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Coagulation > Coagulation > Flashcards

Coagulation Flashcards

Coagulation

1
Q

Platelets:

…in blood
… sequestered in spleen

Live…
Contain…
Plt adhesion: Change shape in contact with…

A

80% blood
20% spleen

Live 7-10 days
Contain mitochondria and specific granules
Change shape in contact with collagen.

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2
Q

Normal platelet adhesion requires….

Once adhered, plts become activated and release…

A

Von willebrands factor and Plt glycoprotein.

Once adhered, plts become activated and release: ionized calcium + glycoprotein complex GP IIb/IIIa

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3
Q

Coagulation…

1.)Vasoconstriction:
compressed by skeletal muscle contraction

2.)Plt adhesion:
Collagen helps plts adhere.

3.)Plts are activated:
After adhere, plts release ionized CA and GPIIb/IIIa from granules and change shape

4.)Plts aggregate:
Spiny plts react together to aggregate.
Requires ionized CA and fibrinogen.

5.)Plt plug, stabilize clot:
Plug is stabilized by fibrin strands.
Plts form plug, stabilize clot and release factor V and PF3.

A

Coagulation factors…

Plasma substances to form fibrin. Mostly proteins except calcium and mostly made in liver.

Coverts prothrombin to thrombin and fibrinogen to fibrin.

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4
Q

Factors needed for conversion of prothrombin to thrombin…

A

PF3

Va

CA2+

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5
Q

Factor needed for conversion of fibrinogen to fibrin….

A

Thrombin

Splits fibrinogen into two peptides, leaving a fibrin monomer. These monomers aggregate to make the final polymerized fibrin clot

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6
Q

Fibrinolysis…

  1. )
  2. )

Kept in check by…
1.)

2.)

A

Fibrinolysis…
1.)Plasminogen (inactive plasmin) to plasmin:
Activated by tPA released by endo cells

2.)Plasmin:
Breaks down fibrinogen and fibrin.
Making FDPs, XDPs, D-dimers

Kept in check by…
1.) alpha 2 antiplasmin

2.)TAFI:
Thrombin activatable fibrinolysis inhibitor

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7
Q

Factor I

A

Fibrinogen

  • Precursor to fibrin
  • Made in liver, doesn’t require vitK for it’s production
  • 200-400mg/dl
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8
Q

Factor II

A

Prothrombin

  • Precursor to thrombin
  • made in liver, needs vit K
  • little remains in serum
  • 8-15mg/dL
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9
Q

Factor III

A

Thromboplastin, tissue factor TF

  • name given to any substance capable of converting prothrombin to thrombin
  • hmw lipoprotein

-brain, lung, vascular endothelium, liver, placenta, kidneys

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10
Q

Factor IV (no longer in use)

A

Ionized CA++

  • essential for clotting, bridge between phospholipid surface of plts and factors
  • needed to activate thromboplastin
  • needed to convert prothrombin to thrombin
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11
Q

Factor V

A

Labile factor/Proaccelerin/AcG

Prothrombin accelerator

  • needed to convert prothrombin to thrombin
  • globulin made in liver, def in liver disease
  • labile: activity destroyed in clotting process; most unstable, half-life 25hrs
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12
Q

Factor VII

A

Proconvertin/Stable Factor
SPCA (serum prothrombin conversion accelerator)

  • stable factor: not destroyed or consumed
  • requires vit K, made in liver, in plasma and Serum
  • only used in extrinsic pathway
  • activates tissue thromboplastin
  • accelerates thrombin from prothrombin
  • monitored by PT, half life 4-6hrs
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13
Q

Factor VIII:C

A

Antihemophilic factor/AHF/AHG

  • ability to correct coag issues in hemophilia A
  • Combination of VIII:C and VIII:vWF.
  • VIII/vWF unit measured VIII assay and APTT
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14
Q

Factor IX

A

PTC (plasma thromboplastin component)

Christmas factor
AHB

  • Stable protein factor, liver, needs vitK
  • Not consumed so in plasma and Serum
  • Helps in making Intrinsic thromboplastin
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15
Q

Factor X

A

Stuart-Prower factor

  • not consumed, in plasma and Serum
  • needs vitK
  • intrinsic pathway, helps make thromboplastin
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16
Q

