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Blood Coagulation Flashcards

1
Q

Steps of hemostasis

A
  • Initiation
  • Localization
  • Propagation/amplification
  • Termination
  • Elimination
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2
Q

Vessel wall - endothelial cells and subendothelial components

A

Initiation

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3
Q

Platelets- circulating cellular elements

A

Localization

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4
Q

Plasma coagulation proteins (factors)

A

Propagation/Amplification

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5
Q

Plasma coagulation protein inhibitors

A

Termination

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6
Q

Fibrinolytic system

A

Elimination

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7
Q

Clinical test to to assess the functionality of intrinsic pathway, Used to test for common congenital hemophilias (deficiencies in IX, VIII, or XI) and to monitor heparin treatment

A

activated partial thromboplastin time (APTT)

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8
Q

Normal time range for APTT test

A

30-50 seconds

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9
Q

Prolongations in the aPTT are observed in deficiencies of factors…

A

XI, IX, VIII, X, and V, prothrombin, or fibrinogen

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10
Q

In APTT test ____ and ____ are added to the test plasma sample

A

Kaolin and cephalin

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11
Q

Refers to tissue factor, which is expressed on subendothelial cells

A

Extrinsic pathway

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12
Q

Clinical test to assess the functionality of the extrinsic pathway.

A

Prothrombin time (PT) Used to test for the rare congenital deficiencies: More often it is used to diagnose acquired bleeding disorders resulting from vitamin K deficiency, oral anticoagulants (e.g. warfarin), and liver disease

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13
Q

Added to test plasma sample in PT test

A

Lipidated tissue factor

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14
Q

Normal range for PT test

A

10-15 seconds (shorter pathway)

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15
Q

Prolongations in the PT are observed in deficiencies of

A

factors VII, X, V, prothrombin, or fibrinogen.

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16
Q

Deficiencies in all of the factors, except factor , lead to a bleeding tendency in the affected individual

A

XII

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17
Q

Activated factor enzymes are designated with an

A

“a” e.g. factor Xa

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18
Q

sequence of zymogen to enzyme conversions, with each enzyme activating the next zymogen in the sequence

A

waterfall or cascade

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19
Q

Roles of thrombin

A
  • Cleaves Fibrinogen
  • Activates Platelets
  • Activates procofactors (FV and FVIII)
  • Activates zymogens (FVII, FXI and FXIII)
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20
Q

Common constituents of coagulation complexes

A
  • Vitamin K-dependent (VKD) zymogen
  • Ca2+
  • Protein cofactor(s):
    • Protein C: Protein S- inhibits FVa and FVIIIa Specific inhibitor for Protein C (Protein C inhibitor; PCI)
    • Protein Z + Ca2+ Protein Z-dependent protease inhibitor inhibits FXa
    • Appropriate membrane surface -
      • activated platelets (VIIIa/IXa complex, Va/Xa complex) -subendothelial cells, typically fibroblasts (TF/VIIa complex)
21
Q

Group of related, fat soluble compounds, which differ in the number of side-chain isoprenoid units

22
Q

The reduced form of vitamin K2 (vitamin KH2) is required for

A

the post-translational, gamma-carboxylation of several proteins involved in blood clotting

23
Q

Gla-Containing Proteins

A
  • Prothrombin
  • Factor VII
  • Factor IX
  • Factor X
  • Protein C
24
Q

Haplotype A represents individuals at risk for __________and haplotype B represents individuals at risk for

A

excessive anticoagulation with standard warfarin dosing, subtherapeutic anticoagulation from standard warfarin dosing

25
Deficiency of _______ is rare because of its wide distribution in nature, and its production by intestinal bacteria
Vitamin K
26
Vitamin K deficiency found in individuals with ______ and \_\_\_\_\_\_. It is associated with \_\_\_\_\_\_\_\_\_
liver disease and fat malabsorption.; bleeding disorders
27
This group is at risk for Vitamin K deficiency
Newborn infants (especially preemies) Placenta is insufficient in the transfer of maternal vitamin K
28
Heparin fragments _____ enhance ____ inhibition of _____ and \_\_\_\_
(18 & 5); AT3; thrombin and FXa
29
Hemophilias A and B are cause by deficiencies in factors _____ or \_\_\_\_\_, respectively
VIII or IX Affect 1 in 10,000 males
30
Hemophilia is inherited as a
recessive X-linked trait (Mom would be an unaffected carrier)
31
Hemophilia is treated by
* administration of factor VIII or factor IX concentrates * Recombinant factor VIII or IX proteins * Gene therapy trials
32
Hemophilias A and B are cause by deficiencies in factor, _____ or \_\_\_\_\_respesctively
VIII or IX
33
Genetic defects of bleeding disorders/hemmorrhages are
* platelet abnormalities * blood vessel wall abnormalities * clotting factor deficiencies (hemophilias) * excess clot breakdown (fibrinolysis)
34
Acquired defects of bleeding disorders/hemmorrhages are
* liver disease (site of clotting factor synthesis) * vitamin K deficiency * autoimmune disease (platelet destruction) * trauma
35
Bleeding disorders can span the spectrum from \_\_\_\_\_\_\_vessels to \_\_\_\_\_\_\_...
weeping blood; full-fledged...internal and external hemorrhage
36
Hemorrhage is treated by
factor replacement
37
Thrombosis can be manifested as _________ It is the major cause of \_\_\_\_\_\_\_and \_\_\_\_\_\_.
a transient, short-term or episodic event in individuals with chronic or recurring clotting.; both stroke and heart attacks.
38
The genetic defects of thrombosis
clotting factor INHIBITOR deficiencies decreased fibrinolysis
39
Acquired defects of thrombosis:
Atherosclerosis Lupus anticoagulants
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44
45
_Blood coagulation factors and diseases_: * Increased expression of Antithrombin II, TPA, PAI -- * High plasma Fibrinogen levels-- * Genetic variants in FII-- * Inflammatory Markers and FI, FVIII-- * Endothelial Tissue Factor upregulation --
* Associated with Atrial Fibrillation, Strokes * Thromboembolism * Associated with severity of colorectal cancer * Associated with increased risk of HCC (Patients with HCV) * Associated with chronic renal diseases * Associated with increased risk of heart failure
46
Pharmacologic Approaches to Prevent Thrombosis
Antiplatelet agents - block activation, aggregation or intraplatelet agonist synthesis Effective anticoagulant therapy includes both antiplatelet and antithrombin agents
47
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49
NECESSITY FOR BLOOD CLOTTING
* PREVENT EXCESSIVE BLOOD LOSS FROM THE BODY * PREVENTS BLOOD PRESSURE FROM FALLING TO A LOW LEVEL AS PRESSURE IS NEEDED * SEALS A WOUND * PREVENTS THE ENTRY OF MICROORGANISMS AND FOREIGN PARTICLES INTO THE BODY THROUGH THE WOUND

M1 (48 decks)

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