MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY
DEPARTMENT OF PATHOLOGY
GENERAL PATHOLGY ASSIGNMENT
Name: MUGANZI JONATHAN
Reg no:2021/MBR/023
Qn;
Discuss embolism, thrombosis and infarction
Thrombosis is the pathologic formation of an intravascular clot called thrombus.
It can occur in an artery or a vein but most commonly in the deep veins of the leg below the
knee. Thrombus can be confused with a postmortem clot, however, to distinguish the two lines of
Zahn (alternating layers of platelets/fibrin and RBCs) and attachment to the vessel wall are seen
with thrombosis.
There are three major risk factors for thrombosis and these make up the Virchow triad. These
are;
i) Disruption in blood flow; Normal blood flow is continuous and laminar, keeps the platelets
and clotting factors dispersed and inactivated therefore when there is stasis and turbulence there
is increased risk of thrombosis. This can be seen in immobilized patients where there is increased
risk of deep vein thrombosis and in the case of aneurysms.
ii) Endothelial cell damage; Endothelial cells protect the body against thrombosis by several
mechanisms including blockage of exposure to subendothelial collagen and underlying tissue
factor, production of prostacyclin and NO which facilitate vasodilation and inhibit platelet
aggregation, secretion of heparin-like molecules that inactivate thrombin and coagulation factors,
secretion of tissue plasminogen activator(tPA) which converts plasminogen to plasmin that
cleaves fibrin and serum fibrinogen, destroys coagulation factors and blocks platelet aggregation.
Endothelial cells also secrete thrombomodulin which redirects thrombin to activate protein C that
inactivates factors V and VIII. When the endothelium is damaged due one or more of
atherosclerosis, vasculitis and high levels of homocysteine, all the above mechanisms are
disrupted and thrombosis risk increases.
iii)Hypercoagulable state; This results from excessive procoagulant proteins or anticoagulant
proteins and may be acquired or inherited. The common abnormalities that result in a
hypercoagulable state include protein C and S deficiency (autosomal dominant) that decreases
the negative feedback on the coagulation cascade due to reduced inactivation of factors V and
VIII. A mutated form of factor V called factor V Leiden that lacks a cleavage site for
deactivation by protein C and S is another abnormality that leads to hypercoagulable state and is
the most common hereditary disorder leading to the same. Hypercoagulable state is also
observed in a hereditary disorder involving a point mutation in prothrombin called prothrombin
20210A causes increased gene expression leading to elevated levels of prothrombin and as a
result increased thrombin leading to thrombus formation. ATIII deficiency and oral
contraceptives are other factors associated with hypercoagulable state.
Embolism is the formation of an intravascular mass that travels and occludes
downstream vessels.
There are different forms of embolus that can form and these include;
i) Thromboembolism which is due to a thrombus that dislodges and is the commonest type of
embolus. It can lead to pulmonary embolism and systemic embolism.
ii) Atherosclerotic embolus which is due to an atherosclerotic plaque that dislodges and is
characterized presence of cholesterol clefts in the embolus.
iii) Fat embolus which is associated with long bone fractures and soft tissue trauma.It develops
while fracture is still present or shortly after repair and is characterized by dyspnea as fat often
with bone elements is seen in the pulmonary vessels as well as petechiae on the skin overlying
the chest.
iv) Gas embolus which is seen classically in decompression sickness as seen with deep sea
divers. Often presents with joint and muscle pain and respiratory symptoms.
v) Amniotic fluid embolus which is seen when a amniotic fluid enters maternal circulation
during labour or delivery. It presents with shortness of breath, neurological symptoms and DIC
( due to the thrombogenic nature of amniotic fluid). Upon examination of the embolus, squamous
cells and keratin debris from fetal skin are observed.
Infarction is the necrosis of tissue in an area of the body due to inadequate blood
flow. It occurs when the blood flow to a particular organ or tissue is significantly reduced
leading to oxygen and nutrient deprivation. The most common cause of infarct is the formation
of blood clot or plaque that obstructs the blood vessels supplying the affected area.
Infarcts can be classified as red infarcts or white infarcts. Red infarcts are those that affect veins
that drain loosely packed or soft tissue such as lungs and gut and white infarcts are those that
involve occlusions in arterial blood supply to organs especially those that have tough tissue like
kidneys. Tissue area with an infarct are usually wedge shaped and the tip of the wedge is usually
the site of occlusion.