Factor XI

A

Plasma thromboplastin antecedent
PTA

  • Circulates as a complex with HMWK
  • Helps with making thromboplastin
  • Doesn’t need vit K
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17
Q

Factor XII

A

Hageman factor/contact factor/glass factor

  • active when in contact with glass
  • not consumed, in serum and plasma
  • doesn’t need vitK
  • def not at risk for bleeding
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18
Q

Factor XIII

A

Fibrin stabilizing factor, fibrinase

Made by megakaryocytes
Enzyme catalyzes polymerization of fibrin
Needed for tissue growth and repair

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19
Q

Fitzgerald factor other name…

A

High molecular weight kininogen/HMWK

A cofactor that Yields kinin, Precursor of bradykinin
Doesn’t need vitK

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20
Q

prekallikrein/Fletcher factor other name…

A

Prokallikrein

  • activates Plasminogen
  • recruits phagocytes
  • doesn’t need vitK
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21
Q

Fibrinogen: factor…

A

I

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22
Q

Prothrombin: factor…

A

II

  • Precursor to thrombin
  • made in liver, needs vit K
  • little remains in serum
  • 8-15mg/dL
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23
Q

Thromboplastin, tissue factor TF:

factor…

A

III

  • name given to any substance capable of converting prothrombin to thrombin
  • hmw lipoprotein

-brain, lung, vascular endothelium, liver, placenta, kidneys

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24
Q

Ionized CA++: former name…

A

Factor IV

  • essential for clotting, bridge between phospholipid surface of plts and factors
  • needed to activate thromboplastin
  • needed to convert prothrombin to thrombin
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25
Q

Labile factor/Proaccelerin/
Prothrombin accelerator:
factor…

A

V

  • needed to convert prothrombin to thrombin
  • globulin made in liver, def in liver disease
  • labile: activity destroyed in clotting process; most unstable, half-life 25hrs
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26
Q

Proconvertin/Stable factor/SPCA (serum prothrombin conversion accelerator):
factor…

A

VII

  • stable factor: not destroyed or consumed
  • requires vit K, made in liver, in plasma and Serum
  • only used in extrinsic pathway
  • activates tissue thromboplastin
  • accelerates thrombin from prothrombin
  • monitored by PT, half life 4-6hrs
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27
Q

Antihemophilic factor/AHF/AHG:

Factor…

A

VIII:C

  • AHG/AHF are terms used to designate procoagulant in normal plasma but deficient in hemophilia
  • ability to correct coag issues in hemophilia A. Mixing normal plasma with hemophilia A plasma will correct AHF def.
  • Combination of VIII:C and VIII:vWF.
  • VIII/vWF unit measured VIII assay and APTT
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28
Q

PTC (plasma thromboplastin component)

Christmas factor
AHB
factor…

A

IX

  • Stable protein factor, liver, needs vitK
  • Not consumed so in plasma and Serum
  • Helps in making Intrinsic thromboplastin
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29
Q

Stuart-Prower factor: factor…

A

X

  • not consumed, in plasma and Serum
  • needs vitK
  • helps make thromboplastin
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30
Q

Plasma thromboplastin antecedent/PTA: factor…

A

XI

  • Circulates as a complex with HMWK
  • Helps with making thromboplastin
  • Doesn’t need vit K
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31
Q

Hageman factor/contact factor/glass factor: factor…

A

XII

  • active when in contact with glass
  • not consumed, in serum and plasma
  • doesn’t need vitK
  • def not at risk for bleeding
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32
Q

Fibrin stabilizing factor, fibrinase

factor…

A

XIII

Made by megakaryocytes
Enzyme catalyzes polymerization of fibrin
Needed for tissue growth and repair

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33
Q

High molecular weight kininogen/HMWK

other name…

A

Fitzgerald factor

A cofactor that Yields kinin, Precursor of bradykinin
Doesn’t need vitK

34
Q

prekallikrein/Fletcher factor

Other name…

A

Prokallikrein

  • activates Plasminogen
  • recruits phagocytes
  • doesn’t need vutK
35
Q

Intrinsic pathway:

In circulating blood

Activated by certain contact surface

Factors/Cascade…

A

Intrinsic pathway:

  • 1.)12 to 12a (contact factor)
    2. )Fitzgerald, Fletcher
  • 3.)11 to 11a
    4. )PF3, CA++
  • 5.)9 to 9a (can also be activated by III in extrinsic)
    6. )PF3, CA++
  • 7.)8 to 8a

…common pathway…

36
Q

Extrinsic pathway
Not in circulating blood
Factors…

A

1.)III/Tissue thromboplastin:
Cofactor

2.)CA++:
From Plt granules

3.)VII to VIIa

  1. ) a. Can help activate IX in intrinsic pathway or
    b. Common pathway
37
Q

PF3:

A

Plt factor 3

phospholipid released from platelet membranes

38
Q

Common pathway:

Factors ..

