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Thrombosis (Types of thrombi (Mural - adherent to one side of vessel wall,…
Thrombosis
Types of thrombi
- Mural - adherent to one side of vessel wall, lumen not
-
- Occlusive - lumen totally obstructed
- Coralline - irregular, can become occlusive
- Propagating - progressive involvement of thrombus into other vessel
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- Ball - unattached spherical thrombus
- Septic - presence of infection
- Vegetations - thrombi on heart valves
Fates of thrombi:
Propagation: Thrombus enlarges along a vessel, involving more branches
- Lysis and Resolution (most favourable outcome): Thrombus undergoes lysis by fibrinolytic system (enzymatic action of plasmin) Also by therapeutic drug administration
- Calcification: Dystrophic calcification of thrombus (vein stone)
- Infection: May give rise to septicaemia, gangrene or abscesses
- Retraction, Organization, Recanalization
- Thromboembolism: Detachment of thrombus or small fragment (thromboembolus), travelling to distant location
- Infarction: If thrombus interrupts blood flow, anoxia and necrosis of tissue will result e.g. myocardial infarct (heart attack) e.g. cerebral infarct (stroke)
Aetiology of thrombosis(Virchows triad): Changes in vessel wall, Changes in blood flow and changes in blood constituents.
1)Damage to the endothelium by: Atherosclerosis, infection, toxic injury, immune mechanisms
3)Thrombotic diatheses: Thrombocythaemia (high platelets) Polycythaemia (high RBCs, WBCs) Hyperproteinaemia (high plasma proteins) Hyperlipidaemia ( high cholesterol) Hypercoagulability of blood (high clotting factors) Hyperoestrinism (highendogenous/exogenous oestrogen)
Pale (White thrombi) platelets, fibrin form in fast flowing blood and associated to atherosclerosis (damage to wall)
Dark (red) thrombi
Fibrin, red and white blood cells
From in static blood
Associated with obstruction
Mixed(Laminated) Platelets, fibrin both RBC AND WBC Laminations are Lines of Zahn, forms in slow flowing blood, associated with narrowed lumen
Clinical risk factors: Ageing , Medical history, Immobility, Hormonal, smoking and specticaemia.