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Exam 1 Flashcards

1
Q

What is the goal of primary hemostasis?

A

Formation of a platelet plug

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2
Q

How is primary hemostasis accomplished?

A

vasoconstriction of blood vessels -> platelet adhesion -> platelet secretion of granular content -> platelet aggregation -> formation of platelet plug

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3
Q

What is the goal of secondary hemostasis?

A

Fibrin clot formation

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4
Q

How is secondary hemostasis accomplished?

A

activation of coagulation cascade

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5
Q

What is the goal of fibrinolysis?

A

removal of fibrin clot

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6
Q

How is fibrinolysis accomplished?

A

Production of plasmin to degrade fibrin

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7
Q

What do endothelial cells in the vascular intima produce that maintain normal blood flor?

A

prostacyclin - PLT inhibitor and vasodilator
Nitric oxide - induces vasodilation and inhibits PLTs
Tissue factor pathway inhibitor (TFPI) - controls activation of extrinsic pathway

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8
Q

What do endothelial cells produce that inhibit thrombin? (anticoagulants)

A

Thrombomodulin and Heparan Sulfate

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9
Q

Procoagulant properties of the vascular intima

A
  • can promote vasoconstriction during injury to vessels and expose collagen which activates PLTs
  • endothelial cells secrete VWF when activated by thrombin
  • secrete P-selectin (promotes PLT and LK binding)
  • supports tissue factor
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10
Q

Adhesion of platelets

A

platelets stick to non-platelet surfaces

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11
Q

Aggregation of platelets

A

Platelets adhere to eachother

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12
Q

Secretion of platelets

A

platelets discharge the contents of their granules

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13
Q

Procoagulant: Factor I (nickname and function)

A

Factor I AKA Fibrinogen

Thrombin substrate, polymerizes to form fibrin

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14
Q

Procoagulant: Factor II (nickname and function)

A

Factor II AKA Prothrombin

Serine Protease

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15
Q

Procoagulant: Factor III (nickname and function)

A

Factor III AKA Tissue Factor

Cofactor

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16
Q

Procoagulant: Factor IV (nickname and function)

A

Factor IV AKA Ionic Calcium

Mineral

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17
Q

Procoagulant: Factor V (nickname and function)

A

Does not have a nickname

Cofactor

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18
Q

Procoagulant: Factor VII (nickname and function)

A

Does not have a nickname

Serine Protease

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19
Q

Procoagulant: Factor VIII (nickname and function)

A

Factor VIII AKA Antihemophilic factor

Cofactor

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20
Q

Procoagulant: VWF (nickname and function)

A

von Willebrand Factor

Factor VIII carrier and platelet adhesion

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21
Q

Procoagulant: Factor IX (nickname and function)

A

Factor IX AKA Christmas Factor

Serine protease

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22
Q

Procoagulant: Factor X (nickname and function)

A

Factor X AKA Stuart-Prower factor

Serine Protease

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23
Q

Procoagulant: Factor XI (nickname and function)

A

Does not have a nickname

Serine protease

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24
Q

Procoagulant: Factor XII (nickname and function)

A

Factor XII AKA Hageman factor

Serine protease

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25
Q

Procoagulant: Prekalikrein (nickname and function)

A

Fletcher Factor, pre-K

Serine protease

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26
Q

Procoagulant: High Molecular Weight Kininogen (nickname and function)

A

Fitzgerald factor, HMWK

Cofactor

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27
Q

Procoagulant: Factor XIII (nickname and function)

A

Factor XIII AKA Fibrin-stabilizing factor (FSF)

Transglutaminase

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28
Q

Procoagulant: Platelet Factor 3 (nickname and function)

A

Phospholipids, phosphatidylserine, PF3

Assembly molecule

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29
Q

What procoagulants are serine proteases?

A

II, VII, IX, X, XI, XII, Prekallikrein

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30
Q

Which procoagulant has the shortest half-life? What is the half-life?

A

Factor VII, half-life of 6 hours

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31
Q

Which procoagulant has the highest molecular weight?

A

VWF

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32
Q

Which procoagulant is found in the highest concentration in the blood?

A

Factor I (Fibrinogen)

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33
Q

Vitamin-K dependent coagulation factors

A 
Factor II (prothrombin)
Factor VII 
Factor IX (christmas factor) 
Factor X (stuart-prower factor)
Protein C
Protein S
Protein Z
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34
Q

How does does vitamin K work to activate vitamin-k dependent coagulation factors?

A

Vitamin K adds a carboxyl group which allows them to bind to calcium. Bound calcium enables vitamin k dependent factors to bind to phospholipids to form complexes with other factors

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35
Q

List the components of the extrinsic tenase complex.

What do these factors activate? (I.e. what is their substrate)

A

Factor VIIa, Factor III (tissue factor), phospholipid, and calcium
- Activates Factor X (stuart-prower) and factor IX (christmas factor)

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36
Q

List the components of the intrinsic tenase complex. What do these factors activate? (I.e. what is their substrate)

A

Factor IXa, Factor VIIIa, phospholipid, and calcium

Activates Factor X

37
Q

List the components of the prothrombinase complex. What do these factors activate? (I.e. what is their substrate)

A 
Factor Xa, Factor Va, phospholipid, and calcium 
Activates prothrombin (factor II)
38
Q

What is the purpose of a cofactor?

A

Binds to its serine protease, allowing the enzyme to be stable and reactive

39
Q

What is a zymogen?

