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Mercy CLS 7/8: Coagulation/Body Fluids > 3) Secondary hemostasis > Flashcards

3) Secondary hemostasis Flashcards

1
Q

Intrinsic pathway

A
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2
Q

Extrinsic pathway

A
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3
Q

Common pathway

A
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4
Q

In vitro intrinsic pathway

A
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5
Q

the end product of secondary hemostasis

A

fibrin clot

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6
Q

biochemical change resulting in activated coag factors

A

cleavage of peptide fragments

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7
Q

required for the local concentration of trace plasma coag factors

examples

A

surface mediated interactions

in vivo: collagen, phospholipid vesicles (PF3)
in vitro: glass, ellagic acid, kaolin

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8
Q

a small amount of enzyme formed initially leads to a relatively enormous quantity of enzyme

A

biological amplification system

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9
Q

end stage enzyme of hemostasis

A

thrombin

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10
Q

3 parts of fibrin clot formation

A

extrinsic pathway
intrinsic pathway
common pathway

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11
Q

the ——- pathway relies on TF, which is limited, so it requires the ———- pathway for sustained coagulation to proceed

A

extrinsic
intrinsic

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12
Q

TF is the limiting factor for…

A

extrinsic pathway

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13
Q

intrinsic and extrinsic pathways converge by their action on…

A

X

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14
Q

extrinsic pathway rapidly forms thrombin within…

A

15 sec

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15
Q

(extrinsic/intrinsic) pathway starts first

A

extrinsic

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16
Q

—— acts as the enzyme converting TF to its tenase

A

VII

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17
Q

acts as a bridge in reactions of secondary hemostasis

A

Ca

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18
Q

because the extrinsic pathway’s tenase is rapidly inactivated by ————-, the intrinsic pathway is needed

A

tissue factor pathway inhibitor (TFPI)

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19
Q

2 functions of tenase

A
  • activate X
  • activate IX
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20
Q

2 ways intrinsic pathway can be activated

A
  • tenase activates IX
  • XI activated by thrombin, which will then activate IX
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21
Q

in vitro, XIIa activates —–, but this does not seem to happen in the body

A

XI

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21
Q

IXa acts as a ————- that utilizes ——– from plts to form a complex with ———-

A

serine protease
PF3
VIII

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22
Q

Xa acts as a ———— which utilizes phospholipids to form a complex with ——, called the —————

A

serine protease
V
prothrombinase

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23
Q

factor II

A

prothrombin

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24
Q

activates prothrombin

A

prothrombinase

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25
Q

thrombin acts as a ————— to convert…

A

serine protease
fibrinogen to fibrin

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26
Q

——– is activated by thrombin to crosslink “D” portions of fibrin

A

XIII

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27
Q

stages of fibrin development

A
  1. fibrinogen—D-E-D molecules with A & B peptides attached to E
  2. fibrin monomer—thrombin cleaves off A and B
  3. fibrin polymer—D-E-D molecules spontaneously attach
  4. stabilized fibrin polymer—XIIIa crosslinks D portions
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28
Q

activated factors must stay ———– so as not to cause clotting elsewhere

how?

A

localized

  • vasoconstriction & vasodilation
  • fibrin seal, active factors contained in plug
  • inhibitory proteins bind activated factors
  • liver clearance of factors complexed with inhibitors
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29
Q

examples of positive feedback in coagulation

A
  • thrombin promotes release of plt factor Va
  • thrombin activates V and VIII
  • Xa activates VII and VIII
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30
Q

examples of negative feedback in coagulation

A
  • thrombin inactivates Va and VIIIa at higher conc
  • Xa inactivates VII
  • fibrin formation limits available thrombin
  • FDPs inhibit fibrin formation
31
Q

functions of thrombin

A
  • irreversible plt aggregation
  • fibrinogen → fibrin
  • activates V, VIII, XI, XIII
  • downregulation of coagulation when bound to thrombomodulin + protein C
32
Q

coagulation inhibitors

A
  • antithrombin III
  • heparin cofactor II
  • protein C
  • protein S
  • tissue factor pathway inhibitor (TFPI)
  • thrombomodulin
33
Q

