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Haematology + Immunology > Bleeding And Thrombosis > Flashcards

Bleeding And Thrombosis Flashcards

1
Q

What is involved in clot formation

A

Platelets,
vWF,
Coagulation factors

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2
Q

Why is a clot confined to site of injury?

A

Natural anticoagulants

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3
Q

What leads to the break-down of the clot

A

Fibrinolytic system

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4
Q

What happens when resting platelets and coagulation factors come across an abnormal surface and physiological activator

A

They are activated

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5
Q

What is the process of platelet adhesion in vessel damage

A

Abnormal surface is recognised

When tissue is damaged tissue factor is released allowing a localised appropriate clot formation

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6
Q

What are the platelet surface molecules?

A

Platelet glycoproteins for binding for key ligands
Sites for vWF, collagen, fibrinogen

Cell surface receptors for ADP, epinephrine and thrombin

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7
Q

What do alpha granules and dense granules release from the platelet

A

Alpha granule- vWF and thrombin

Dense granule- ADP/ATP, calcium serotonin

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8
Q

What does the platelet bind to and to what receptors?

A

GP IIb/IIIa binds to fibrinogen

GP 1b binds to vWF

GP Ia/IIa and GP VI bind to collagen (in site of tissue damage)

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9
Q

What are the platelets role in haemostasis

A

Adhere
Activation
Aggregation
Coagulation

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10
Q

What does vWF have binding sites for?

A

Collagen,
Platelets,
Factor VIII

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11
Q

Function of vWF

A

Allows for apporpriate clot formation to stop bleeding

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12
Q

What makes up the primary haemostatic (platelet) plug?

And what then causes definitive haemostasis

A

Platelets, vWF, collagen and fibrinogen

Definitive haemostasis we need fibrin formation

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13
Q

How does fibrin formation occur?

A 
Via dominos of clotting factors 
Clotting agents cascade:
-factor XII
-factor XI
-factor XI
-factor VIII
-factor X
-prothrombin
-fibrinogen
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14
Q

describe the coagulation pathway

A

Tissue factor is released at the site of damage

TF binds to VII and activates it

This Binds to factor X, activates it and then binds to activated V

This leads to prothrombin converting to thrombin (need more)

So have intrinsic pathway:
Factor 11 activated 
Binds to factor 9, activates 
Binds to factor 8, activates 
Binds to factor 10

Converts prothrombin into thrombin

Thrombin then converts fibrinogen into fibrin

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15
Q

What is the final clot

A

Fibrin clot

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16
Q

What needs to happen after fibrin clot formed

A

Coagulation pathway needs to be reversed

17
Q

What are the natural anticoagulants

A

Tissue Factor Pathway Inhibitor,
AT,
Activated protein C protein S complex

18
Q

What is the function of TFPI

A

Binds to activated X and turns it off

19
Q

What is the function of activated protein C protein S complex

A

Protein complex turns off activated VII and V

20
Q

What is the main function of antithrombin

A

Turns off activated X and thrombin

21
Q

What happens when the natural anticoagulants are deficient

A

DVT,

PE

22
Q

What is the name of the process of clot breakdown

A

Fibronlysis

23
Q

What do endothelial cells produce in regards to coagulation

A

Activators of plasminogen

Plasminogen needs tPA to cleave into plasmin

24
Q

What is plasmin role

A

Plasmin attacks clot and produces breakdown products

-fibrin degradation products (FDP and Ddimer)

25
Q

What inhibits fibronolysis

A

PA1-1

PA1-2

26
Q

How do clopidogrel, prasugrel, ticagrelor work?

A

Bind to ADP on platelet and block

27
Q

How do abciximab, tirofiban, eptifibatide work

A

Bind to GP IIb/IIIa on platelet and block

28
Q

How does aspirin work

A

Blocks COX thus blocks conversion of arachadonic acid to thromboxane A2
Thus blocks aggregation of platelets

29
Q

Management of patient with stent

A

Aspirin

Ticagrelor

30
Q

How does warfarin work

A

Prevents factors from becoming activated thus stops conversion of prothrombin to thrombin

31
Q

How do heparins work

A

Heparins bind to antithrombin

32
Q

How do DOACs work

A

Attach to thrombin site and prevent pathway from working

Eg rivaroxaban, edoxaban, apixaban
Dabigtran, bivalirudin/ argatroban

Haematology + Immunology (21 decks)

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