1-7. CLOT FORMATION

The soluble protein "fibrinogen" is transformed into the insoluble "fibrin" in a very complex, but rapid, process. Besides the fibrinogen, the clotting process requires prothrombin (which is converted into thrombin), vitamin K, calcium, thromboplastin, and many other factors that participate in the clotting process. When the platelets stick to the surface of the damaged vessel, calcium ion, and active thromboplastin are released from the cells and split prothrombin into two parts. One of these parts is thrombin. When thrombin is released from the prothrombin, it transforms the fibrinogen into fibrin.

a. The fibrin becomes a network of fibers or threads that trap blood cells, platelets, and plasma to form the blood clot. Calcium ions appear necessary for the operation of the sequence that results in the release of thrombin from prothrombin.

b. The synthesis of prothrombin and some of the other clotting process factors takes place in the liver. Vitamin K is needed for the liver to produce these factors. If any of these factors are in short supply or absent, the person would have a tendency to bleed. This is characteristic of a genetically transmitted disease called "hemophilia."

c. This clotting process is the same one that causes a thrombus (blood clot) to form in the blood vessels of the leg or arm. Normally, the body contains the factor "heparin" in the tissues. This substance is produced in many organs of the body, and it prevents clotting in the absence of blood vessel damage. If there is a breakdown in this system, the drug "dicumarol" can be used clinically as an anticoagulant. It blocks the stimulating effect of vitamin K on the liver. Therefore, the liver produces less prothrombin, and the blood loses its tendency to form thromboses.