Hemostasis and thrombosis are two sides of a finely balanced system of blood cells and proteins that protects the vasculature from injury-induced hemorrhage. Prior to the development of systematic farming and ranching, with its attendant dietary changes, and against a history of physical activity, hunting, and fighting, human evolution selected for a homeostatic system that favored blood clotting over hemorrhage. However, with current sedentary lifestyles and the “advent” of the “Western diet,” hypertension, the ability to smoke two packs of cigarettes a day (something next to impossible when a smoker had to “roll their own”), and most recently, convenience foods that allow “super-sizing” dietary calories, sodium, and fats, atherosclerotic damage to the vasculature has, in many persons, turned physiologic hemostasis into pathologic thrombosis, responsible for more deaths in the Western world than any other category of disease. Based on careful descriptions of congenital bleeding and clotting disorders and biochemical fractionation of blood coagulation proteins and cells, our understanding of the molecular mechanisms of physiologic and pathologic blood coagulation is quite advanced. From such studies have come targets for new therapies that can intervene in pathologic thrombosis or help repair the blood coagulation system in states of pathologic hemorrhage.
Based on the extensive discussions of the pathophysiology of hemorrhage and thrombosis found in the 9th edition of Williams Hematology part XII, the thought leaders that contributed to this monograph have extensively updated the clinically relevant chapters to reflect one of the fastest changing fields of medicine. The book is designed for the advanced medical student, who wishes a more thorough treatment of the (typically) 3-week block of the second year of medical school devoted to hematology; for medicine and pediatric residents and hematology/oncology fellows faced with patients with bleeding and clotting disorders on a myriad of medications; and for physicians at all levels of lifelong learning, in order to remain current with anticoagulant and antiplatelet therapies.