We also imagine blood as a homogenous liquid. Yes, it is indeed a liquid, but it is made up of a few components – blood serum, blood cells, proteins, and a few other different substances.
There are a lot of mechanisms that support the composition and properties of the blood so that it neither clogs too much nor is it too “fluid”.
From chemistry class or simply from dissolving instant coffee or dry soup, we find that temperature is one of the factors that affect chemical reactions. Similarly, clotting and anti-clotting mechanisms are, basically, chemical reactions occurring in cascade order, catalyzed by enzyme systems. Each enzyme has its own characteristics and optimal temperature for functioning.
And speaking of temperatures, we have come to the main topic of this article. We have all heard that it is recommended some surgical interventions, if not urgent, should be postponed for autumn. So, is bleeding more intense during the warmer months of the year, and are the higher temperatures the only reason?
But let’s first see how the balance, equilibrium, is maintained in the blood system
Clotting and anti-clotting mechanisms
Hemocoagulation – blood clotting – is a protective mechanism that can occur both intravascularly (inside the vessels) and extravascularly (outside the vessels). It is a cascade reaction triggered by various factors and resulting in the formation of a blood clot.
Factors that trigger blood coagulation
Some of the most important are:
- Disruption of the integrity of the blood vessel
- Blood elements coming in contact with connective tissue components from the intracellular, extravascular space (outside the vessels)
- The very damage to tissues can lead to the discharge of factors in the bloodstream contributing to the “initiation” of the hemocoagulation process.
Hemocoagulation involves substances originating from platelets, blood plasma, tissues, and endothelial cells that span the inner surface of the vessel wall. The liver is the main site where most of the blood clotting factors are produced.
The most important part of the coagulation cascade is the activation of the prothrombin activator, which transforms prothrombin into thrombin. The latter mediates the fibrinogen transformation into fibrin.
This entire avalanche chain reaction runs for a short period of 10-15 seconds and leads to the formation of a dense fibrin mesh at the site of the injury. Consequently, blood cells and components are caught in the network.
The normal coagulation pathway represents a balance between the procoagulant pathway that is responsible for clot formation and the mechanisms that inhibit the same beyond the injury site.
The main “enemy” of fibrin is the plasminogen that breaks it down. The endothelium continually counteracts pathological clotting. It has been found that the most common cause of thrombosis is precisely the damage to the endothelium of the vessels.
So, does the higher temperature lead to more bleeding?
If we put something warm on our skin, it gradually turns red. This is because high temperature triggers vasodilation on the surface vessels – they expand accordingly and fill up with more blood.
Conversely, low temperatures have the opposite constrictive effect on blood vessels. Frozen fingers are usually pale because low temperatures cause the vessels to shrink, and so there is less blood in them.
During the summer season, when the weather is hot, the body uses thermoregulation to keep itself from overheating. One of its “tools” is precisely dilatation (expansion) of peripheral vessels, thanks to which blood from the core of the body transfers the heat out of it through these surface vessels.
Given these examples, if a surgical intervention is conducted during the summer season, there is a greater risk of bleeding in the postsurgical period. The reason is these blood vessels are harder to constrict as they are physiologically dilated.
This, however, is not a contraindication for the manipulation. The physician and the surgeon are the people who have the final say.
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