5-SECONDARY HOMEOSTASIS Flashcards
1
Q
What is the process that converts soluble fibrinogen into insoluble fibrin?
A
Secondary hemostasis
2
Q
What type of process does secondary hemostasis involve?
A
Cascade-like
3
Q
What does secondary hemostasis conclude with?
A
Formation of an insoluble fibrin clot
4
Q
What does secondary hemostasis primarily depend on?
A
Coagulation factors
5
Q
Besides coagulation factors; what else does secondary hemostasis depend on?
A
Cofactors and inhibitors
6
Q
What is the final result of secondary hemostasis?
A
Stabilized fibrin clot
7
Q
What interacts on the platelet surface to produce fibrin?
A
Coagulation factors
8
Q
What factor stabilizes fibrin?
A
Factor XIII
9
Q
What is the function of factor I (Fibrinogen)?
A
Forms fibrin clot
10
Q
What is the function of factor II (Prothrombin)?
A
Precursor to thrombin
11
Q
What is the function of factor III (Tissue Factor)?
A
Initiates coagulation cascade
12
Q
What is the function of factor IV?
A
Calcium
13
Q
What is the function of factor V (Proaccelerin)?
A
Cofactor in prothrombinase complex
14
Q
What is the function of factor VII (Proconvertin)?
A
Activates factor X in extrinsic pathway
15
Q
What is the function of factor VIII (Antihemophilic Factor)?
A
Cofactor in intrinsic pathway
16
Q
What is the function of factor IX (Plasma Thromboplastin Component)?
A
Activates factor X in intrinsic pathway
17
Q
What is the function of factor X (Stuart-Prower Factor)?
A
Activates prothrombin to thrombin
18
Q
What is the function of factor XI (Plasma Thromboplastin Antecedent)?
A
Activates factor IX in intrinsic pathway
19
Q
What is the function of factor XII (Hageman Factor)?
A
Initiates contact activation pathway
20
Q
What is the function of factor XIII (Fibrin Stabilizing Factor)?
A
Cross-links fibrin
21
Q
What is the function of Prekallikrein (Fletcher Factor)?
A
Activates factor XII and kininogen
22
Q
What is the function of HMWK (Fitzgerald Factor)?
A
Cofactor in contact activation
23
Q
What is the substrate for coagulation enzymes?
A
Substance acted upon by enzyme
24
Q
What are zymogens?
A
Enzyme precursors
25
What type of enzymes are most coagulation factors?
Serine proteases
26
What do serine proteases do?
Convert zymogens into active enzymes
27
What is a cofactor in coagulation?
Aids in activation of zymogen
28
What is the role of calcium in coagulation?
Required for complex formation on phospholipid surfaces
29
What is the site of production for most coagulation factors?
Liver
30
What is the most concentrated coagulation factor?
Fibrinogen
31
What components make up Factor VIII Complex?
VIII:C (coagulant); VIII:vWF
32
What cells produce VIII:vWF?
Megakaryocytes and endothelial cells
33
Which factors are part of the Extrinsic Pathway?
III; VII
34
Which factors are part of the Intrinsic Pathway?
XII; XI; IX; VIII
35
Which factors are part of the Common Pathway?
X; V; II; I
36
Which factors are in the Fibrinogen Group?
I; V; VIII; XIII
37
What is a characteristic of the fibrinogen group factors?
Vitamin K independent but calcium dependent
38
What happens to the fibrinogen group factors during coagulation?
Completely consumed
39
Are fibrinogen group factors present in serum?
No
40
Which factors are part of the Prothrombin Group?
II; VII; IX; X; protein C; protein S
41
What is a characteristic of prothrombin group factors?
Vitamin K dependent and calcium dependent
42
How does Vitamin K affect these prothrombin group factors?
Required for carboxylation and calcium binding
43
Which factors are part of the Contact Group?
XII; XI; PK; HMWK
44
What is a characteristic of contact group factors?
Vitamin K independent and calcium independent
45
What is the role of contact group factors?
