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Blood Clotting

Blood clotting occurs due to a complex process of coagulation that heals a bleeding blood vessel with at clot. Blood platelets and plasma protein fibrinogen are vital to the blood clotting process. People can suffer from various blood clotting disorders such as formation of blood clots due to excessive blood clotting. The PT or Prothrombin Time Blood Test is done before any surgery to check a patient's bleeding and clotting factors. PTT or Partial Thromboplastin Time Blood Test checks for a clotting disorder.


Blood clots

Blood clots can form in the heart or legs or brain or even in the lungs. These clots can travel through the blood vessels and hamper the flow of blood. This can lead to damage in the organs. Blood clot in the veins of the arm or legs can lead to DVT or Deep Venous Thrombosis. Pulmonary embolism is a condition where a blood clot travels to the lungs. Blood clots during pregnancy can lead to miscarriage or pre eclampsia.


Excessive bleeding

Bleeding disorders can occur due to severe liver disease. Hemophilia is an inherited bleeding disorder. Bleeding disorders can also be a side effect of medicines.

Intracranial Hematoma

Head injuries account for approximately 70% of traumatic accident deaths. Intracranial hematoma plays an important role in the death and disability that are associated with head injury. Intracranial hematoma is a serious and possibly a life threatening condition that often requires immediate medical attention. Many patients with intracranial hematoma harbor mass lesions that require emergency decompression. Other causes include brain tumors, liver disease, autoimmune syndromes and bleeding disorders.


The human brain floats within the skull. It is surrounded by cerebrospinal fluid which cushions the brain from the bounces of everyday movements. Sometimes it becomes impossible for the fluid to absorb the force of a sudden blow or a quick stop. Under such situations, the brain may slide forcefully against the inner wall of the skull and get bruised. An intra-cranial hematoma occurs when the blood vessel ruptures between the skull and the brain. The blood leaks between the brain and the skull. This collection of blood, hematoma, which is possibly clotted, compresses the brain tissue. Some hematomas require surgery to remove the blood clot whereas some others can be treated without surgery.


Symptoms of intracranial hematoma include headache, nausea, vomiting, lethargy and slurred speech. The pupils may appear of unequal size. Memory loss is often associated with head trauma. One may even forget that they have suffered a blow. These symptoms of intracranial hematoma may occur either immediately or several weeks or months after a blow has been received in the head.


Injury in the head is the most common cause of intracranial hematoma. Among elderly persons, even a mild head trauma is more likely to cause a hematoma in the brain. Hematoma resulting from injury in the head is classified as:


Subdural hematoma: This occurs when the blood vessels, most often the veins rupture between the brain and the dura mater which is the outermost of three membrane layers that covers the brain. The blood that leaks forms a hematoma. This compresses the brain tissue. The danger here is that if the hematoma keeps growing then there is a progressive decline in consciousness and possible death. The risk of subdural hematoma is greater in people who use aspirin or other anticoagulants regularly. Alcoholics and very young and very old people also stand to be affected by subdural hematoma. All types of subdural hematomas require medical attention as soon as the symptoms become apparent. Other wise permanent brain damage may be the result.


Epidural hematoma: This type of hematoma occurs when the blood vessel, usually the artery, ruptures between the surface of the dura mater and the skull. Morbidity and mortality from epidural hematoma is substantial unless immediate medical attention is given. The cause of epidural hematoma is most of the time road automobile accidents or any other traumatic injuries.


Intraparenchymal hematoma: When blood pools in the white matter of the brain, Intraparenchymal hematoma occurs. There may be multiple severe Intraparenchymal hematomas after a head trauma. Serious brain damage can occur, as the neurons can no longer communicate.

A physician may find it difficult to diagnose intracranial hematoma, as it may not be immediately apparent. It is better to seek medical advice after any significant blow has been received to the head and if the patient has lost consciousness or experiences symptoms such as headache, lethargy, nausea and vomiting. A CT scan or MRI scan is suggested to define the position and size of a hematoma.


After a head injury, doctors use medications such as corticosteroids and diuretics to control the edema in the brain after head injury. Often surgery is required. If the blood clot is localized and there is no excessive clotting, then perforation is made through the skull and the liquid is removed by suction. Large hematomas require opening of a section of the skull to remove blood clots.

It is essential to wear appropriate safety equipment and gadgets during sports, including helmet when riding, motorcycling, horseback riding, skating or doing any other activity that may result in injury to head. Chances of motor vehicle accidents can be minimized by wearing a seat belt.


Fibrinogen level

Fibrinogen is a blood plasma protein that is made by the liver. It is required by the body in adequate levels to stop bleeding during an injury. Too high or too little fibrinogen doesn't favor the body. Too little fibrinogen can impair the body's ability to form a stable blood clot thus resulting in bleeding disorders. High levels predispose a person to coronary and cerebral artery disease, even if other risk factors are low.


For over 10 years, extensive study on Fibrinogen levels and its impact on health are being conducted. The observations are:


  • High fibrinogen levels are on par with other known risk factors such as elevated LDL cholesterol, elevated triglycerides, obesity and diabetes.

  • There is ample data that indicates a genetic connection. Fibrinogen levels have been found to be high in persons with a family history of heart disease.

  • Exposure to cold increases fibrinogen levels by 23%. Consequently, mortality from heart attack and stroke are higher in winter compared to hot summer months.

  • High levels of fibrinogen suggest atherosclerosis. It may also worsen existing injury to artery walls.

  • Above normal fibrinogen levels increases the risks of heart attacks (two times more as compared to those with low level) and strokes.

To assess Fibrinogen levels, a blood test is required. Normal fibrinogen level is considered to be between 200 and 400 mg/L. Based on fibrinogen test results, preventive measures can be taken to keep the heart healthy. Hence Fibrinogen test is part of a general evaluation of cardiovascular disease. A test to measure fibrinogen levels is recommended for:


  • Individuals with a family history of cardiovascular problems.
  • Men and women who smoke and drink too much alcohol.
  • Men and women who lack physical activity.
  • Women who take oral contraceptives, or are post-menopausal.
  • Those with an unexplained or prolonged bleeding.
  • Anyone with an acquired bleeding disorder.
  • Excessive bruising.
  • Excessive bleeding from the gums.
  • Frequent nosebleeds.
  • Hemorrhage of the gastrointestinal tract.
  • Too many small clots forming throughout the body.

    Alternative names for the blood test are serum fibrinogen, plasma fibrinogen, factor I and Hypofibrinogenemia test. Few days before administering the fibrinogen test, the doctor may recommend stopping medications, particularly blood thinning medications. The actual test is done by taking sample of blood from the arm. The blood sample is sent to the laboratory for analysis. Normal fibrinogen levels reflect the normal clotting ability of the blood. If the fibrinogen test reflects abnormal levels, certain diagnostic tests will be required to detect the exact cause. Post treatment of the underlying cause, fibrinogen levels are most likely to return to normal levels.


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    Collection of Pages - Last revised Date: December 10, 2019