A
  1. )X to Xa
  2. )V to Va (needs PF3, Ca++)
  3. ) Prothrombin/II to thrombin
  4. ) a. Fibrinogen to fibrin (monomer)
    b. XIII to XIIIa

5.) Fibrin to stable fibrin clot (polymer)

39
Q

Antithrombin III

Inhibits…

A

Inhibits thrombin

40
Q

Protein C/S combination:

Inhibits…

A

Inactives factors 5a and 8a

41
Q

Tissue factor pathway inhibitor/TFPI

Prevents…

A

Activation of prothrombin by Xa

42
Q

Protein Z

Inhibits…

A

Factor Xa

43
Q

Warfarin

Other name…
Inhibits…

A

Coumadin

Inhibits vit K dependent factors

44
Q

Heparin

Inhibits…

A

Inhibits thrombin and factor X

45
Q

Clopidogrel/Plavix

Inhibits…

A

Inhibits Plt aggregation

46
Q

Aspirin

Inhibits…

A

Inhibits Plt aggregation and release of PF3

47
Q

Acquired coagulation disorder…

A

Vit K def

Anticoagulant therapy

DIC

Autoantibodies to coag factors

48
Q

Inherited coagulation disorders

A

Hemophilia A, B

Def or dys of factors

49
Q

Hemophilia A

Other name…
Def in…
Common in..

A

Classic hemophilia
functional deficiency in VIII:C subunit

Most common inherited coag disorder, 85%

Sex linked and Mostly males

Bleeding but normal VIII:vWF/BT

50
Q

Hemophilia B

Other name…
Common in ..
Factor def ..

A

Christmas disease

Sex linked, mostly males

IX

51
Q

Acquired platelet disorders

A

Aspirin: irreversibly affects aggregation

Deceased megakaryocytes made: infection

ITP: ab to plts decrease plts

TTP: plts used in microthrombi, decreasing number

Sequestered in spleen: enlarged spleen

52
Q

Inherited platelet disorders

A

vWD: most common, deceased Plt adhesion

Bernard-Soulier syndrome: large plts, deceased adhesion

Glanzmanns thrombasthenia: lack GIIIb/a, decreased aggregation

53
Q

Hemophilia A:

PT, aPTT, BT, PLT ct

A

func def in VIII:C

aPTT: prolonged

PT, BT, PLT: normal

54
Q

Hemophilia B:

PT, aPTT, BT, PLT ct

A

func def in IX

aPTT: prolonged

PT, BT, PLT ct: normal

55
Q

vWD:

PT, aPTT, BT, PLT ct

A

deceased Plt adhesion

Hereditary, in different subtypes, def in VIII:vWF

PT, aPTT, and BT: prolonged

PLT ct: normal

56
Q

Warfarin therapy

PT, aPTT, BT, PLT ct

A

Inhibits vitK dependent factors

PT, aPTT: prolonged

BT, PLT ct: normal

57
Q

Glanzmanns thrombasthenia

PT, aPTT, BT, PLT ct

A

Lack GIIIb/a, deceased PLT aggregation

58
Q

ITP

PT, aPTT, BT, PLT ct

A

Ab to PLTs

BT: prolonged

PLT: below normal

PT, aPTT: normal

59
Q

Prolonged PT in def of factors…

A

2-5-7, 10

Extrinsic and common pathways

60
Q

Prolonged PT in what therapies/situations…

A

Warfarin, heparin therapy

Liver disease

Vit K def

61
Q

PT/protime:

most common coag

Used for:
Monitor warfarin, Presurgery coag screening

Tests prothrombin and other factors
*Prothrombin is vitK dependent, made in liver

A

PT test:

Commercial tissue thromboplastin and Ca++

Combine anticoagulated plasma (3.2% citrated) with reagent to form fibrin clot.

