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Coagulation > Coagulation Lecture 1 > Flashcards

Coagulation Lecture 1 Flashcards

1
Q

What is Hemostasis

A
  • process where body stops bleeding (cessation) and maintains blood in the fluid state
  • one of most important natural defense mechanisms
  • Result of the activation of hemostatic mechanism is a thrombus (platelet) plug
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2
Q

What is the Hemostatic mechanism

A
  • the hemostatic mechanism involves a complex interaction between the blood vessels, platelets and coagulation factors
  • assures the clots in the body are only formed where they should be
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3
Q

What are 2 types of hemostasis?

A

Primary and Secondary hemostasis

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4
Q

What is Primary hemostasis?

A

Primary hemostasis is platelet adhesion to exposed collagen within the endothelium of the vessel wall

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5
Q

What is Secondary Hemostasis?

A

Secondary hemostasis is the enzymatic activation of coagulation proteins to produce fibrin from fibrinogen

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6
Q

What is Vasoconstriction?

A

Damaged blood vessel contracts to decrease blood flow; blood flow is diverted around damaged vasculature

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7
Q

What are normal blood vessels lined with?

A

Endothelial cells that are normally both non-thrombogenic and inhibit platelet aggregation

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8
Q

For platelet adhesion to occur what two things must be true

A
  1. Adequate # of platelets

2. Platelets functioning normal

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9
Q

Name for Factor I

A

Fibrinogen

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10
Q

Name for factor II

A

Prothrombin

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11
Q

Name for factor III

A

Tissue thromboplastin

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12
Q

Name for factor IV

A

Calcium

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13
Q

Name for factor V

A

Proaccelerin (Labile Factor)

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14
Q

Name for Factor VII

A

Proconvertin, serum prothrombin conversion accelerator (SPCA)

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15
Q

Name for Factor VIII

A

Anti-hemolytic factor A

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16
Q

Name for Factor IX

A

Plasma thromboplastin component, Christmas factor, anti-hemolytic factor B

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17
Q

Name for Factor X

A

Stuart-Prower Factor

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18
Q

Name for Factor XI

A

Plasma thromboplastin anticedent

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19
Q

Name for Factor XII

A

Hageman Factor

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20
Q

Name for Factor XIII

A

Fibrin stabilizing factor

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21
Q

Describe: Factor I - Fibrinogen

A
  • precursor of fibrin

* synthesize in the liver does not require vitamin K for production

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22
Q

Describe: Factor II - prothrombin

A
  • precursor of thrombin
  • synthesize in the liver through the action of vitamin K
  • most abundant of the vitamin K dependent clotting proteins
  • longest half-life of the vitamin K dependent clotting proteins
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23
Q

Describe: Factor III - tissue thromboplastin

A
  • Converts prothrombin to thrombin

* found in all body tissues

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24
Q

Describe: Factor IV- ionized calcium

A
  • Helps to activate thromboplastin (Factor III) and convert prothrombin to thrombin
  • serves as a bridge between platelets and clotting factors
25
Q

Describe: Factor V - Proaccelerin or labile factor

A
  • necessary to convert prothrombin to thrombin
  • synthesized in the liver
  • it’s activity deteriorates within a few hours
  • heat labile
26
Q

Describe: Factor VII- Proconvertin or stable factor

A
  • not destroyed or consumed in the clotting process

* essential only for the extrinsic coagulation pathway

27
Q

Describe: Factor VIII- anti-hemophilic factor

A

• deficiency of this coagulation factor causes hemophilia

28
Q

Describe Hemophilia A
(Factor VIII:C)
(3 key points)

A
  • A sex linked recessive coagulation disorder
  • causes bleeding into joints and intramuscular hemorrhage
  • Bleeding time is normal
29
Q

Describe Von Willebrands Disease
(Factor VIII:vWF)

3 key points

A
  • Autosomal inheritance
  • Platelets cannot adhere properly to subendothelial surface causing severe hemorrhaging
  • Consistently abnormal bleeding time
30
Q

Describe: Factor IX - plasma thromboplastin component

A
  • absence of factor causes hemophilia B

* synthesized in the liver and requires vitamin K for production

31
Q

Describe hemophilia B

A
  • sex linked recessive coagulation disorder
  • absence of factor IX causes hemophilia B
  • Symptoms are similar to hemophilia
  • Prolonged PT and APTT and normal bleeding time
32
Q

Describe: Factor X - Stuart-Prower Factor

A
  • essential to intrinsic pathway

* synthesized by liver and vitamin K dependent

33
Q

Describe: Factor XI -plasma thromboplastin antecedent

A
  • synthesize in the liver

* essential for intrinsic pathway

34
Q

Describe: Factor XII- Hageman Factor

A
  • Found in serum and plasma
  • not consumed during the clotting process
  • synthesized in the liver
  • NOT vitamin K dependent
  • known as contact factor because it becomes active when it comes in contact with glass, a negatively charged surface
35
Q

