Activation of Hageman factor is initiated by negatively charged surfaces which may be provided by several biologic substances [20,28,35,53]. Activation of Hageman factor results in the initiation of three plasma protein systems: the kinin generation system [30,52], the fibrinolytic sequence [21,36], and the intrinsic pathway of coagulation [41]. Bradykinin generation results from the action of activated Hageman factor or its fragments on prekallikrein, generating kallikrein [23] which cleaves the active peptide bradykinin from kininogen, an alpha-glycoprotein. Bradykinin both enhances vascular permeability and produces peripheral vasodilation and, therefore, is important in the inflammatory response. Similarly, Hageman factor or its fragments activate the fibrinolytic sequence by converting the plasminogen proactivator to the plasminogen activator [24,26]. This active molecule then converts plasminogen to plasmin, the active fibrinolytic enzyme in man. The third plasma protein system initiated by the activation of Hageman factor is the intrinsic pathway of coagulation. Activated Hageman factor converts pre-plasma thromboplastin antecedent (pre-PTA) to its active form PTA (the 11th clotting factor) [41], which then activates factor IX in the coagulation sequence. Thus, the contribution of Hageman factor activation to tissue injury is not merely limited to the initiation of coagulation by activation of factor XI, but includes activation of prekallikrein to achieve bradykinin generation and activation of plasminogen proactivator in order to form plasmin. In addition, two enzymes activated in these sequences, kallikrein and plasminogen activator, also function in neutrophil chemotaxis [25,27]. Subsequent interactions may also generate biologically active products from the complement system, as well, primarily via the action of plasmin on C1, the first component of complement [42], and on C3, the third component of complement [33]. Thus, the activation of Hageman factor by immunologic or nonimmunologic events introduces coagulation and fibrinolysis, augments leukocyte chemotaxis and results in enhanced vascular permeability. Therefore, regulation and control of these biologically active products resulting from Hageman factor activation are critical to modulating the effects of tissue injury. In this section we will discuss the circulating plasma factors which appear operative in regulating the biologic activity of these pathways. We will discuss each of the Hageman factor dependent systems in sequence.