Holiday Issue - 12 Days, 12 Factors - Coincidence?
by Donna Castellone, MS, MT (ASCP) SH • December 07, 2022

Turns out that there is a fair amount of significance to the number twelve (12). It is a symbol of cosmic order, the number of space and time- time is measured in groups of 12 hours, and there are 12 months in a year.1
It has always been a significant number in ancient cultures. It appears to have originated from the ancient dozen system which was most likely a unique numbering system in the Neolithic era. Twelve represents the 12 Hierarchies of ancient scripture, and 12 constellations of the zodiac.2 Physicists postulate there are 12 dimensions to our universe existing simultaneously along-side our own. In the Old and New Testament 12 is used 189 times.3
12 days of Christmas
The 12 days of Christmas refers to the time starting on Christmas day and ending on January 5th, which is the day before the Feast of the Epiphany. This has been celebrated since 567! The song the 12 days of Christmas was first published in 1780, but may have existed long before. The arrangement of the music as we know comes from 1909.4 The gifts listed within the "12 Days of Christmas" include a partridge, turtle doves, french hens, calling birds, golden rings, geese, swans, maids, ladies, lords, pipers and drummers. So. what do these 12 gifts mean? Is there a secret code in the song? Based on Christianity- the following 12 days interpretation is speculated as:
- A Partridge in a Pear Tree is said to represent the birth of Jesus
- Two Turtle Doves symbolize both the Old and the New Testaments.
- Three French Hens stand for faith, hope, and love.
- Four Calling Birds are the four gospels: Matthew, Mark, Luke, and John.
- Five Golden Rings represent the first five books of the Old Testament.
- Six Geese-a-Laying are the six days of creation.
- Seven Swans-a-Swimming symbolize the gifts of the Holy Spirit: Prophecy, serving, teaching, exhortation, giving, leading, and mercy.
- Eight Maids-a-Milking are the eight Beatitudes from The Sermon on the Mount
- Nine Ladies Dancing represent the fruit of the Spirit: Love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self-control.
- Ten Lords-a-Leaping are the Ten Commandments.
- Eleven Pipers Piping stand for the eleven faithful disciples.
- Twelve Drummers Drumming, finally, symbolize the twelve points of belief stated in the Apostles' Creed.4
12 and Coagulation
The number 12 is often found in the human body: there are 12 cranial nerves, 12 ribs on the average human body, and 12 systems of the human body (cardiovascular, digestive, etc.). Additionally, the weight of blood is about 1/12 of our body.5
Of course we as clotters know, there are 12 coagulation factors. The majority of factors are precursors of proteolytic enzymes called zymogens which circulate in their in active form. When the factor is activated it has an "a" added to the Roman numeral. Factor V and VIII are glycoproteins and FXIII is a transglutaminase. The factors work together in a chain of events including feedback mechanisms with the final event being the generation of thrombin.6
The following is a review of the 12 coagulation factors and their role in the coagulation cascade.
Name |
Synonym |
Role in Modern Coagulation Cascade Model |
|||
Factor I |
Fibrinogen |
|
Assists in the formation of the fibrin clot |
PT prolonged, aPTT prolonged |
|
Factor II |
Prothrombin Prethrombin |
Assists factor Xa in formation of trace thrombin in the initiation phase and assists factors VIIIa, IXa, Xa, and Va to form thrombin in the propagation phase of hemostasis |
PT prolonged, aPTT prolonged |
||
Tissue factor (formerly known as factor III) |
Tissue factor Tissue thromboplastin |
Assists factor VII and Ca2+ in the activation of factors IX and X during the initiation phase of hemostasis |
PT prolonged, aPTT prolonged |
||
Calcium (formerly known as factor IV) |
Calcium Ca2+ |
Essential to the activation of multiple clotting factors |
N/A |
||
Factor V |
Proaccelerin Labile factor, accelerator globulin (AcG) |
Assists factors VIIIa, IXa, Xa, and II in the formation of thrombin during the amplification and propagation phases of hemostasis |
PT prolonged, aPTT prolonged |
||
Factor VII |
Proconvertin Stabile factor, serum prothrombin conversion accelerator, autoprothrombin I |
Assists tissue factor and Ca2+ in the activation of factors IX and X |
PT prolonged, aPTT normal |
||
Factor VIII |
Antihemophilic factor (AHF) Antihemophilic globulin (AHG), antihemophilic factor A, platelet cofactor 1 |
Activated by trace thrombin during the initiation phase of hemostasis to amplify formation of additional thrombin |
PT normal, aPTT prolonged |
||
Factor IX |
Plasma thromboplastin component (PTC) Christmas factor, antihemophilic factor B, platelet cofactor 2 |
