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Haematology > Haemostasis- Bleeding and Thrombosis > Flashcards

Haemostasis- Bleeding and Thrombosis Flashcards

1
Q

How much of the population is anticoagulated

A

1/4

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2
Q

What is the main risk coupled with use of anticoagulants?

A

Risk of bleeding

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3
Q

Which factors are activated to form a clot upon damage to a vessel?

A

Platelets
vWF
Coagulation factors

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4
Q

What components are confined to the site of injury?

A

Natural anticoagulants

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5
Q

Which system resolves a clot a week later?

A

Fibrinolytic system

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6
Q

Why are the constituents of blood inactive in the plasma?

A

Prevent adhesion to the endothelium

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7
Q

What is produced by the endothelium to prevent blood constituents sticking to it?

A

Heparins
Thrombomodulin
Nitric oxide
Prostacyclin

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8
Q

Which 2 factors provoke clot formation?

A

Abnormal surface

Physiological activator

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9
Q

Platelets are activated upon binding via receptors to which substance?

A

Sub-endothelial collagen

Exposed when the vessel is damaged

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10
Q

What is released into the circulation once injury occurs to stimulate clot formation?

A

Tissue Factor

Not normally found in circulation

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11
Q

What 2 structures are found on the platelet surface?

A

Glycoproteins - act as binding sites

Cell Surface Receptors

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12
Q

Which substances bind to glycoproteins on platelet surface?

A

vWF
Collagen
Fibrinogen

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13
Q

Which molecules bind to platelet cell surface receptors?

A

ADP
Adrenaline
Thrombin

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14
Q

How are molecules secreted onto the surface of platelets?

A

Through the open canalicular system

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15
Q

Which platelet glycoproteins bind collagen?

A

GP Ia

GP VI

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16
Q

Which platelet glycoproteins bind VWF

A

GP Ib

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17
Q

Which platelet glycoproteins bind fibrinogen?

A

GP IIb

GP IIIa

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18
Q

What cleaves fibrinogen to form fibrin?

A

Thrombin

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19
Q

3As of Clot formation

A

Adherence
Activate
Aggregate

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20
Q

What constituents promote adherence?

A

Collagen binding to GP Ia

vWF binding to GP Ib

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21
Q

What process drives aggregation?

A

Conversion of arachidonic acid to thromboxane –> aggregation

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22
Q

What enzyme catalyses the conversion of arachidonic acid to thromboxane?

A

COX

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23
Q

Which drug acts to inhibit COX?

A

Aspirin

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24
Q

Which drug inhibits ADP binding and the P2Y12 Pathway?

A

Clopidogrel

inhibits arachidonic acid conversion

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25
How does Scramblase alter the membrane to aid the activation of coagulation factors?
Flips membrane so phospholipids are on outside
26
Which factor is crucial at site of injury and lack of which will result in what disease?
Von Willebrand factor | Von Willebrand disease
27
How is the primary haemostatic plug formed?
Platelets bind to fibrinogen via GP IIB/IIIa Complex then binds to vWF
28
What occurs simultaneously to formation of primary haemostatic plug?
Coagulation activation
29
Define haemostasis
Fibrin formation
30
What is a zymogen?
A molecule in an inactivated form
31
Name the zymogen form of fibrin
Fibrinogen - cleaved by thrombin
32
Which factor is deficient in Haemophilia A?
Factor VIII
33
Which factor is deficient in Haemophilia B?
Factor IX
34
Haemophilia leads patients prone to
Bleeding
35
Which therapy prevents coagulation factors being activated?
Antithrombotic therapy
36
Which substances are produced by the extrinsic coagulation cascade?
Thrombin | Fibrin
37
Which part of the coagulation cascade produces a greater amount of thrombin?
Intrinsic
38
Describe the extrinsic coagulation cascade
Factor VII and TF --> VIIa Factor VIIa activates conversion of F X to Xa Xa activates conversion of F V to Va Va activates conversion of prothrombin to thrombin Thrombin cleaves fibrinogen to form fibrin
39
Factor VIIa activates which clotting factor
Factor X | Converted to Xa
40
Factor Xa activates which clotting factor
Factor V | Converted to Va
41
Factor Va activates which conversion
Prothrombin to thrombin
42
Describe the intrinsic coagulation cascade
Activated by thrombin Factor XI is converted to XIa IXa and VIIIa activate X to Xa Follows extrinsic cascade
43
Intrinsic cascade is activated by?
Thrombin
44
Name 3 natural anticoagulants
Tissue Factor Pathway Inhibitor (TFPI) Activated Protein C and Protein S as cofactor Antithrombin
45
Mechanism of TFPI
Converts Xa and VIIa back to inactive form
46
Protein C and S bind which 2 factors
Bind VIIIa and Va
47
Antithrombin binds which 2 factors
Xa and thrombin
48
Which proteases are involved in fibrinolysis
tPA and uPA
49
What does tPA cleave?
Plasminogen to Plasmin
50
At which site does tPA cut to cleave plasminogen to plasmin?
Serine site
51
What effect does plasmin have on clots?
Causes it to fragment producing FDP
52
Name an FDP
D-dimer
53
Which diagnosis does D-dimer exclude?
DVT in low risk patients
54
Liver transplant causes a short term excess of?
Antiplasmin alpha 2
55
Function of antiplasmin alpa 2
Inhibits plasmin Clotting increased Thrombosis
56
Which enzyme and therefore process does aspirin inhibit?
COX | Aggregation
57
What do Clopidogrel, Prasugrel and Ticagrelor inhibit?
ADP PY212 Pathway | Prevents aggregation
58
What is inhibited by Abciximab, Tirofiban, Eptifibatide?
GPIIb, GP IIIa | Inhibits binding of fibrinogen
59
Name a few conditions in which Antithrombotic drugs would be used
``` TIA Stroke NSTEMI STEMI Diabetes Hypercholesterol ```
60
Typical management of conditions where there is thrombotic risk
Primary and secondary prevention May combine drugs Stenting ; combine aspirin and ticagrelor to prevent clot
61
What would happen to a patients antithrombotic medication if surgery was required?
Cease medication
62
Which clotting factors does Warfarin inhibit?
F II, VII, IX , X
63
What do the clotting factors inhibited by Warfarin have in common?
F II, VII, IX , X | All Vitamin K dependent factors
64
Which factor is knocked out by heparin?
Factor Xa
65
What has increased activity and is bound by heparin?
Antithrombin
66
Rivaroxaban, Apixaban and Edoxaban inhibit which coagulation factor and at which site?
Xa | Serine site
67
What is inhibited by Dabigatran?
Thrombin

Haematology (7 decks)

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