Hemostasis and Homeostasis

IV. General Conclusions and Summary

1. Normal hemostasis depends on the combined participation of 3 sorts of hemostatic factors: vascular (including its participation in local hemodynamics), platelet and blood clotting factors, the level of which when it can be assessed largely exceeds the requirements of the organism.

2. Disordered hemostasis usually results from combined moderate deficiencies of at least 2 of these factors, i.e. from an “immediate” multi-causation.

3. The mechanisms of homeostasis keeping hemostatic factors production at a suitable level are still unknown.

4. Inversely we have a fairly good knowledge of the mechanisms neutralizing or removing from the blood stream activated blood clotting factors and hemostatic compounds released by platelets.

5. When the latter mechanisms are defective and when concomitantly, blood clotting factors and platelets are sufficiently activated and/or endothelium is widely damaged, then disseminated intravascular coagulation occurs, which may lead to deficiencies of at least 2 hemostatic factors, and hence to a more or less severe bleeding tendency.

6. Thus, just as such acute or subacute hemorrhagic syndromes complicating consumption coagulopathies are based upon an “immediate” multi-causation consisting of several defective hemostatic factors, they depend on a “remote” multi-causation with respect to the origin of these joint deficiencies.

7. Between both of these multi-causations, immediate and remote, there is a single pathway : an important, continuous and sufficiently rapid thrombin formation.

8. This explains why the best treatment of acute and subacute hemorrhagic disorders complicating disseminated intravascular coagulation is the administration of heparin.

Spaet’s and our own views are only a beginning. Most of the problems concerning relations between hemostasis and homeostasis are still unsolved, for instance nature and origin of the vascular factor impeding the arrest of bleeding in idiopathic thrombocytopenic purpura, the pathogenesis of several chronic hemorrhagic conditions associated with disseminated vascular coagulation, the influence of the nervous system, catamenia, pregnancy, etc. on various hemorrhagic syndromes, etc., to say nothing of the effects of muscular exercise on von Willebrand’s disease. They deserve systematically conducted research work.

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