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Final D&D > Combined Hemostasis > Flashcards

Combined Hemostasis Flashcards

1
Q

Extrinsic pathway

A

tissue factor pathway

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2
Q

intrinsic pathway

A

contact activation pathway

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3
Q

extrinsic tenase

A

7a, TF –> 10 or 9 + anionic phospholipid + Ca

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4
Q

Intrinsic tenase

A

9a, 8a –> 10 + anionic phospholipid + Ca

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5
Q

Prothrombinase

A

5a, 8a –> prothrombin + anionic phospholipid + Ca

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6
Q

Protein C complex

A

thrombin, thrombomodulin –> protein C + anionic phospholipid + Ca

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7
Q

Initiation

A

1) Tissue injury exposes TF
2) Circulating 7 binds to TF and becomes activated
3) TF/7a complex (extrinsic 10ase) activates 10 or 9
4) 10a binds to 5a (prothrombinase) activates prothrombin

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8
Q

Amplification

A

1) Thrombin activates 5, 8, 11 while 7a/TF activates 9

2) 9a binds to 8a (intrinsic 10ase) activates 10 to make more thrombin

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9
Q

Propagation

A

1) Thrombin convert fibrinogen → fibrin which undergoes polymerization
2) Thrombin activates 13
3) 13a crosslinks and strengthens overlapping fibrin strands

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10
Q

Antithrombin

A

SERPIN; inactivates 7a, 9a, 10a, 11a

Heparin is co-factor

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11
Q

Protein C pathway

A

1) thrombomodulin induces conformational change in thrombin
2) altered thrombin not able to activate platelets or convert fibrinogen to fibrin but can activate protein C
3) activated protein C with protein S (cofactor) inactivates 5a and 8a

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12
Q

TFPI

A

single chain polypeptide reversibly inhibit 10a and 7a-TF complex

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13
Q

Fibrinolysis

A

1) plasminogen (proenzyme) activated by conversion to plasmin by either
a. t-PA secreted from vascular endothelial cells
b. u-PA secreted from many cells

2) Plasmin cleaves fibrin at multiple sites releasing fibrin degradation products (D-dimer) → 2 D domains from adjacent fibrin monomers

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14
Q

1) PAI-1

A

inactivates t-PA and u-PA

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15
Q

2) Alpha 2 antiplasmin

A

inactivates plasmin

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16
Q

3) TAFI

A

acts on fibrin by cleaving terminal residues reducing binding sites for plasminogen

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17
Q

Heparin and LMWK

A

activate antithrombin → inhib 10a and thrombin

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18
Q

tPa and streptokinase

A

activate plasmin → break up fibrin

19
Q

Warfarin

A

vitamin K reductase inhibitor → cannot recycle vitamin K → inhib 2, 7, 9, 10, S, C

20
Q

Hemostasis

A

forms thrombus (clot) to repair vessel injury

21
Q

Primary hemostasis-

A 
FORMATION OF WEAK PLATELET PLUG 
	Adhesion
	Activation
	Aggregation	
	Forms a platelet plug
22
Q 
Steps in Primary hemostasis 
#1: Vessel wall injury
A

1) Vessel wall injury- exposes subendothelium + collagen

2) Transient vasoconstriction of vessels, decr blood supply

23
Q

Steps in Primary hemostasis #2: Platelet adhesion

A

3) vWF binds subendothelial collagen
4) Platelet bind vWF using Gp1b receptor
5) vWF derived from Weibel Palade bodies of endothelial cells and alpha granules

24
Q 
Steps in Primary hemostasis
#3: Platelet Activation
A

6) Adhesion induces shape change in platelets

7) Degranulation releases ADP (dense grnaules to expose Gp2b/3a receptor) and TXA2 for platelet AGGREGATION

25
Q 
Steps in Primary hemostasis
#4: PLATELET Aggregation
A

8) Platelets aggregate at site of injury via Gp2b/3a using fibrinogen as linking molecule → forms platelet plug

26
Q

Secondary hemostasis

A

Fibrin is crosslinked yielding a stable fibrin-thrombus

27
Q

What is required to activate zymogens?

A

Requires phospholipid surface (SURFACE OF PLATELETS) and calcium

28
Q

PT

A

measures extrinsic + common pathway (LESS #s)

better for measuring effect of Warfarin

29
Q

PTT

A

measures intrinsic + common pathway (MORE #S)

better for measuring effect of Hep

30
Q

What activates factor 12

A

lupus anticoagulant:
How to test for it?
subendothelial collagen

31
Q

What activates factor 7

A

tissue thromboplastin

32
Q

Hemophilia A

A

Factor 8 deficiency
X linked recessive; mostly affects males

Incr PTT; normal PT;
decr Factor 8;
normal platelet count

33
Q

Hemophilia B; Christmas disease

A

Factor 9 deficiency

34
Q

Coagulation factor inhibitor

A

Acquired antibody against coag factor → so can’t be involved in coag cascade

35
Q

Explain how a 1:1 mixing study can distinguish a clotting factor deficiency from an inhibitor of coagulation.

A

• A 1:1 mixing study of normal plasma with patients plasma can indicate if disease is due to a clotting factor deficiency or from an inhibitor of coagulation.
○ If PTT is not corrected after two hours of incubation–> disease is due to inhibitor.
○ If PTT corrects, clotting factor deficiency.

36
Q

lupus anticoagulant:

How to test for it?

A

Q
• Detect by:
- greatly prolonged PTT,
- no bleeding tendency,
- can have thrombotic syndromes (DVT, PE, thrombotic strokes, or recurrent miscarriages).
(more likely to clot, but slower to clot)

37
Q

vWF Disease

A

most common inherited coagulation disorder

Increased bleeding time (poor platelet adhesion so can’t seal off blood vessel quickly); incr PTT (because can’t stabilize factor 8 so simil to hemophilia A); normal PT

Abnormal ristocetin- Ristocetin normally causes platelets to aggregate

38
Q

treatment of vWF

A

DDAVP

Increases vWF release from Weibel-Palade bodies of endothelial cells

39
Q

Vitamin K purpose in coag cascade

A

gut → liver → activated by epoxide reductase → gamma carboxylate 2, 7, 9, 10, C, S

40
Q

Liver failure

A

Decreased production of coat factors
Decreased activation of vit K by epoxide reductase

Test using PT

41
Q

DIC

A

Widespread microthrombi result in ischemia and infarction

Consumption of platelets and factors

42
Q

Lab tests for DIC

A

Decr platelet count

Incr PT/PTT (b/c forming thrombi)

Decr fibrinogen (using up linker proteins btwn platelets)

Microangiopathic hemolytic anemia (RBC sheared as cross frags of platelets → forming schistocytes)

Elev fibrin split products (D-dimer)
Crosslinked with fibrinogen → when get cut in blood vessel → lyse crosslinked fibrin = D-dimer

43
Q

Fxn of plasmin

A

(1) cleaves cross-linked fibrin and serum fibrinogen (prevent future thrombus production)
(2) destroys coag factors to shut down formation of thrombus
(3) blocks platelet aggregation

44
Q

Purpose of fibrinolysis

A

Fibrinolysis = after form thrombus, must remove thrombus to heal wound site

Final D&D (16 decks)

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