APA 2 - Hemostasis Flashcards
1
Q
Tunica Intima is also the ________ layer. It is the lining separating flowing blood from the _______.
A
endothelial / vessel
2
Q
Endothelial cells synthesize and secrete procoagulants, anticoagulants and fibrinolytics. What are these (7)
A
vWF, tissue factor, nitric oxide, prostacyclin, thromboxane A2, ADP, Tissue Factor Pathway Inhibitor
3
Q
The tunica intima forms a barrier separating FLUID CONTENTS within the blood vessel from the highly THROMBOGENIC material that lies in the _____ _____
A
tunica media
4
Q
Necessary cofactor for ADHERENCE of platelets to suvendothelial layer
A
Von Willebrand factor (vWF)
5
Q
Activates the clotting cascade pathway when INJURY to the vessel occurs
A
Tissue Factor
6
Q
Endothelial cells that cause VASCONSTRICTION
A
Thromboxane A2, Adenosine diphosphate (ADP)
7
Q
Endothelial Cells that cause VASODILATION
A
Nitric oxide, Prostacyclin
8
Q
Endothelial cell that is a coagulation INHIBITOR
A
Tissue Factor Pathway Inhibitor
9
Q
Tunica media is considered ________ and is what?
A
subendothelial / Extremely thrombogenic and very active
10
Q
Where is collagen and fibronectin located?
A
Tunica Media
11
Q
Tunica __________ is the outermost or 3rd layer. Control of blood flow is influenced by the vessel’s degree of ________.
A
contraction
12
Q
Nitric oxide influences vessel-wall vasodilation by causing ______ ______
A
muscle relaxation
13
Q
Mediators of the Intima Layer
A
VWf, Tissue factor, prostacyclin, nitric oxide
14
Q
Meidators of the Media layer (subendothelial)
A
collagen, fibronectin
15
Q
Collagen is a ___________ and its function is ______ _____
A
procoagulant / tenisle strength
16
Q
vWF is a ___________ and its function is _________
A
procoagulant / adhesion
17
Q
Fibronectin is a _______ and its function is _________
A
procoagulant / mediates cell adhesion
18
Q
Tissue pathway factor inhibitor is an _________ and its function is
A
anticoagulant / inhibits tissue factor
19
Q
Nitric oxide is a _________ and smooth muscle relaxer
A
vasodilator
20
Q
Prostacyclin causes __________ and inhibits ________ as well as promotes smooth muscle relaxation
A
vasodilation / aggregation
21
Q
__________ are an essential component of the thromobgenic response
A
Platelets
22
Q
Platelets are formed in the _____ ____. What is the concentration, survival and daily platelet use?
A
bone marrow / Concentration: 150,000 - 300,000 Survivial: 8-12 days Daily use: 7.1 x 10^3
23
Q
Platelet characteristics
A
contain mitochondira, glycogen stores, contractile proteins, calcium and enzymes, Alpha granules, dense granules
24
Q
Alpha Granules of platelets store proteins like
A
vWF, fribrinogen, fibronectin, platelet factor 4, platelet growth factor
25
Dense granules of platelets store non-proteints like
serotonin, ADP, ATP, histamine, epinephrine
26
Platelet cells produce _________ which activate coagulation factors and influence recruitment of ________
thrombin / platelets
27
Do platelets have a nuclues, DNA or RNA?
NO
28
Platelets are ________ unless activated as a result of tissue trauma
inactive
29
Adequate hemostasis is not possible in the absence of ________ platelets
activated
30
Clot formation happends when there is a disruption of _______ _______. Vessel wall contraction happens immediately due to _______ reflex, ____________ and ________. Then you have formation of the primary plug which involves (ADHESION, ACTIVATION, AGGREGATION )
endothelial lining / ANS , thromboxane A2, ADP
31
What are the 8 steps to formation of the primary plug (adhesion)?
1. vWF mobilizes from the endothelial cells and emerges from the endothelial lining. 2. Glycoprotein Ib (GpIB) receptors emerge from the surface of the platelet. 3. GpIb attaches to vWF and attracts additional platelets to the endothelial lining. 4. vWF makes platelets "sticky" and allows them to adhere to site of injury 5. Tissue factor causes the platelet to undergo a conformational change and become "activated", then IIb and IIIa extend from the platelet 6. The GpIIb-IIIa receptor complex links activated platelets together (aggregation) to form a primary platelet plug 7. The platelets mound together to seal and heal the site of injury within the blood vessel. 8. As platelets undergo this "activation" process they also release alpha and dense granules, contractile granules, thrombin, and procoagulant mediators in the blood
32
_________ _______ causes the platelet to undergo a confomrational change and become "activated"
tissue factor
33
Two additional glycoproteins extend from the platelet. What are they?
