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APA 2 > APA 2 - Hemostasis > Flashcards

APA 2 - Hemostasis Flashcards

1
Q

Tunica Intima is also the ________ layer. It is the lining separating flowing blood from the _______.

A

endothelial / vessel

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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

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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

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4
Q

Necessary cofactor for ADHERENCE of platelets to suvendothelial layer

A

Von Willebrand factor (vWF)

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5
Q

Activates the clotting cascade pathway when INJURY to the vessel occurs

A

Tissue Factor

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6
Q

Endothelial cells that cause VASCONSTRICTION

A

Thromboxane A2, Adenosine diphosphate (ADP)

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7
Q

Endothelial Cells that cause VASODILATION

A

Nitric oxide, Prostacyclin

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8
Q

Endothelial cell that is a coagulation INHIBITOR

A

Tissue Factor Pathway Inhibitor

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9
Q

Tunica media is considered ________ and is what?

A

subendothelial / Extremely thrombogenic and very active

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10
Q

Where is collagen and fibronectin located?

A

Tunica Media

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11
Q

Tunica __________ is the outermost or 3rd layer. Control of blood flow is influenced by the vessel’s degree of ________.

A

contraction

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12
Q

Nitric oxide influences vessel-wall vasodilation by causing ______ ______

A

muscle relaxation

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13
Q

Mediators of the Intima Layer

A

VWf, Tissue factor, prostacyclin, nitric oxide

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14
Q

Meidators of the Media layer (subendothelial)

A

collagen, fibronectin

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15
Q

Collagen is a ___________ and its function is ______ _____

A

procoagulant / tenisle strength

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16
Q

vWF is a ___________ and its function is _________

A

procoagulant / adhesion

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17
Q

Fibronectin is a _______ and its function is _________

A

procoagulant / mediates cell adhesion

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18
Q

Tissue pathway factor inhibitor is an _________ and its function is

A

anticoagulant / inhibits tissue factor

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19
Q

Nitric oxide is a _________ and smooth muscle relaxer

A

vasodilator

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20
Q

Prostacyclin causes __________ and inhibits ________ as well as promotes smooth muscle relaxation

A

vasodilation / aggregation

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21
Q

__________ are an essential component of the thromobgenic response

A

Platelets

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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

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23
Q

Platelet characteristics

A

contain mitochondira, glycogen stores, contractile proteins, calcium and enzymes, Alpha granules, dense granules

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24
Q

Alpha Granules of platelets store proteins like

A

vWF, fribrinogen, fibronectin, platelet factor 4, platelet growth factor

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25
Q

Dense granules of platelets store non-proteints like

A

serotonin, ADP, ATP, histamine, epinephrine

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26
Q

Platelet cells produce _________ which activate coagulation factors and influence recruitment of ________

A

thrombin / platelets

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27
Q

Do platelets have a nuclues, DNA or RNA?

A

NO

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28
Q

Platelets are ________ unless activated as a result of tissue trauma

A

inactive

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29
Q

Adequate hemostasis is not possible in the absence of ________ platelets

A

activated

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30
Q

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 )

A

endothelial lining / ANS , thromboxane A2, ADP

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31
Q

What are the 8 steps to formation of the primary plug (adhesion)?

A
  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
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32
Q

_________ _______ causes the platelet to undergo a confomrational change and become “activated”

A

tissue factor

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33
Q

Two additional glycoproteins extend from the platelet. What are they?

A

IIb and IIIa

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34
Q

Activated platelets show little cell feet called ________

A

pseudopdia

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35
Q

Pseudopods link activated platelets together with ______ to form a mound to “patch” injury to vessel walls.

A

fibrinogen

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36
Q

Cofactors (ZYMOGENS) are enzymes with the exception of factors ___ and ____.

A

V and VIII

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37
Q

Coagulation cofactors (ZYMOGENS) circulate in an inactive state until they are activated to assist in the process of _______

A

coagulation

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38
Q

What activates Zymogens?

A

tissue or organ damage

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39
Q

Which factors are synthesized by the liver?

A

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

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40
Q

Review slide 31

A

all the factors and function/action. Making a few cards on the ones that stand out.

41
Q

Action of fibrinogen

A

forms a clot

42
Q

Action of calcium

A

promotes clotting reactions

43
Q

action of vWF

A

mediates adhesion

44
Q

T/F The extrinsic and intrinsic pathways function independent of each other but in conjunction with platelet activity and the common coagulation pathway

A

TRUE

45
Q

The extrinsic pathway AKA _____ _______ pathway, becomes activated by the release of TISSUE FACTOR when injury occurred _______ the vessel wall (organ trauma or crushing injuries)

A

Tissue factor / outside

46
Q

Extrinsic pathway think Factor III and Factor VII

A

Factor III - tissue factor AND Factor VII - Proconvertin

47
Q

The intrinsic pathway AKA ____ _______ pathway is initiated when damage occurs to the ____ ____ themselves

A

contact activation / blood vessels

48
Q

The intrinsic pathway is initiated by _________ and high molecular weight _______

A

prekallikrein / kininogen

49
Q

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

A

Fibrin

50
Q

So once the intrinsic or extrinsic pathway has started it will lead to the ____ ______

