Ch 7 - Bleeding and Haemostasis Flashcards
Where are platelets produced and at what rate?
In the bone marrow from porgenitor megakaryocytes at a rate of approx 10^11 platelets/day
What are the main substances released from platelet granules to recruit and activate other platelet?
TxA2 and ADP
What are the 3 phases of the cell-based model of coagulation?
- Initiation
- Amplification
- Propagation
What are the three endothelial inhibitors of platelet reactivity?
- Prostacyclin (PGI2) - limits response to TxA2
- Ectoadenosine diphosphatase (ecto-ADPase) - metabolises ADP released from platelets, inhibiting recruitment and activation
- Nitric oxide - decreases Ca influx thereby reducing affinity of fibrinogen binding sites
What are the three natural anticoagulant pathways?
- Antithrombin - inactivates coagulation proteins which escape into the circulation (mostly thrombin and factor X). ALso inhibits neutrophil adherence excerting a potent anti-inflam effect
- Activated protein C - Inactivates VIIIa and Va and slows thrombin formation. Enhances fibrinolysis
- Tissue factor pathway inhibitor - Inactivates Xa, and VIIIa-TF
How is fibrin autoregulatory?
It acts as both a coenzyme for plasminogen activation (increases its efficacy 1000 fold) and is also a substrate for plasmin. I.e Fibrin stimulates the production of plasmin which then degrades fibrin
How can you estimate platelet count?
Multiply average number of platelets per HPF by 15,000
What are the normal BMBT in dogs and sedated cats?
- Dogs - less than 3 min
- Sedated cat - 34 -105 seconds
Elevated with thrombocytopaenia, thrombocytopathis or vasculopathy
Which pathways do PT and APPT test?
PT - extrinsic and common
APPT - intrinsic and common
How much does a single factor need to be reduced by before you will see an increase in the PT or APPT?
less than 25-30% of normal concentration
Which factor is effected first with VitK deficiency and which pathway/test will be prolonged?
Factor VII due to its short half-life. Causes an increased PT (extrinsic pathway)
What pathways does ACT test?
Intrinsic and common - significantly less sensitive then APPT
What casuse elevated fibrin split products? In which conditions can it be elevated?
Formed when plasmin lyses fibrinogen or fibrin.
Commonly seen with DIC. Also with thromboembolism, neoplasia, IMHA, hepatic failure, sepsis, SIRS, heat stroke, trauma, GDV etc
What are d-Dimers?
Specific degradation products of cross-linked fibrin. Specific for concurrent active coagulation and fibrinolysis
What are the three hypotheses to explain acute traumatic coagulopathy?
- DIC with hyperfibrinolytic phenotype
- Enhanced thrombomodulin-thrombin protein C pathway
- Catecholamine-induced endothelial damage
How does acidaemia effect coagulation?
- Increased fibrinogen degradation
- Impairs coagulation protein activity (fXa-Va)