FIGURE 3.

The coagulation cascade activated following pulmonary vascular endothelial cell injury. The pulmonary vascular hypoxic and inflammatory scenario leads to the following events: 1) endothelial cell injury and upregulates TF expression on monocytes; 2) the injuried endothelial cells promote platelets to release P-selectin, which further increases TF production; 3) the endothelial cells per se release P-selectin, which adheres to platelets and leukocytes, facilitating their deposition onto the endothelia; 4) the increased production of TF enhances thrombin production, which promotes conversion of fibrinogen to fibrin; 5) the deposited leukocytes and platelets are entangled with fibrin, leading to in situ pulmonary thrombosis. TF, tissue factor; WPb, Weibel-Palade bodies; PSGL-1, P-selectin glycoprotein ligand 1.