A

An inactivated enzyme

40
Q

Factor II (_________) is transformed into ________, which then acts to transform _________ into ______.

A

Prothrombin, Thrombin, Fibrinogen, Fibrin

41
Q

What are the substrates of thrombin?

A

Fibrinogen, Factor V, Factor VIII, Factor XI, Factor XIII

42
Q

What is the main enzyme (protease) of the coagulation pathway?

43
Q

What factor does VWF transport? Why does it need this factor?

A

Factor VIII; increases half-life

44
Q

Which coag factors are a part of the intrinsic pathway?

A

XII, Pre-K, HMWK, XI, IX, VIII, X, V, prothrombin (II), and fibrinogen (I)

45
Q

Which coag factors are a part of the extrinsic pathway?

A

VII, X, V, prothrombin (II), and fibrinogen (I)

46
Q

Which coag factors are a part of the common pathway?

A

X, V, prothrombin (II), and fibrinogen (I)

47
Q

What are the contact factors?

A

Factor XII, HMWK (fitzgerald factor), and pre-K (fletcher factor)

48
Q

How does thrombin activate fibrin?

A

Thrombin cleaves fibrinogen, cleaved fibrinogen is a fibrin monomer, exposed fibrin monomer ends come together to form a fibrin polymer

49
Q

Role of TFPI

A

serine protease inhibitor (inhibits extrinsic tenase complex)

50
Q

Function of protein C and protein S

A

work together to ensure body is not clotting too much; blocks thrombin generation (serine proteases)

51
Q

role of antithrombin (AT)

A

serine protease inhibitor (serpin)

52
Q

role of plasmin

A

principal enzyme of the fibrinolytic system (serine protease)

53
Q

function of TPA and UPA

A

convert plasminogen to plasmin

54
Q

function of PAI-1

A

inhibits plasminogen activation by inactivating TPA and UPA

55
Q

function of alpha-2 antiplasmin

A

inhibits free plasmin

56
Q

function of TAFI

A

inhibits fibrinolysis

57
Q

Where do D-dimers come from and what does their presence indicate?

A

they are a product of digestion of fibrin after plasmin breaks them down, their presence may indicate DIC

58
Q

Neonatal period

A

First 4 weeks of life

59
Q

Infancy

A

First year of life

60
Q

Childhood

A

Ages 1 to puberty (8-12 yrs)

61
Q

Small for gestational age

A

2500 g or less

62
Q

Very low birth weight infants

A

1500g or less

63
Q

Extremely low birth weight microopremies

A

1000g or less

64
Q

Large for gestational age

65
Q

How do PT/PTT results in pediatric patients compare to adults?

A

Pediatrics have a prolonged PT/PTT compared to adults.

66
Q

How do the coagulation factor levels and regulatory protein levels in pediatrics compare to those in adults?

A

Pediatrics have decreased coagulation factors and decreased regulatory proteins, which balance eachother out and mean that pediatrics are not more likely to clot and/or have bleeding disorders.

67
Q

How do coagulation factors/reg proteins in the elderly population compare to regular adults? How does this affect PT/INR?

A

Elderly have increased coagulation factors the older they get, so elderly patients have increased risk of thrombosis. PT/INR would be decreased, meaning more likely to clot.

68
Q

How do coagulation factors in pregnant women compare to those of non-pregnant adults?

A

Pregnant women have increased procoagulants and decreased anticoagulants.

69
Q

Virchow’s triad - what is it? what are the 3 components?

A

Determines risk of thrombosis in pregnant women

  1. Stasis
  2. Hyper coagulability
  3. Endothelial damage
70
Q

reticulated/stress platelets

A

immature platelets that appear to compensate for thrombocytopenia (too little platelets) - larger than mature PLTs

71
Q

Platelet plasma membrane

A

phospholipid bilayer composed of cholesterol and phospholipids

72
Q

PLT glycocalyx

A

PLT membrane surface, covers the bilayer

73
Q

SCCS (surface connected canalicular system)

A

enables platelets to store hemostatic proteins

route for endocytosis and for secretion of alpha granule content during PLT activation

74
Q

DTS (dense tubular system)

A

sequesters calcium and contains enzymes that support PLT activation

75
Q

alpha granules

A

alpha granules fuse with SCCS during PLT activation and supports plasma coagulation (50-80 in each PLT)

76
Q

dense granules

A

when PLT is activated, dense granules release contents directly into plasma (2-7 in each PLT)

77
Q

GP Ia/IIa ligand

78
Q

GP VI ligand

79
Q

GP Ib/IX/V ligand

A

VWF and thrombin

80
Q

GP IIb/IIIa ligand

A

Fibrinogen, VWF

81
Q

TP alpha and TP beta ligand

A

thromboxane

82
Q

alpha 2 adrenergic ligand

A

Epinephrine

83
Q

PAR1 and PAR4 ligand

84
Q

P2Y1 and P2Y12 ligand

85
Q

white clot

A

comprised of platelets and VWF -> platelet plug

too many can indicate inappropriate platelet activation

86
Q

red clot

A

formed after coagulation occurs -> stabilized fibrin clot

too many can represent inappropriate coagulation

87
Q

purpose of eicosanoid synthesis pathway

A

reduces cAMP concentration, increases calcium levels, and activate platelets

88
Q

main enzyme of the fibrinolytic system

89
Q

what is plasmin’s main substrate?

Coagulation (5 decks)

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