A

common pathway

51
Q

The common pathway - formation of Xv- Prothrombinase complex

A

Factor X - stuart prowers and Factor V - Proaccelerin

52
Q

The common pathway - Activation of Factor II - Prothrombin

A

Factor IIa - Thrombin

53
Q

The common pathway - Activation of Factor I - Fibrinogen

A

Factor Ia - Fibrin

54
Q

The common pathway - Activation of Factor XIII provides ________ stabilizing

A

fibrin

55
Q

Read page 882 in nagelhout it explains the common pathway

A

pg 882

56
Q

The ______ pathway is the terminal pathway in the coagulation cascade

A

common

57
Q

Fibrin (Factor Ia) together with Fibrin stabilizing factor (Factor XIII) secure the initial clot as a stable ________ plug and bleeding stops

A

secondary

58
Q

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.

A

serum

59
Q

Conversion of ______ to _____ is an important step for both pathways

A

Prothrombin / Thrombin

60
Q

Thrombin activates what 4 factors?

A

I, V, VIII, XIII

61
Q

Thrombin recruits _____ to the injured area

A

recruits

62
Q

Adequate _________ must be present to activate sufficient fibrin to form a “stable” or “secondary” clot

A

thrombin

63
Q

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 __________.

A

anticoagulant / endothelial / inhibit / coagulation

64
Q

Most of the coagulation proteins are synthesized in the _______. Calcium, which is not a true factor comes from ______. vWF is formed in _______ ______.

A

liver / diet / endothelial cells

65
Q

Which factors are vitamin K dependent?

A

II, VII, IX, X

66
Q

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 __________.

A

endothelial / platelets / anticoagulants / coagulation

67
Q

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.

A

TF/VII and Thrombin

68
Q

AMPLIFICATION, based on the Cell Based Theory is where thrombin generation increases and activation of _____ ______ persists

A

clotting factors

69
Q

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

A

coagulation / thrombin / Fibrinogen / Fibrin

70
Q

Cell based theory explains why some deficiencies don’t cause _______.

A

bleeding

71
Q

Once the disrupted vessel is sesaled, there is no further need for the hemostatic _________. The fibrinolytic system exists to degrade __________

A

plug / fibrin

72
Q

First step in the fibrinolytic system is increased _____ _____ to site of injury. Then removal of ________ mediators from vessel which are ADP and thromboxane

A

blood flow / procoagulant

73
Q

In reference to the fibrinolytic system, ______ which first acted as a coagulant, now acts as an ________ and activateds other anticoagulant mediators

A

thrombin / coagulant

74
Q

What is thrombin’s role in the fibrinolytic system?

A
  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
Q

Antithrombin III corrals clotting factors (IX, X, XI, XII) and this influences Factor ___

A

II

76
Q

Fibrinolysis is a a process that is controlled by ______ _____

A

plasma proteins

77
Q

Clots are composed of plasminogen, plasmin, fibrin and fibrin ________ degredation products

A

degredation

78
Q

Describe plasminogen

A

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
Q

Plasmin ________ fibrin and fibrin degredation products

A

degrades

80
Q

With Fibrinolysis, waste products of the clot are removed with the circulating _______

A

blood

81
Q

Fibrinolytic mediators _______ the fibrinlysis process

A

stop

82
Q

Alpha antiplasmin and tissue plasminogen activator inhibitor (tPA inhibitor) halt fibrinolysys when the clot is _________

A

digested

83
Q

Antiplatelet medications that influence coagulation

A

NSAIDS, persantine, Thienopyridine

84
Q

Antifibrinolytics that influence coagulation

A

Amicar, Tranexamic acid

85
Q

Dietary medications that influence coagulation

A

Vitamin K and E, CoQ10, Zinc, Omega3 fatty acids

86
Q

Herbaal medications that influence coagulation

A

Garlic, ginger, ginkgo, Feverfew, fish oil, flaxseed oil, Black Cohash, Cranberry

87
Q

Bleeding time tests ________ contraction and _________ function

A

microvascular / platelet

88
Q

Platelet function provides the number of platelets in blodd but does not evaluate ________.

A

function

89
Q

Platelet count < 100,000 mm3

A

thrombocytopenia

90
Q

Platelet count <50,000

A

expect bleeding

91
Q

Platelet count <20,000

A

spontaneous bleeding

92
Q

The PT is a measure of the efficacy of ________ and common pathways while the PTT is a measure of the _______ and common pathways

A

extrinsic / intrinsic

93
Q

PT factors

A

III, VII, and I, II, V, X

94
Q

PTT factors

A

XII, XI, IX, VII and X, V, II, I, XIII

95
Q

Most common inherited coagulation disorder

A

Von Willebrand Disease (vWD)

96
Q

vWF has two main functions….

A

fascilitate platelet adhesion, behave as a plasma carrier for factor VIII

97
Q

vWF is synthesized in endothelial cells and ________

A

megakaryocytes

98
Q

Look at slide 82

A

clinical conditions associated with DIC

99
Q

Intraoperative management of patients with sickle cell disease

A

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

APA 2 (7 decks)

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