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Liz's Hemostasis/Coagulation > Fibrinolytic System: DIC > Flashcards

Fibrinolytic System: DIC Flashcards

1
Q

Five components of the fibrinolytic system

A
  • Plasminogen
  • Plasmin
  • Plasminogen activators
  • Plasminogen and plasmin inhibitors
  • Fibrinogen/fibrin
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2
Q

Five substances in which plasmin is capable of digesting

A

The fibrinogen group (I, V, VIII, XIII) plus fibrin

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3
Q

What is the general mode of action/function of plasminogen activators?

A

To convert plasminogen to plasmin

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4
Q

What is the primary plasminogen activator and its source of origin?

A

Tissue Plasminogen Activator (TPA) and is found in the endothelial cells that line the vessels (fibrinolytic property of the vascular intima)

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5
Q

What is the consequence of a plasminogen activator deficiency?

A

Thrombosis

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6
Q

What is the general mode of action/function of plasminogen and plasmin inhibitors?

A

Serves as a check on fibrinolysis by forming an irreversible complex w/ plasminogen or plasmin

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7
Q

What is the primary inhibitor of plasminogen?

A

Plasminogen Activator Inhibitor 1 (PAI-1)

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8
Q

What is the primary inhibitor of plasmin?

A

α-2-antiplasmin

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9
Q

What is the consequence of a deficiency in plasminogen?

A

Thrombosis

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10
Q

What is the consequence of a deficiency in plasmin inhibitors?

A

Bleeding

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11
Q

This is a substrate in which plasmin acts upon and involves hydrolytic digestion of this by plasmin to form soluble degradation products

A

Fibrinogen/fibrin

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12
Q

Plasmin has the ability to degrade both fibrinogen and fibrin into a series of well characterized end products known as ____ and ____

A
  • Fibrinogen Degradation Products (FDP)

- Fibrin Degradation Products (FSP)

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13
Q

What are the two early degradation products?

A

Fragments X and Y

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14
Q

What kind of clotting do fragments X and Y do when fibrin acts on them?

A

“Slow clotting”

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15
Q

What are the two late degradation products?

A

Fragments D and E

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16
Q

Fragments D and E have an ____ effect and don’t allow fibrin monomers to line up to form loose bonding

A

Antipolymerization

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17
Q

What are the final split products generated from one fibrinogen molecule?

A

2D and 1E

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18
Q

How are degradation products cleared from the body?

A

?

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19
Q

This is an intermediate degradation product formed when plasmin acts upon fibrin that was transmitted through the action of XIIIa. It is formed because plasmin cannot degrade the cross-linked covalent bonds between the D domains.

A

D-Dimer

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20
Q

Nomenclature for D-Dimer

A

DD or D2E

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21
Q

Clinical significance of a positive D-Dimer

A

Indicates a clot was/is present

22
Q

Two synonyms for DIC (essay)

A
  • Consumption coagulopathy

- Defibrination syndrome

23
Q

Seven clinical states associated w/ DIC (essay)

A
  • OB “complications”
  • Trauma
  • Sepsis
  • Intravascular hemolysis
  • Liver disease
  • Promyelocytic leukemia
  • Burn patients
24
Q

What is the consequence of uncontrolled formation and deposition of fibrin?

A

Leads to thromboses

25
Q

Six coagulation components consumed in clotting

A

I, II, V, VIII, XIII, platelets

26
Q

What is the consequence of the secondary activation of the fibrinolytic system?

A

Leads to bleeding

27
Q

Five coagulation components that are digested by plasmin

A

I, V, VIII, XIII, fibrin

28
Q

Clinical presentation of DIC

A
  • Multiple site bleeding
  • Epistaxis
  • Hematuria
  • Oozing from intravascular sites
  • Petechiae/purpura
  • Renal failure (due to free hemoglobin)
29
Q

Treatment for DIC

A
  • Treat underlying condition
  • FFP and/or platelet txns
  • Heparin therapy
  • Antifibrinolytic therapy (AMICAR)
30
Q

Results of CBC w/ DIC

A
  • Schistocytes

- Decreased platelets

31
Q

Results of a PT and APTT in DIC

A

Prolonged PT and APTT

32
Q

Results of a fibrinogen in DIC

A

Decreased

33
Q

Results of a platelet count in DIC

A

Decreased count

34
Q

Four confirmatory tests for DIC

A
  • Thrombin clotting time (TCT)
  • Reptilase test
  • FDP/FSP
  • D-Dimer
35
Q

Thrombin clotting time

  • Principle
  • Expected result
A
  • ?

- Prolonged b/c it takes longer for fibrinogen to form a fibrin clot

36
Q

Repitlase time

  • Principle
  • Expected result
A
  • ?

- Prolonged, adding reptilase instead of thrombin to plasma

37
Q

FDP/FSP

  • Principle
  • Expected result
A
  • ?

- Positive, more split products and acts as an antithrombin

38
Q

D-Dimer

  • Principle
  • Expected result
A
  • ?

- Positive, fibrinogen is influenced by XIII and DDs are left over

39
Q

Three conditions in which primary fibrinolysis may occur?

A
  • Open heart surgery
  • Metastatic prostate cancer
  • Lightening strike patients
40
Q

Blood smear evaluation

- DIC vs. primary fibrinolysis

A
  • DIC: schistocytes

- Primary fibrinolysis: no schistocytes

41
Q

D-Dimer

- DIC vs. primary fibrinolysis

A
  • DIC: positive

- Primary fibrinolysis: negative

42
Q

Platelet count

- DIC vs. primary fibrinolysis

A
  • DIC: decreased (consumed in clotting)

- Primary fibrinolysis: Normal

43
Q

Blood smear

- DIC vs. TTP

A
  • DIC: schistocytes

- TTP: schistocytes

44
Q

D-Dimer

- DIC vs. TTP

A
  • DIC: positive

- TTP: negative

45
Q

Platelet count

- DIC vs. TTP

A
  • DIC: decreased

- TTP: decreased

46
Q

PT

- DIC vs. TTP

A
  • DIC: prolonged

- TTP: usually normal

47
Q

APTT

- DIC vs. TTP

A
  • DIC: prolonged

- TTP: usually normal

48
Q

in TTP, microthrombi are deposited through the body in microcirculation composed primarily of ____, not fibrin like in DIC. This is PRIMARY hemostasis.

A

Platelets

49
Q

This enzyme is synthesized in the kidney and is secreted mainly by epithelial cells in the urinary tract

A

Urokinase

50
Q

Which factor is derived from contact activation

A

XIIa

Liz's Hemostasis/Coagulation (10 decks)

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