue thromboplastin to be released from damaged cells (outside
blood)

9. Activation of
prothrombin to
thrombin
Conversion
of
fibrinogen
to fibrin

11. SO WHY DOESN'T’ THE BLOOD
CLOT INSIDE INTACT BLOOD
VESSELS?

12. NATURAL INHIBITORS OF COAGULATION
CASCADE
• Smoothness of the endothelium
• Continuous blood flow
• Prostacyclin (secreted by the platelets)
• Heparin (secreted by the mast cells)
• Antithrombin III (secreted by the liver)
• Protein C & S (natural anticoagulants)

13. CAUSES OF BLEEDING
DURING OR AFTER SURGERY

14. CAUSES OF BLEEDING
DURING OR AFTER SURGERY
• Poor control during surgery
• Defects of hemostasis

15. DEFECTS OF HEMOSTASIS
• Congenital
• Acquired

16. CONGENITAL DEFECTS OF HEMOSTASIS
• Hemophilia A (factor VIII deficiency)
• Hemophilia B (factor IX deficiency)

17. ACQUIRED DEFECTS OF
HEMOSTASIS
• Liver diseases
• Vitamin K deficiency
• Disseminated intravascular
coagulation
• Anticoagulants
• Massive blood transfusion
• Platelet disorders

18. PRE-OPERATIVE EVALUATION
OF HEMOSTASIS

19. HISTORY
• Easy bruising
• Nose bleeds
• Prolonged bleeding after
cuts
• Bleeding >3 mts. After
brushing tooth
• Prolonged/excessive
menstrual cycles
• Severe bleeding after
tooth extraction / surgery

20. HISTORY
• Liver disease, renal
failure or hypersplenism
• Family H/O hemophilia
• Current or recent use of
drugs that may interfere
with hemostasis

21. EXAMINATION –CUTANEOUS SIGNS OF LIVER DISEASE
JAUNDICE
SPIDER NEVI

22. EXAMINATION
SKIN FOR BRUISES

23. EXAMINATION
HEMARTHROSIS &
MUSCLE HEMATOMA

24. EXAMINATION
HEPATOMEGALY &
SPLENOMEGALY

25. LAB TESTS FOR
HEMOSTASIS
• Bleeding time
• Prothrombin time
• Partial thromboplastin test
• Platelet count
• Bone marrow aspiration
• Fibrinogen assay
• Fibrin degradation product