IIb and IIIa
34
Activated platelets show little cell feet called ________
pseudopdia
35
Pseudopods link activated platelets together with ______ to form a mound to "patch" injury to vessel walls.
fibrinogen
36
Cofactors (ZYMOGENS) are enzymes with the exception of factors ___ and ____.
V and VIII
37
Coagulation cofactors (ZYMOGENS) circulate in an inactive state until they are activated to assist in the process of _______
coagulation
38
What activates Zymogens?
tissue or organ damage
39
Which factors are synthesized by the liver?
Fibrinogen (I), Prothrombin (II), Proaccelerin (V), Proconvertin (VII), Antihemophiliac (VIII), Christmas (IX), Stuart Prower (X), Hageman (XII), Fibrin Stabilizing (XIII). So factors 1, 2, 5, 7, 8, 9, 10, 11, 12, 13
40
Review slide 31
all the factors and function/action. Making a few cards on the ones that stand out.
41
Action of fibrinogen
forms a clot
42
Action of calcium
promotes clotting reactions
43
action of vWF
mediates adhesion
44
T/F The extrinsic and intrinsic pathways function independent of each other but in conjunction with platelet activity and the common coagulation pathway
TRUE
45
The extrinsic pathway AKA _____ _______ pathway, becomes activated by the release of TISSUE FACTOR when injury occurred _______ the vessel wall (organ trauma or crushing injuries)
Tissue factor / outside
46
Extrinsic pathway think Factor III and Factor VII
Factor III - tissue factor AND Factor VII - Proconvertin
47
The intrinsic pathway AKA ____ _______ pathway is initiated when damage occurs to the ____ ____ themselves
contact activation / blood vessels
48
The intrinsic pathway is initiated by _________ and high molecular weight _______
prekallikrein / kininogen
49
In the intrinsic pathway it involves Factors 12, 11, 9 and 8 with the end result of generation of ________ from the activation of PROTHROMBIN and THROMBIN
Fibrin
50
So once the intrinsic or extrinsic pathway has started it will lead to the ____ ______
common pathway
51
The common pathway - formation of Xv- Prothrombinase complex
Factor X - stuart prowers and Factor V - Proaccelerin
52
The common pathway - Activation of Factor II - Prothrombin
Factor IIa - Thrombin
53
The common pathway - Activation of Factor I - Fibrinogen
Factor Ia - Fibrin
54
The common pathway - Activation of Factor XIII provides ________ stabilizing
fibrin
55
Read page 882 in nagelhout it explains the common pathway
pg 882
56
The ______ pathway is the terminal pathway in the coagulation cascade
common
57
Fibrin (Factor Ia) together with Fibrin stabilizing factor (Factor XIII) secure the initial clot as a stable ________ plug and bleeding stops
secondary
58
Once the secondary plug is formed, it retracts, eliminating its ______. As it retracts it weaves the edges of the vessel together, healing thes site of injury.
serum
59
Conversion of ______ to _____ is an important step for both pathways
Prothrombin / Thrombin
60
Thrombin activates what 4 factors?
I, V, VIII, XIII
61
Thrombin recruits _____ to the injured area
recruits
62
Adequate _________ must be present to activate sufficient fibrin to form a "stable" or "secondary" clot
thrombin
63
Thrombin also acts as an _________. It prevents runaway clot formation by releasing tissue plasminogen activator (tPA) from __________ cells. It stimulates Protein C and Protein S to ______ clot formation. It forms a relationship with ANTITHROMBIN III to interfere with __________.
anticoagulant / endothelial / inhibit / coagulation
64
Most of the coagulation proteins are synthesized in the _______. Calcium, which is not a true factor comes from ______. vWF is formed in _______ ______.
liver / diet / endothelial cells
65
Which factors are vitamin K dependent?
