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THE TECHNIQUES developed for the control of operative hemorrhage are sufficient that, save for accident, massive surgery is possible without excessive blood loss. These technical skills unfortunately are of little aid in patients who have an abnormal tendency to bleed due to a defective clotting mechanism.
While the biochemists and physiologists have greatly enriched our knowledge of blood coagulation, their findings have been applied primarily to in vitro observations. The basic scientists have proved the clotting mechanism to be more complex than had been appreciated in the past, demonstrating that several fields of scientific endeavor are involved. Among these are enzymology, physical and biochemical phenomena, thermodynamics, surface tension and the physiology and anatomy of the blood vessels.
We are told that in the absence of trauma or tissue breakdown blood within the circulation has no tendency to clot. The trigger mechanism that initiates coagulation is tissue injury either to the