Involved in the contact phase (activation of XII)
46
What test evaluates the Intrinsic and Common Pathways?
APTT
47
Which factors does the APTT measure?
XII; XI; X; IX; VIII; V; II; I
48
What is another name for the Intrinsic Pathway?
Contact Activation Pathway
49
What test evaluates the Extrinsic Pathway?
PT
50
Which factors does the PT measure?
VII; X; V; II; I
51
What is another name for the Extrinsic Pathway?
Tissue Factor Pathway
52
What are the stages of secondary hemostasis?
Generation of thromboplastin; conversion of prothrombin to thrombin; conversion of fibrinogen to fibrin
53
Where does major site of inhibition occur?
Endothelium; platelet
54
What test measures the period required for blood to clot after removal from the body?
Coagulation or Clotting Time
55
What does coagulation or clotting time detect?
Coagulation factor deficiency
56
What is the normal value for capillary blood method of coagulation time?
2-4 minutes
57
What is the normal value for whole blood or Lee and White method of coagulation time?
7-15 minutes
58
What specimen is used for Prothrombin Time (PT)?
Platelet Poor Plasma
59
What reagents are used for Prothrombin Time (PT)?
Thromboplastin and Calcium Chloride
60
What is the normal value for Prothrombin Time (PT)?
12-14 (10-12) seconds
61
What therapy is the Prothrombin Time (PT) used to monitor?
Coumadin Therapy
62
What is the action of coumadin?
Vitamin K Antagonist
63
What compounds are included in coumadin?
Dicumarol; Indanedione; Warfarin
64
Which coumadin compound is most commonly used oral anticoagulant?
Warfarin
65
What can be used to neutralize coumadin?
Vitamin K supplement/FFP
66
What is measured in Prothrombin Time (PT)?
Clot formation in citrated plasma after addition of thromboplastin and calcium
67
Which factors does Prothrombin Time (PT) monitor?
Extrinsic and Common Pathways
68
What tissue is used in rabbit brain thromboplastin?
Rabbit brain or lung tissue
69
What is the name of most sensitive PT reagent derived from human brain thromboplastin?
Manchester Reagent
70
What is the standardized way of reporting PT?
INR – International Normalized Ratio
71
Why was the INR introduced?
To minimize differences in PT results due to different reagents
72
What INR range must be achieved for most indications?
2.0 - 3.0
73
What INR range is recommended for patients with prosthetic heart valves?
2.5 to 3.5
74
What is the target INR for pulmonary embolism treatment?
3
75
What does ISI stand for?
International Sensitivity Index
76
What is the ISI used for?
Correction factor for each lot number of reagent
77
Where is the ISI found?
On PT reagent bottle
78
Who assigns the ISI?
Manufacturers
79
What does an ISI <1.0 mean?
More sensitive thromboplastin
80
What does APTT stand for?
Activated Partial Thromboplastin Time
81
What is the normal value for APTT?
35-45 (25 – 35) seconds
82
What therapy is the APTT used to monitor?
Heparin Therapy
83
What is the action of heparin?
Anti-thrombin
84
What is used to neutralize Heparin in case of overdose?
Protamine sulfate
85
What is measured in APTT?
Clot formation in citrated plasma after addition of partial thromboplastin reagent and calcium chloride
86
Which factors does the APTT monitor?
Intrinsic and Common Pathways
87
What reagents are used in APTT?
Activator; Phospholipid; Calcium chloride reagent
88
What are examples of activators for APTT reagent?
Kaolin; ellagic acid & celite
89
What role does Phospholipid take in APTT reagent?
Substance for platelet factor 3
90
What is the full name of Stypven Time?
Russell Viper Venom Time
91
What is detected by the Stypven Time?
Factor deficiency in the common pathway
92
What venom is used in Stypven Time?
East Indian Viper (Vipera russelli)
93
Which factor is directly activated by Stypven Time venom?
Factor X
94
What is the normal value for Stypven Time?
6-10 seconds
95
What is contained in the Stypven reagent?
Platelin and CaCl2
96
What process does thrombin time measure?