in vivo inhibition of thrombin and Xa

A

antithrombin III

34
Q

directly inhibits thrombin

A

heparin cofactor II

35
Q

inhibits Va and VIIIa

A

protein C

36
Q

cofactor to protein C

A

protein S

37
Q

vitamin K dependent anticoags

A

protein C + protein S

38
Q

protein —- is synth in the liver
protein —- is synth by VECs

A

C
S

39
Q

inhibits VIIa-TF complex and Va

A

TFPI

40
Q

TFPI synth

A

VECs

41
Q

binds thrombin giving it anticoagulant activity (activates protein C)

A

thrombomodulin

42
Q

thrombomodulin location

A

VEC surface

43
Q

adsorb onto clot when fibrin is formed

A

plasminogen
plasminogen activators

44
Q

acts on fibrin to allow gradual dissolution

A

plasmin

45
Q

gradual, progressive process leading to reestablishment of blood flow

A

fibrinolysis + tissue repair

46
Q

FDPs

A

fibrin degradation products

47
Q

produced by fibrinolysis

A

FDPs

48
Q

FDP fate

A

cleared by the liver

49
Q

function of plasminogen

A

converted to plasmin for fibrinolysis

50
Q

activators of fibrinolysis in tissues & blood

A

tissues
- t-PA
- u-PA

blood
- plasminogen activators
- XIIa
- kallikrein

51
Q

t-PA
u-PA

A

tissue/urokinase plasminogen activator

52
Q

released by VECs and action limited to site of fibrin clot

A

t-PA

53
Q

used in fibrinolysis & in vitro hemostasis

A

XII
kallikrein

54
Q

exposed collagen with a negative charge provides a site for —— attachment, which mediates endogenous activation of fibrinolysis

A

XII

55
Q

2 functions of HMWK

A
  • prekallikrein → kallikrein
  • kallikrein activation of XII
56
Q

HMWK

A

high molecular weight kininogen

57
Q

other roles of XII, PK, and HMWK

A

kinin system
complement system

58
Q

converts single chain u-PA to double chain u-PA, increasing efficiency of plasminogen activation

A

kallikrein

59
Q

it’s hypothesized that protein C indirectly liberates…

A

t-PA from VECs, initiating fibrinolysis

60
Q

4 FDPs

A

X
Y
D
E

61
Q

pathologic action of plasmin

A

degradation of fibrinogen, V and VIII

62
Q

nonspecific test for FDPs

A

immunoassay

63
Q

fragment X

A

D-E-D without small peptides from carboxyl end of alpha chains

fibrinogen degradation

64
Q

fragment Y

A

D-E

65
Q

specific FDP indicating degradation of fibrin
indicates…

A

D-dimer

pathologic clotting occurred

66
Q

FDP detected on automated analyzer

A

D-dimer

67
Q

inhibitors of fibrinolysis

A
  • plasminogen activator inhibitors (PAI-1/2)
  • 𝛼2 antiplasmin
  • 𝛼2 macroglobulin
  • thrombin activated fibrinolysis inhibitor (TAFI)
68
Q

inhibit t-PA and u-PA

A

PAI-1/2

69
Q

inhibits free plasmin, not bound to fibrin

A

𝛼2 antiplasmin

70
Q

2nd line plasmin inhibitor (backup)

A

𝛼2 macroglobulin

71
Q

removes binding site of plasminogen from fibrin
activated by thrombin

A

TAFI

72
Q

PTT: ——– pathway
PT: ——— pathway

A

intrinsic
extrinsic

73
Q

lab tests are not physiological in that excess ———— are added in both PT and PTT (not a limiting factor)

A

phospholipid

74
Q

only PT is abnormal

A

problem with extrinsic system

75
Q

only PTT is abnormal

A

problem with intrinsic system

76
Q

PT and PTT are both abnormal

A

problem with common pathway
OR
multiple factor problems (liver disease, DIC)

Mercy CLS 7/8: Coagulation/Body Fluids (9 decks)

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