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The essential step in blood coagulation is the change of a soluble protein-like substance, fibrinogen, to an insoluble gel called fibrin. This gel is normally rapidly formed when blood is extravasated; and under certain circumstances it may be formed intravascularly. The clotting of extravasated blood is the most important defense against undue hemorrhage. If there is a high grade defect of coagulation the patient will exhibit a bleeding tendency. The nature of such defects in the mechanism of coagulation is, therefore, a subject of intense clinical interest.
The theories of blood coagulation are notoriously complicated and unsatisfactory. There is, however,
PROTHROMBIN DEFICIENCY IN RELATION TO THE BLEEDING TENDENCY. Ann Intern Med. 1938;11:2284–2287. doi: 10.7326/0003-4819-11-12-2284
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Published: Ann Intern Med. 1938;11(12):2284-2287.
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