Rate of thrombin-induced cleavage of fibrinogen to fibrin monomers
97
What does Thrombin Time evaluate?
Formation of thrombin
98
What is the normal value for Thrombin Time?
10 to 14 seconds or <20 seconds
99
What conditions prolong Thrombin Time?
Fibrinogen Deficiency; FDP/FSP Presence; Thrombolytic agent presence; High concentrations of immunoglobulins; Heparin Therapy
100
What are multiple roles of Thrombin (IIa)?
Promotes wound healing and tissue repair; stimulates platelet aggregation; converts Fibrinogen to fibrin; converts Plasminogen to plasmin; converts Protein C to APC
101
What enzyme is found in the venom of Bothrops atrox snake; and what is its function?
Reptilase; thrombin-like enzyme
102
What is the normal value for Reptilase Time?
10 to 15 seconds
103
What conditions prolong Reptilase Time?
dysfibrinogenemia; fibrinogen deficiency; presence of FDP/FSP; thrombolytic agent (streptokinase)
104
Which common anticoagulant does not affect Reptilase Time?
heparin therapy
105
What other names does Urea Solubility Test go by?
Duckert's Test; Factor XIII Assay
106
What deficiency is detected by Urea Solubility Test?
Factor XIII deficiency
107
What reagent is used in Urea Solubility Test?
5 M Urea
108
What substitutes can be used for the reagent in Urea Solubility Test?
1% monocloroacetic acid or 2 % acetic acid
109
What is the normal result of Urea Solubility Test?
insoluble to urea (24°C)
110
What process is detected in Prothrombin Consumption Test?
thrombogenesis capability
111
What result is found in a Prolonged PT and APTT in Factor I deficiency?
Prolonged
112
What result is found in a Prolonged PT and APTT in Factor II deficiency?
Prolonged
113
What result is found in a Prolonged PT and APTT in Factor V deficiency?
Prolonged
114
What result is found in a Prolonged PT but Normal APTT in Factor VII deficiency?
Prolonged
115
What result is found in a Normal PT and Prolonged APTT in Factor VIII deficiency?
Prolonged
116
What result is found in a Normal PT and Prolonged APTT in Factor IX deficiency?
Prolonged
117
What result is found in a Prolonged PT and APTT in Factor X deficiency?
Prolonged
118
What result is found in a Normal PT and Prolonged APTT in Factor XI deficiency?
Prolonged
119
What result is found in a Normal PT and Prolonged APTT in Factor XII deficiency?
Prolonged
120
What conditions lead to a abnormal APTT but not abnormal PT?
VIII; IX; XI; & XII defect
121
What conditions lead to a abnormal PT but not abnormal APTT?
VII defect
122
What conditions lead to a abnormal PT and APTT?
X; V; II; & I defects or medical conditions such as DIC; liver disease; vitamin K deficiency and massive transfusion
123
What is detected by performing a SUBSTITUTION TESTS/ MIXING STUDIES?
what coagulation factor is deficient in a certain patient
124
What is determined by performing a SUBSTITUTION TESTS/ MIXING STUDIES?
if etiology of prolonged PT or PTT is due to a factor deficiency or an inhibitor
125
What is the action of circulating anticoagulants?
Inactivate an activated coagulation factor or block interaction between coagulation factors and platelets
126
What does
127
What is the process that converts soluble fibrinogen into insoluble fibrin?
Secondary hemostasis
128
What type of process does secondary hemostasis involve?
Cascade-like
129
What does secondary hemostasis conclude with?
Formation of an insoluble fibrin clot
130
What does secondary hemostasis primarily depend on?
Coagulation factors
131
Besides coagulation factors; what else does secondary hemostasis depend on?
Cofactors and inhibitors
132
What is the final result of secondary hemostasis?
Stabilized fibrin clot
133
What interacts on the platelet surface to produce fibrin?
Coagulation factors
134
What factor stabilizes fibrin?
Factor XIII
135
What is the function of factor I (Fibrinogen)?
Forms fibrin clot
136
What is the function of factor II (Prothrombin)?