Def in extrinsic or common will be prolonged

Time required for fibrin clot to form. Ref range 10-13 secs

Use INR due to thromboplastin differing. INR 1.0-1.4
*PT secs/mean of normal of facility secs

62
Q

APTT:

Factors in Intrinsic tested:

A

8, 9, 11, 12

Fitzgerald, Fletcher

89-11-12, Fi-Fl

63
Q

APTT:

Factors in common pathway tested:

A

1,2, 5,10

125-10

64
Q

APTT:

Monitor low dose heparin and intrinsic/common def

Not influenced by Plt numbers

Plasma plus partial thromboplastin and CaCl2

A

APTT:

PT plasma is added to partial thromboplastin to help activate intrinsic pathway mimicking PF3.

Then CaCl2 is added.

Time for fibrin clot to form after CaCl2 is APTT

Varies on whole or citrated.

29-34 secs

65
Q

APTT

Prolonged in ..

A

1,2,5
8,9,10,11,12

Heparin

VitK def

66
Q

BT

Ivy ref…
ACT ref…

A

Ivy: 2-9sec

ACT: 81-125 sec

67
Q

PT citrated

Plasma ref:

INR:

A

Plasma: 10-13sec

INR: 1.0-1.4

68
Q

PT- Hemochrom Jr

Whole blood…

Plasma equivalent…

INR…

A

Whole blood: 20-26secs

Plasma equivalent: 8-15sec

INR: 0.8-1.5sec

69
Q

APTT: plasma

Citrated ref

A

24-34 secs

70
Q

APTT: Hemochron Jr

Whole blood…
Plasma equivalent…

A

Whole blood: 93.2-116.8 sec

Plasma equivalent: 20.6-38.6 sec

71
Q

DIC:
circulatory thrombosis, hemorrhaging… malfunction to maintain balance of clotting and fibrinolysis

Factors and PLTs decrease

Lab results for DIC: 
PLT ct...
Serum fibrinogen...
PT, aPTT...
FDPs, XDPs
A

Lab results for DIC:

PLT ct and Serum fibrinogen: deceased

PT and aPTT: prolonged

FDPs and XDPs: increased

72
Q

Fibrinolysis:

Both fibrinogen and fibrin are cleaved by plasmin.

FDPs:

XDPs:
*Contains…

A

FDPs: fibrin degradation products

XDPs: cross linked fibrin degradation products
*Contains D-dimers (protein fragments, terminal product). D-dimers only made as a result of cross linked fibrin being lysed.

Important to distinguish between FDPs and XDPs because it’s more serious to have XDPs (pathological fibrinolysis).

73
Q

VIII:vWF

A

von Willebrand factor

  • the other factor in VIII subunit
  • plt adherence , binging plts to endothelium
  • not involved in coagulation pathway
  • antigenic, helps Plt aggregation induced by ristocetin
74
Q

von Willebrand factor

Factor…

A

VIII:vWF

  • the other factor in VIII subunit
  • plt adherence , binging plts to endothelium
  • not involved in coagulation pathway
  • antigenic, helps Plt aggregation induced by ristocetin
75
Q

Fibrinogen group

A

Thrombin sensitive, acts on all below factors
Consumed, not in plasma

1, 5, 8, 13

I, V, VIII, XIII

76
Q

Prothrombin group

A

Vit K dependent
Not consumed, in serum and plasma
Coumarin type drugs decrease these

2,7,9,10

II, VII, IX, X

77
Q

Contact group

A

Not consumed, don’t need vitK

11,12, Flet, Fit

IX, XII, prokallikrein, HMWK

78
Q

Natural anticoagulants…

A

AT-III: antithrombin III, major thrombin inhibitor

AT-III heparin cofactor/HC-II: heparin dependent thrombin inhibitors

Protein C: in liver, inactive zymogen

Protein S: cofactor

79
Q

Factors only in the extrinsic pathway…

A

III, VII

3,7

80
Q

Factors only in the instrinsic pathway…

A

8,9 11,12

HMWK, PK

81
Q

Factors inhibited by Coumarin/Need VitK

A

2, 7, 9,10

82
Q

PT measures factors…

A

1,2, 5, 7, 10

Coumadin therapy

Coagulation (1 decks)

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