10/2 Hemorrhage and Thrombosis

Question 1

What are the 5 general causes of hemorrhage?

Answer 1

1. trauma2. Tumor3. Ulcer4. Necrosis5. Depletion of hemostatic factors

Question 2

What are pinpoint hemorrhages in the skin where supposedly the platelets don’t work? can they be found elsewhere?

Answer 2

1. Petechiae2. yes, a picture shows them in intestinal mucosa

Question 3

What is the order in regards to size–smallest to largest– of hemorrhage into the skin?

Answer 3

Petechiae<Ecchymoses

Question 4

What is a localized collection of clotted blood into a space or potential space? What color is it in gross biopsy?

Answer 4

1. Hematoma2. Blackish

Question 5

What is the name for tarry black stools? what region of body is bleeding?

Answer 5

1. Melena2. upper GI bleed

Question 6

What is the name for bloody stools?

Answer 6

hematochezia

Question 7

What is occult bleeding?

Answer 7

small amount of bleeding into the stools that is only detectable by chemical tests

Question 8

What is the name for nose bleeds?

Answer 8

epitaxis

Question 9

What is the name for bleeding between normal menstrual cycles?

Answer 9

metorrhagia

Question 10

What is the name for excessive menstrual blood loss?

Answer 10

menorrhagia

Question 11

Review or memorize the following general steps towards a clot formation?

Answer 11

vessel injury–> tissue factor activates coagulation cascade–>thrombin generation—> fibrin generation–> clot

Question 12

Where are the proenzymes stored for coagulation cascade before they are activated?

Answer 12

They are circulating (many are created in liver)

Question 13

What factor is fibrin (the final product of coagulation cascade) cross linked by?

Answer 13

Factor XIII

Question 14

What is the coagulation cascade activated by?

Answer 14

Tissue factor (thromboplastin) when vessel is damaged

Question 15

What does tissue factor bind/complex to? What does this complex activate?

Answer 15

1. Factor VII and VIIa2. Factors IX and X

Question 16

What does factor Xa do?

Answer 16

Converts a small amount of prothrombin to thrombin

Question 17

What factors does thrombin activate?

Answer 17

• V to Va-
  VIII to ViIIa-
  XI to XIa

Question 18

What does XIa activate?

Answer 18

lots of thrombin

Question 19

What does thrombin do?

Answer 19

converts fibrinogen to fibrinconverts Factor XIII to XIIIa

Question 20

Does the intrinsic or extrinsic pathway deal with factor VII?

Answer 20

Extrinsic–started with tissue injury

Question 21

What test measures the intrinsic pathway? extrinsic pathway?

Answer 21

1.PTT2. Prothrombin Time

Question 22

On what factor does the intrinsic pathway and extrinsic pathway converge on?

Answer 22

X

Question 23

Where is Von willebrand factor made?

Answer 23

endothelial cells and megakaryocytes

Question 24

Where is tissue plasminogen activator synthesized?

Answer 24

endothelial cells

Question 25

Where is Facotr VIII made?

Answer 25

endothelial cells

Question 26

What are the 3 main components to regulate the coagulation cascade?

Answer 26

Protein C and S pathwayAntithrombinTissue plasminogen pathway inhibitor

Question 27

What does protein C and S do to factors V and VIII? What else does it neutralize?

Answer 27

1. Inactivates them2. Plasminogen activator inhibitor

Question 28

What does antithrombin do? What is it enhanced by?

Answer 28

1. antithrombin blocks the serine active site of thrombin and other serine proteases(factors IXa, Xa, and XIa)2. heparin

Question 29

What does TFPI down regulate?

Answer 29

the initiation of the coagulation network

Question 30

What breaks down the fibrin polymer? what does it produce?

Answer 30

PlasminProduces d-dimers

Question 31

What activates plasmin?

Answer 31

Tissue plasminogen activator tPA

Question 32

What is a blood clot within a blood vessel?

Answer 32

Thrombi

Question 33

What are the 3 reasons for why blood clots in vivo?

Answer 33

1. abnormalities of the blood vessel2. alterations of blood constituents3. aberrations of the blood flow

Question 34

What causes thrombi?

Answer 34

Abnormal blood or a hypercoaguable state-acquired-deficiency of natural coagulants

Question 35

What is lupus anticoagulant a sign of?

Answer 35

antiphospholipid antibody syndrome

Question 36

What is the most common cause of acquired thrombophilia that can be tested for in the lab>?

Answer 36

1. antiphospholipid antibody syndrome

Question 37

What are the 3 key findings of antiphopholipid antibody syndrome?>

Answer 37

1. venous and arterial thrombus2.recurrent fetal loss3. thrombocytopenia

Question 38

Does lupus anticoagulant prolong or decrease phospholipid coagulation tests?

Answer 38

Prolongs

Question 39

Does lupus anticoagulant always occur with lupus erythematosus

Answer 39

no, only 10%

Question 40

What is Factor V leiden?

Answer 40

mutation in Factor V. Unable to be cleaved by activspted

Question 41

Review the following list of things that contribute to inherited thrombophilia---

Answer 41

``` prothrombin gene muation protein C deficiency protein S Antithrombin deficiency hyperchomocystenemia Dysfibrinogenemia ```

Question 42

What are 5 clinical features of thrombophilic patent?

Answer 42

1. Family History of thrombus 2. Thrombosis at a young age 3. idiopathic thrombus 4. thrombosis after trivial provocation 5 thrombosis in an unusual site

Question 43

What type of thrombi is white, made from platelets and fibrin, and if they become occlusive lead to infarction?

Answer 43

Arterial thrombi

Question 44

What type of thrombi is red and made of cellular elements ad fibrin

Answer 44

?venous thrombi

Question 45

What are lines of zahn?

Answer 45

Attached to a wall and imply thrombus at a site of blood flow.

Question 46

What are the 4 fates of thrombus?

Answer 46

propagation embolization dissolution organization

Question 47

Under which fate of thrombus can occluded vascular flow be re-established?

Answer 47

Organizational fate