Assists factors Va and VIIIa in the amplification phase and factors VIIIa, Xa, Va, and II to form thrombin in the propagation phase |
PT normal, aPTT prolonged |
||
Factor X |
Stuart-Prower factor Autoprothrombin III, thrombokinase |
Assists with formation of trace thrombin in the initiation phase and acts with factors VIIIa, IXa, Va, and II to form thrombin in the propagation phase |
PT prolonged, aPTT prolonged |
||
Factor XI |
Plasma thromboplastin antecedent (PTA) Antihemophilic factor C |
Activated by thrombin produced in the extrinsic pathway to enhance production of additional thrombin inside the fibrin clot via the intrinsic pathway; this factor also participates in slowing down the process of fibrinolysis |
PT normal, aPTT prolonged |
||
Factor XII |
Hageman factor Glass factor, contact factor |
Contact activator of the kinin system (e.g., prekallikrein, and high-molecular-weight kininogen) |
PT normal, aPTT prolonged |
||
Factor XIII |
Fibrin-stabilizing factor (FSF) Laki-Lorand factor (LLF), fibrinase, plasma transglutaminase |
Activated by thrombin and assists in formation of bonds between fibrin strands to complete secondary hemostasis |
PT normal, aPTT normal |
Name |
Synonym |
Role in Modern Coagulation Cascade Model |
|||
Factor I |
Fibrinogen |
|
Assists in the formation of the fibrin clot |
PT prolonged, aPTT prolonged |
|
Factor II |
Prothrombin Prethrombin |
Assists factor Xa in formation of trace thrombin in the initiation phase and assists factors VIIIa, IXa, Xa, and Va to form thrombin in the propagation phase of hemostasis |
PT prolonged, aPTT prolonged |
||
Tissue factor (formerly known as factor III) |
Tissue factor Tissue thromboplastin |
Assists factor VII and Ca2+ in the activation of factors IX and X during the initiation phase of hemostasis |
PT prolonged, aPTT prolonged |
||
Calcium (formerly known as factor IV) |
Calcium Ca2+ |
Essential to the activation of multiple clotting factors |
N/A |
||
Factor V |
Proaccelerin Labile factor, accelerator globulin (AcG) |
Assists factors VIIIa, IXa, Xa, and II in the formation of thrombin during the amplification and propagation phases of hemostasis |
PT prolonged, aPTT prolonged |
||
Factor VII |
Proconvertin Stabile factor, serum prothrombin conversion accelerator, autoprothrombin I |
Assists tissue factor and Ca2+ in the activation of factors IX and X |
PT prolonged, aPTT normal |
||
Factor VIII |
Antihemophilic factor (AHF) Antihemophilic globulin (AHG), antihemophilic factor A, platelet cofactor 1 |
Activated by trace thrombin during the initiation phase of hemostasis to amplify formation of additional thrombin |
PT normal, aPTT prolonged |
||
Factor IX |
Plasma thromboplastin component (PTC) Christmas factor, antihemophilic factor B, platelet cofactor 2 |
Assists factors Va and VIIIa in the amplification phase and factors VIIIa, Xa, Va, and II to form thrombin in the propagation phase |
PT normal, aPTT prolonged |
||
Factor X |
Stuart-Prower factor Autoprothrombin III, thrombokinase |
Assists with formation of trace thrombin in the initiation phase and acts with factors VIIIa, IXa, Va, and II to form thrombin in the propagation phase |
PT prolonged, aPTT prolonged |
||
Factor XI |
Plasma thromboplastin antecedent (PTA) Antihemophilic factor C |
Activated by thrombin produced in the extrinsic pathway to enhance production of additional thrombin inside the fibrin clot via the intrinsic pathway; this factor also participates in slowing down the process of fibrinolysis |
PT normal, aPTT prolonged |
||
Factor XII |
Hageman factor Glass factor, contact factor |
Contact activator of the kinin system (e.g., prekallikrein, and high-molecular-weight kininogen) |
PT normal, aPTT prolonged |
||
Factor XIII |
Fibrin-stabilizing factor (FSF) Laki-Lorand factor (LLF), fibrinase, plasma transglutaminase |
Activated by thrombin and assists in formation of bonds between fibrin strands to complete secondary hemostasis |
PT normal, aPTT normal |
Adapted from https://medical-dictionary.thefreedictionary.com/coagulation+factors7
12 Interesting Factor Facts:
- In 1856 Virchow using chemical analysis found that fibrin could not exist in an isomeric liquid state, but there was a precursor state that was very different this was called
Fibrinogen8 - Prothrombin, or Factor II was discovered in the early 19th century by Andrew Buchanan when he found that fresh serum accelerated the clotting of slow clotting fluids, so there must be a clot promoter developed during clotting. This fibrin ferment or Thrombin- FIIa was studied by Alexander Schmidt.9
- It was known as early as 1882 that tissue juices greatly augmented clotting. Tissue factor or thromboplastin was extracted from dried brain in 1912 by Howell.9