Describe: Factor XIII - fibrin stabilizing factor

A
  • Stabilizes fibrin clot

* important in tissue growth and repair

36
Q

Fletcher Factor (Prekallikrein)

A

• activates plasminogen

  • synthesized in the liver
  • combine with factor XII, this factor helps convert XI to XIa
37
Q

Fitzgerald Factor - High Molecular Weight kininogen (HMWK)

A
  • synthesized in the liver
  • Combines with factor XII and the Fletcher factor to convert XI to XIa

•Combines with Factor XIa to convert IX to IXa

38
Q

What are the groups that hemostatic mechanism can be divided into

A
  1. Extravascular effects
  2. Vascular effects
  3. Intravascular effects
39
Q

Describe the Extravascular effects of the hemostatic mechanism

A
  • physical effects of the surrounding tissues which close and seal the tear in the vessel that is injured
  • Biochemical effects of certain substances that are released from the tissues
40
Q

Vascular Effects of the hemostatic mechanism

A
  • platelets release serotonin during vasoconstriction which continues to narrow blood vessels on a more long-term basis
  • blood vessel structure:
  • endothelial membranes of the blood vessels contain collagen
  • when circulating platelets come in contact with collagen platelet aggregation occurs and a clot forms
41
Q

Intravascular effects of the hemostatic mechanism

A
  • Platelet : formation of platelet plug

* plasma coagulation factors: activation of the intrinsic system of coagulation to form a fibrin network

42
Q

What are the function of platelets in depth

A
  • release substances for vasoconstriction, platelet aggregation, coagulation and vascular repair
  • provide a negatively charged phospholipid surface for factor X in prothrombin activation
  • provide surface membrane glycoproteins for attachment to other platelets via fibrinogen
  • platelets aggregate or stick together to assist coagulation
43
Q

Plasma coagulation factors

A
  • coagulation proteins (plasma and tissue factors) and Calcium and work together on the surface of platelets to form a fibrin clot
  • coagulation factors are protein in nature with the exception of calcium which is a mineral
44
Q

Three categories of plasma coagulation factors

A
  1. Fibrinogen group
  2. Prothrombin group
  3. Contact group
45
Q

Fibrinogen group consists of what

A
  • consist of factors I, V, VIII and XIII
  • DO NOT require vitamin K for synthesis
  • Factors V and VIII are labile
  • factors increase in pregnancy, inflammation, and with oral contraception use
46
Q

Prothrombin group consists of what?

A
  • includes factors II, VII, IX and X
  • REQUIRE vitamin K for synthesis and or decrease in acquired vitamin K deficiencies
  • prothrombin group factors are stable
47
Q

Vitamin K dependent factors

A

II, VII, IX and X

48
Q

What does the contact group consist of

A
  • Factors XI, XII, Prekallikrein and HMWK
  • DO NOT depend on Vitamin K for synthesis
  • Prekallikrein and HMWK aid in the activation of the clot lysing enzyme plasminogen
49
Q

How are activated factors written

A

With an “a” behind The Roman numeral

50
Q

What are the three stages of the coagulation cascade

A
  1. Generation of thromboplastic activity
  2. Generation of thrombin
  3. Conversion of fibrinogen to fibrin
51
Q

What does the generation of thromboplastic activity do

A

Prepares for the conversion of prothrombin to thrombin

52
Q

What does the generation of thrombin do

A

Thromboplastin converts prothrombin to thrombin

53
Q

What does conversion of the fibrinogen to fibrin mean

A

Fibrin clot formed

54
Q

Extrinsic pathway

A

Tissue injury > Factor III (in presence of Calcium (Factor IV)> activates Factor VII to VIIa> which activates Factor X to Xa ……. then goes to common pathway

III (+ Ca) —> VII –> VIIa -»> common pathway (X to Xa)

55
Q

Fibrinolysis

What enzyme is responsible for digestion of fibrin?

What removes the waste products of fibrinolysis?

A

• plasmin is the active enzyme (proteolytic enzyme) responsible for digesting fibrin

  • not found in circulating blood
  • plasminogen (non active) circulates in blood

• The waste products of fibrinolysis are removed from the body by the reticuloendothelial system (RES)

56
Q

Intrinsic pathway

A

Factor XII (contact factor) -> XI (+CA IV) –> VIII-» X then common pathway

57
Q

Fibrinolysis

A
  • Result of converting fibrinogen to fibrin a.k.a. fibrin clot a.k.a thrombus
  • as soon as clotting begins fibrinolysis begins to break down the clot
  • The fibrinolysis system maintains equilibrium in our body
  • directly proportional relationship, if coagulation is increase then fibrinolysis is increased
58
Q

The common pathway

A

X to Xa -> V (+Ca IV and PF3) –> II -> I (+thrombin) -> fibrin in prescience of XIII

Coagulation (4 decks)

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