Precursor to thrombin
137
What is the function of factor III (Tissue Factor)?
Initiates coagulation cascade
138
What is the function of factor IV?
Calcium
139
What is the function of factor V (Proaccelerin)?
Cofactor in prothrombinase complex
140
What is the function of factor VII (Proconvertin)?
Activates factor X in extrinsic pathway
141
What is the function of factor VIII (Antihemophilic Factor)?
Cofactor in intrinsic pathway
142
What is the function of factor IX (Plasma Thromboplastin Component)?
Activates factor X in intrinsic pathway
143
What is the function of factor X (Stuart-Prower Factor)?
Activates prothrombin to thrombin
144
What is the function of factor XI (Plasma Thromboplastin Antecedent)?
Activates factor IX in intrinsic pathway
145
What is the function of factor XII (Hageman Factor)?
Initiates contact activation pathway
146
What is the function of factor XIII (Fibrin Stabilizing Factor)?
Cross-links fibrin
147
What is the function of Prekallikrein (Fletcher Factor)?
Activates factor XII and kininogen
148
What is the function of HMWK (Fitzgerald Factor)?
Cofactor in contact activation
149
Which factors are part of the Extrinsic Pathway?
III; VII
150
Which factors are part of the Intrinsic Pathway?
XII; XI; IX; VIII
151
Which factors are part of the Common Pathway?
X; V; II; I
152
Which factors are in the Fibrinogen Group?
I; V; VIII; XIII
153
Which factors are part of the Prothrombin Group?
II; VII; IX; X; protein C; protein S
154
Which factors are part of the Contact Group?
XII; XI; PK; HMWK
155
What test evaluates the Intrinsic and Common Pathways?
APTT
156
Which factors does the APTT measure?
XII; XI; X; IX; VIII; V; II; I
157
What test evaluates the Extrinsic Pathway?
PT
158
Which factors does the PT measure?
VII; X; V; II; I
159
What are the stages of secondary hemostasis?
Generation of thromboplastin; conversion of prothrombin to thrombin; conversion of fibrinogen to fibrin
160
What is the normal value for capillary blood method of coagulation time?
2-4 minutes
161
What is the normal value for whole blood or Lee and White method of coagulation time?
7-15 minutes
162
What is the normal value for Prothrombin Time (PT)?
12-14 (10-12) seconds
163
What is the normal value for APTT?
35-45 (25 – 35) seconds
164
What is the normal value for Thrombin Time?
10 to 14 seconds or <20 seconds
165
What is the normal value for Stypven Time?
6-10 seconds
166
What is the normal value for Reptilase Time?
10 to 15 seconds
167
What does the presence of circulating anticoagulants usually lead to?
prolongation of the APTT (or PT) test; which is not corrected by the addition of normal plasma
168
List examples of circulating anticoagulants.
Lupus inhibitor; Nonspecific anticoagulant; IgG; IgM and IgA which interfere with phospholipid portion of the prothrombinase complex; Xa-Va-calcium-platelet-phospholipid
169
What procedure is used for Lupus inhibitor?
Platelet neutralization procedure or Dilute Russel Viper Venom time
170
What inherited deficiency is also called Hemophilia C or Rosenthal`s Syndrome?
Factor XI deficiency
171
What are the typical symptoms of Factor XI deficiency?
mild bleeding syndrome usually due to trauma; epistaxis; hematuria and menorrhagia
172
Which reagents correct a prolonged APTT in Factor XI deficiency?
Absorbed plasma and aged serum; Fresh Whole Blood; Fresh Frozen Plasma
173
What inherited deficiency is also called Classic Hemophilia or Hemophilia A?
