10/2 Hemorrhage and Thrombosis Flashcards
What are the 5 general causes of hemorrhage?
- trauma2. Tumor3. Ulcer4. Necrosis5. Depletion of hemostatic factors
What are pinpoint hemorrhages in the skin where supposedly the platelets don’t work? can they be found elsewhere?
- Petechiae2. yes, a picture shows them in intestinal mucosa
What is the order in regards to size–smallest to largest– of hemorrhage into the skin?
Petechiae<Ecchymoses
What is a localized collection of clotted blood into a space or potential space? What color is it in gross biopsy?
- Hematoma2. Blackish
What is the name for tarry black stools? what region of body is bleeding?
- Melena2. upper GI bleed
What is the name for bloody stools?
hematochezia
What is occult bleeding?
small amount of bleeding into the stools that is only detectable by chemical tests
What is the name for nose bleeds?
epitaxis
What is the name for bleeding between normal menstrual cycles?
metorrhagia
What is the name for excessive menstrual blood loss?
menorrhagia
Review or memorize the following general steps towards a clot formation?
vessel injury–> tissue factor activates coagulation cascade–>thrombin generation—> fibrin generation–> clot
Where are the proenzymes stored for coagulation cascade before they are activated?
They are circulating (many are created in liver)
What factor is fibrin (the final product of coagulation cascade) cross linked by?
Factor XIII
What is the coagulation cascade activated by?
Tissue factor (thromboplastin) when vessel is damaged
What does tissue factor bind/complex to? What does this complex activate?
- Factor VII and VIIa2. Factors IX and X
What does factor Xa do?
Converts a small amount of prothrombin to thrombin
What factors does thrombin activate?
- V to Va-
VIII to ViIIa-
XI to XIa
What does XIa activate?
lots of thrombin
What does thrombin do?
converts fibrinogen to fibrinconverts Factor XIII to XIIIa
Does the intrinsic or extrinsic pathway deal with factor VII?
Extrinsic–started with tissue injury
What test measures the intrinsic pathway? extrinsic pathway?
1.PTT2. Prothrombin Time
On what factor does the intrinsic pathway and extrinsic pathway converge on?
X
Where is Von willebrand factor made?
endothelial cells and megakaryocytes
Where is tissue plasminogen activator synthesized?
endothelial cells
Where is Facotr VIII made?
endothelial cells
What are the 3 main components to regulate the coagulation cascade?
Protein C and S pathwayAntithrombinTissue plasminogen pathway inhibitor
What does protein C and S do to factors V and VIII? What else does it neutralize?
- Inactivates them2. Plasminogen activator inhibitor
What does antithrombin do? What is it enhanced by?
- antithrombin blocks the serine active site of thrombin and other serine proteases(factors IXa, Xa, and XIa)2. heparin
What does TFPI down regulate?
the initiation of the coagulation network
What breaks down the fibrin polymer? what does it produce?
PlasminProduces d-dimers
What activates plasmin?
Tissue plasminogen activator tPA
What is a blood clot within a blood vessel?
Thrombi
What are the 3 reasons for why blood clots in vivo?
- abnormalities of the blood vessel2. alterations of blood constituents3. aberrations of the blood flow
What causes thrombi?
Abnormal blood or a hypercoaguable state-acquired-deficiency of natural coagulants
What is lupus anticoagulant a sign of?
antiphospholipid antibody syndrome
What is the most common cause of acquired thrombophilia that can be tested for in the lab>?
- antiphospholipid antibody syndrome
What are the 3 key findings of antiphopholipid antibody syndrome?>
- venous and arterial thrombus2.recurrent fetal loss3. thrombocytopenia
Does lupus anticoagulant prolong or decrease phospholipid coagulation tests?
Prolongs
Does lupus anticoagulant always occur with lupus erythematosus
no, only 10%
What is Factor V leiden?
mutation in Factor V. Unable to be cleaved by activspted
Review the following list of things that contribute to inherited thrombophilia—
prothrombin gene muation protein C deficiency protein S Antithrombin deficiency hyperchomocystenemia Dysfibrinogenemia
What are 5 clinical features of thrombophilic patent?
- Family History of thrombus
- Thrombosis at a young age
- idiopathic thrombus
- thrombosis after trivial provocation
5 thrombosis in an unusual site
What type of thrombi is white, made from platelets and fibrin, and if they become occlusive lead to infarction?
Arterial thrombi
What type of thrombi is red and made of cellular elements ad fibrin
?venous thrombi
What are lines of zahn?
Attached to a wall and imply thrombus at a site of blood flow.
What are the 4 fates of thrombus?
propagation embolization dissolution organization
Under which fate of thrombus can occluded vascular flow be re-established?
Organizational fate
