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Haematology > Clotting > Flashcards

Clotting Flashcards

1
Q

What activates platelets?

A

Thrombin
Adenosine diphosphate
Thromboxane A2
Glycoprotein IIb/IIIa

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2
Q

Which drugs inhibit which of the platelet activating mechanisms?

A

Thrombin inhibitors (heparin, Vit K)

Clopidogrel and ticagrelor inhibit adenosine diphosphate

Aspirin inhibits thromboxane A2

Glycoprotein IIb/IIIa inhibitors (tirofiban)

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3
Q

Which molecules cause platelets to aggregate?

A

Thrombin

Fibrin

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4
Q

What dissolves the clot?

A

Plasmin

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5
Q

What is the intrinsic pathway of the coagulation cascade?

A

Factor XII activates factor XI

Factor XIa activates factor IX

Factor IX groups with VIIIa (activated by VII) to activate factor X

COMMON PATHWAY

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6
Q

Which coagulation factors are made in the liver?

A

2, 7, 9 and 10

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7
Q

What is the extrinsic pathway of the coagulation cascade?

A

Factor VII, tissue factor, platelet and calcium activate factor X

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8
Q

What is the common part of the coagulation cascade?

A

Factor X, V, platelets and calcium activate prothrombin to thrombin.

Thrombin then activate fibrinogen to fibrin.

BOOM

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9
Q

What does the PT measure?

A

The time for the extrinsic pathway, normal 12seconds

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10
Q

What is APTT?

A

It measures the intrinsic pathway of coagulation, 42seconds

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11
Q

When is PT elevated?

A

Liver disease

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12
Q

What do we use PT to monitor?

A

Warfarin

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13
Q

Which time do we use to measure unfractioned heparin?

A

APTT

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14
Q

Which diseases can APTT pick up?

A

Haemophilia

vWB

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15
Q

When is the extrinsic pathway activated?

A

In external trauma and large bleeds

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16
Q

When is the intrinsic pathway activated?

A

In internal vascular trauma, platelets activate this

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17
Q

Which pathway uses factor VII?

A

Extrinsic

18
Q

What is weird about factor VIII and IX deficiency?

A

These patients bleed when really you’d think the extrinsic pathway would compensate like it does in XII deficiency

19
Q

Which cells have tissue factor?

A

Fibroblasts

Macrophages

20
Q

Where do TF cells live?

A

Outside the vascular system so they can work extrinsically

21
Q

What do PS and PE do?

A

These are phospholipids inside the cell membranes of coagulation cells

22
Q

What is Flippase and Floppase?

A

They flip PS and PE to outside the cell membrane and shit starts to happen

23
Q

How does the blood know where the clotting will take place?

A

Factor X only works with TF.

TF only exists on the cell that has been exposed by the vascular trauma

24
Q

What are the three stages of haemostasis?

A

Initiation
Amplification
Propagation

25
Q

What is the initiation stage?

A

The cut in the endothelial wall exposes a TF holding cell. TF binds to VII, and together they activate X, which activates V, which causes a small amount of thrombin to be made.

26
Q

What is the amplification stage?

A

If the cut on the wall is big enough, the thrombin will activate the platelets. These will then activate the intrinsic pathway on the platelet surface, starting with VII.

27
Q

What is propagation?

A

The intrinsic pathway will occur at the platelet surface and there will be large amounts of thrombin made, which splits fibrinogen into fibrin and the mesh clot can form.

28
Q

What is aspirin mechanism of action?

A

Thromboxane A2 antagonist

29
Q

What is clopidogrels mechanism of action?

A

Adenosine diphosphate inhibitor

30
Q

What do glycoproteins do re platelets?

A

They gather platelets together and help them stick.

31
Q

What do serum protease inhibitors do?

A

Inhibit excess clot formation

32
Q

What does healthy endothelium secrete to keep clotting under control?

A

Thrombomodulin (TM)

This combines with thrombin and then aPC attaches and this cleaves any indication of clot forming.
This stops unwanted clots

33
Q

What is fibrinolysis?

A

Break down of clots

34
Q

What starts the fibrinolysis cascade?

A

Plasminogen from the liver, is activated by tissue-Plasminogen Activator to plasmin.

35
Q

When does t-PA start working?

A

Only when there is damaged endothelium - so they are local and tPA is released when thrombin is present

36
Q

What does fibrinolysis release?

A

Fibrinolysis Degradation Products (FDP)

D-Dimer

37
Q

What is D-dimer?

A

A marker of clot breakdown as it is a product of fibrin degradation

38
Q

How do FDPs feedback?

A

Negative feedback, inhibiting further blood clotting

39
Q

What is an example of a thrombolytic?

A

Urokinase

Streptokinase

40
Q

Give an example of anti-fibrinolytic

A

Tranexamic acid

41
Q

What is tranexamic acid?

A

An anti-fibrinolytic

Stops the breakdown of clots

Haematology (7 decks)

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