Factor VIII: C Deficiency
174
What mode of inheritance does Classic Hemophilia or Hemophilia A present in?
sex-linked or X-linked
175
What are the typical symptoms of Factor VIII: C Deficiency?
bleeding diathesis; bleeding may result from trauma or maybe spontaneous; hematomas; hemarthroses; epistaxis; hematuria; G.I. bleeding; intracranial hemorrhage; post-operative bleeding
176
Which reagents correct a prolonged APTT in Factor VIII: C Deficiency?
absorbed plasma but not by aged serum; Cryoprecipitate; DDAVP(1-desamino-8-d-arginine-vasopressin); Prothrombin Complex Concentrates
177
What is DDAVP(1-desamino-8-d-arginine-vasopressin)?
an analogue of ADH that maybe substituted for blood components; increases plasma Factor VIII: C by causing its release from endogenous stores; Desmopressin
178
What deficiency does Prothrombin Complex Concentrates correct?
Factor VIII: C Deficiency
179
What does Prothrombin Complex Concentrates contain?
Factors II; VII; IX and X as well as protein C and S
180
What inherited deficiency is also called Hemophilia B or Christmas Disease?
Factor IX Deficiency
181
What is the mode of inheritance for Hemophilia B or Christmas Disease?
sex-linked recessive
182
How does Hemophilia B or Christmas Disease present clinically?
generally milder than Hemophilia A
183
Which reagents correct a prolonged APTT in Factor IX Deficiency?
aged serum but not absorbed plasma; Fresh Frozen Plasma; Factor IX Concentrate
184
What disorder is associated with bruising; epistaxis; menorrhagia and hemorrhage from tooth extractions; deficiency of both Factor VIII:C and Von Willebrand Factor; and platelets that don’t aggregate with ristocetin?
Von Willebrand`s Disease
185
What is the mode of inheritance for Von Willebrand`s Disease?
autosomal trait
186
What laboratory results point to Von Willebrand`s Disease?
prolonged bleeding time; decreased Factor VIII: C and Von Willebrand Factor Activity; abnormal Ristocetin Activity
187
Which reagent corrects all the elements in the Factor VIII complex?
Cryoprecipitate
188
What is the mode of inheritance for Factor VII Deficiency?
autosomal recessive
189
What are the symptoms of Factor VII Deficiency?
mucous membrane and soft tissue hemorrhage may occur in children
190
Which reagents correct a prolonged PT in Factor VII Deficiency?
normal aged serum but not by adsorbed plasma
191
What are the symptoms of Factor X (Stuart Prower Factor) Deficiency?
bruising; soft tissue bleeding; post traumatic or postoperative bleeding
192
Which reagents correct prolonged PT and APTT in Factor X (Stuart Prower Factor) Deficiency?
serum but not by adsorbed plasma; prolonged Stypven Time and PT Conversion Time
193
Which reagents help patients with Factor X (Stuart Prower Factor) Deficiency?
Fresh Frozen Plasma; PT Complex Concentrate
194
What is another name for Factor V Deficiency?
Owren`s Disease or Labile Factor Deficiency
195
What are the symptoms of Factor V Deficiency?
hemorrhagic diathesis
196
What reagent corrects a prolonged PT and APTT in Factor V Deficiency?
adsorbed plasma
197
Which reagents help patients with Factor V Deficiency?
Fresh Frozen Plasma
198
What disorder is also known as Hypoprothrombinemia?
Factor II Deficiency
199
What are the symptoms of Factor II Deficiency?
mild bleeding tendencies
200
Which reagents corrects a prolonged PT and APTT in Factor II Deficiency?
Fresh Frozen Plasma
201
Which disorders need to be ruled out before diagnosis Factor II Deficiency?
Vitamin K deficiency; liver disease and multifactor deficiency
202
What defects can cause Factor I Deficiency?
afibrinogenemia; hypofibrinogenemia; dysfibrigenemia
203
What does Factor I Deficiency lead to?
defect in fibrin formation
204
Which condition results in a spontaneous bleeding with poor wound healing?
Factor XIII Deficiency
205
What type of disease is the liver?
the primary site of procoagulant; fibrinolytic and inhibitory syntheses
206
What lab result is affected by Vitamin K Deficiency?
prolonged PT
207
What causes Vitamin K Deficiency?
decreased dietary intake or increased destruction or absence of normal flora in intestine or if antagonistic drugs are used
