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May 1983

Surface-Mediated Defenses Against Injury

Author Affiliations

From the Department of Medicine, Case Western Reserve University School of Medicine, and University Hospitals of Cleveland. Dr Ratnoff is a Career Investigator of the American Heart Association.

Arch Dermatol. 1983;119(5):432-437. doi:10.1001/archderm.1983.01650290072021

Since the late 1950s, we have come to learn that many of the defenses of the body against injury are interdependent, and that such protective devices as clotting, fibrinolysis, inflammation, and immunologic reactions are not separable phenomena but rather are different facets of one intertwining mechanism. As a coagulationist, I shall support this view by focusing on what I know about an unusual clotting factor, Hageman factor, but I could equally well use as a starting point the complexities of platelet function, or complement, or the systems that generate biologically active polypeptides such as bradykinin.

For two centuries, investigators have marveled that blood, fluid within our vessels, clots when it is shed. About 100 years ago, John Lister,1 better known for other things, made the remarkable observation that shed blood clotted much faster in a porcelain dish than in an india-rubber tube. His very modern conclusion was that clotting

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