- Calcium was discovered to be required in the clotting process late in the 19th century by Maurice Arthus. Pekelharing studies on prothrombin found that calcium acts in the prothrombin to thrombin step of clotting.9
- In 1943 a 20 year old patient was admitted to a hospital in Oslo with severe hemorrhagic disease present since childhood. A Dr. Owren noted the patient was female, no family history, therefore hemophilia could be ruled out. No commercial reagents existed for testing and he needed rabbit brain for thromboplastin- which was not an easy endeavor in Oslo. But he went into the country and was able to find 2 rabbits, and upon testing found a prolonged clotting time. He added barium sulfate to normal plasma which removed prothrombin, and retested, the result was still prolonged. This patient was deficient in a new factor- and so it was called Factor V.8
- In the 1920's cattle in North Dakota and Alberta Canada were dying due to fatal bleeding. The cause was due to improperly cured hay make from sweet clover. Testing showed a normal fibrinogen level but a prolonged one-stage prothrombin time. Karl Paul Link isolated the component in sweet clover and called it dicoumarol. It was used in the treatment of thrombosis. Mann and Hurn found that there was a fall in concentration of a factor that paralleled prothrombin, however this factor was present in serum, and was resistant to heat. This stable factor was called Factor VII.8
- The true nature of hemophilia, which is a sex-linked recessive disorder, was recognized in 1939 by Patek and Stetson who demonstrated that a small amount of globulin material obtained by dilution and acidification of plasma corrected the defect found in hemophilia. This was not found in serum. Factor VIII was referred to as anti-hemophilia or antihemophilic globulin factor.8
- In 1949 Pavlosky showed that mixing plasma from hemophiliacs corrected their clotting defect. The work of Aggeler in 1952 who demonstrated that a male patient who had a several bleeding diathesis had normal levels of FVIII, fibrinogen, prothrombin, FV and FVII and corrected by normal serum. This became plasma thromboplastin component- and designated as Factor IX. Further studies conducted by Biggs, Dougals, MacFarlane, and others show the inheritance was similar to classic hemophilia. It received the name CHRISTMAS DISEASE. The article was published during Christmas week and was interpreted by many people as a syndrome associated with Christmas overeating. In reality it was named after the last name of their first person with the defect!8
- Factor X or Stuart-Prower was seen in 1956. These patients had no correction of their clotting time when Russel Viper Venom corrected FVII deficient patients but not those deficient in FX.8 10. Rosenthal identified a clotting factor in a patient who had mild hemorrhagic symptoms in 1953. FACTOR XI or plasma thromboplastin antecedent. This factor was found to be involved with the process of surface activation early on in the clotting process.8
- In 1965 Ratnoff found a prolonged clotting time in a patient named Hageman who did not present with any hemorrhagic symptoms. Factor XII was involved in the process of surface activation.8
- There were a series of studies beginning in 1889 that showed fibrin was soluble in a solution of urea. In 1933 fibrin produced in the presence of calcium was more resistant and needed for fibrin stabilization. In 1960 Drucker investigated a family that had delayed wound healing. This factor fibrin stabilizing factor or FACTOR XIII is a tranglutaminase that occurs in a precursor form that is activated by thrombin in the presence of calcium.9
Conclusions:
Well, there you have the coincidences of the number 12! It is apparent during this season, in space and time, medicine and throughout time. The number is also an indicator of great understanding and wisdom an ancient number of completions that signals the end of one stage and the beginning of another. So, in this holiday season which closes one year and starts another, I wish you and your family health and happiness.
If you want to ensure good luck for the coming year, you must eat twelve grapes as the clock strikes twelve on New Year’s Eve. Each grape represents one month of the coming year!
References
- https://mysticalnumbers.com/number-12/
- https://www.learning-mind.com/solving-the-mystery-of-the-number-12/
- https://charleneryan.blogspot.com/2010/04/meaning-and-significance-of-number-12.html
- https://parade.com/1108781/kelseypelzer/12-days-of-christmas-meaning/
- https://www.sinobiological.com/research/enzymes/coagulation-factors
- https://medical-dictionary.thefreedictionary.com/coagulation+factors7
- Hougie, C., Fundamentals of Blood Coagulation in Clinical Medicine, McGraw Hill, 1963.
- Owen, C., A History of Blood Coagulation, Mayo Foundation, 2001.