II, VII, IX, X
66
Cell Based theory: The INITIATION phase is triggered by injury to the __________ surface. When injury occurs, Tissue Factor is EXPOSED at the site of injury. In its presence, the endothelial surface of the blood vessel changes, becoming acidic and making its phospholipid surface less repellent to _________. Tissue Factor down-regulates __________ that reside in the subendothelial layer in an effort to promote __________.
endothelial / platelets / anticoagulants / coagulation
67
In cell based theory, _____ complex activate X(common) and IX (intrinsic). Factor X forms a complex with Factor V, and together these two generate a small amount of ________ for clot formation.
TF/VII and Thrombin
68
AMPLIFICATION, based on the Cell Based Theory is where thrombin generation increases and activation of _____ ______ persists
clotting factors
69
PROPOGATION, based on the Cell Based Theory basically means that all factors influencing each other promoting _________. Finally, activated prothrombin results in a large burst of ________. This promotes _____ and _____ creating secondary plug
coagulation / thrombin / Fibrinogen / Fibrin
70
Cell based theory explains why some deficiencies don't cause _______.
bleeding
71
Once the disrupted vessel is sesaled, there is no further need for the hemostatic _________. The fibrinolytic system exists to degrade __________
plug / fibrin
72
First step in the fibrinolytic system is increased _____ _____ to site of injury. Then removal of ________ mediators from vessel which are ADP and thromboxane
blood flow / procoagulant
73
In reference to the fibrinolytic system, ______ which first acted as a coagulant, now acts as an ________ and activateds other anticoagulant mediators
thrombin / coagulant
74
What is thrombin's role in the fibrinolytic system?
1. Prevent "runaway" clot formation by release of tPA from endothelial cells. 2) stimulates protein C and Protein S to inhibit clot formation (factors III, V, VIII) 3) Antithrombin III interferes with coagulation by remobing clotting factors from the clotting cascade (XII, XI, X, XI)
75
Antithrombin III corrals clotting factors (IX, X, XI, XII) and this influences Factor ___
II
76
Fibrinolysis is a a process that is controlled by ______ _____
plasma proteins
77
Clots are composed of plasminogen, plasmin, fibrin and fibrin ________ degredation products
degredation
78
Describe plasminogen
It's an enzyme that is synthesized in the liver and stored in its inactive form. It incorporates itself into forming clot. In the presence of tPA and urokinase, is activated to PLASMIN
79
Plasmin ________ fibrin and fibrin degredation products
degrades
80
With Fibrinolysis, waste products of the clot are removed with the circulating _______
blood
81
Fibrinolytic mediators _______ the fibrinlysis process
stop
82
Alpha antiplasmin and tissue plasminogen activator inhibitor (tPA inhibitor) halt fibrinolysys when the clot is _________
digested
83
Antiplatelet medications that influence coagulation
NSAIDS, persantine, Thienopyridine
84
Antifibrinolytics that influence coagulation
Amicar, Tranexamic acid
85
Dietary medications that influence coagulation
Vitamin K and E, CoQ10, Zinc, Omega3 fatty acids
86
Herbaal medications that influence coagulation
Garlic, ginger, ginkgo, Feverfew, fish oil, flaxseed oil, Black Cohash, Cranberry
87
Bleeding time tests ________ contraction and _________ function
microvascular / platelet
88
Platelet function provides the number of platelets in blodd but does not evaluate ________.
function
89
Platelet count < 100,000 mm3
thrombocytopenia
90
Platelet count <50,000
expect bleeding
91
Platelet count <20,000
spontaneous bleeding
92
The PT is a measure of the efficacy of ________ and common pathways while the PTT is a measure of the _______ and common pathways
extrinsic / intrinsic
93
PT factors
III, VII, and I, II, V, X
94
PTT factors
XII, XI, IX, VII and X, V, II, I, XIII
95
Most common inherited coagulation disorder
Von Willebrand Disease (vWD)
96
vWF has two main functions….
fascilitate platelet adhesion, behave as a plasma carrier for factor VIII
97
vWF is synthesized in endothelial cells and ________
megakaryocytes
98
Look at slide 82
clinical conditions associated with DIC
99
Intraoperative management of patients with sickle cell disease
Standard monitors, hydration 1.5 times maintenance, at least 50% fio2, maintain normocapnea, spo2 >95% at all times, avoid increasing the Hgb greater than 11, maintain normothermia
