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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
Q

How does Scramblase alter the membrane to aid the activation of coagulation factors?

A

Flips membrane so phospholipids are on outside

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26
Q

Which factor is crucial at site of injury and lack of which will result in what disease?

A

Von Willebrand factor

Von Willebrand disease

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27
Q

How is the primary haemostatic plug formed?

A

Platelets bind to fibrinogen via GP IIB/IIIa

Complex then binds to vWF

28
Q

What occurs simultaneously to formation of primary haemostatic plug?

A

Coagulation activation

29
Q

Define haemostasis

A

Fibrin formation

30
Q

What is a zymogen?

A

A molecule in an inactivated form

31
Q

Name the zymogen form of fibrin

A

Fibrinogen - cleaved by thrombin

32
Q

Which factor is deficient in Haemophilia A?

A

Factor VIII

33
Q

Which factor is deficient in Haemophilia B?

A

Factor IX

34
Q

Haemophilia leads patients prone to

A

Bleeding

35
Q

Which therapy prevents coagulation factors being activated?

A

Antithrombotic therapy

36
Q

Which substances are produced by the extrinsic coagulation cascade?

A

Thrombin

Fibrin

37
Q

Which part of the coagulation cascade produces a greater amount of thrombin?

A

Intrinsic

38
Q

Describe the extrinsic coagulation cascade

A

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
Q

Factor VIIa activates which clotting factor

A

Factor X

Converted to Xa

40
Q

Factor Xa activates which clotting factor

A

Factor V

Converted to Va

41
Q

Factor Va activates which conversion

A

Prothrombin to thrombin

42
Q

Describe the intrinsic coagulation cascade

A

Activated by thrombin

Factor XI is converted to XIa
IXa and VIIIa activate X to Xa
Follows extrinsic cascade

43
Q

Intrinsic cascade is activated by?

A

Thrombin

44
Q

Name 3 natural anticoagulants

A

Tissue Factor Pathway Inhibitor (TFPI)
Activated Protein C and Protein S as cofactor
Antithrombin

45
Q

Mechanism of TFPI

A

Converts Xa and VIIa back to inactive form

46
Q

Protein C and S bind which 2 factors

A

Bind VIIIa and Va

47
Q

Antithrombin binds which 2 factors

A

Xa and thrombin

48
Q

Which proteases are involved in fibrinolysis

A

tPA and uPA

49
Q

What does tPA cleave?

A

Plasminogen to Plasmin

50
Q

At which site does tPA cut to cleave plasminogen to plasmin?

A

Serine site

51
Q

What effect does plasmin have on clots?

A

Causes it to fragment producing FDP

52
Q

Name an FDP

A

D-dimer

53
Q

Which diagnosis does D-dimer exclude?

A

DVT in low risk patients

54
Q

Liver transplant causes a short term excess of?

A

Antiplasmin alpha 2

55
Q

Function of antiplasmin alpa 2

A

Inhibits plasmin
Clotting increased
Thrombosis

56
Q

Which enzyme and therefore process does aspirin inhibit?

A

COX

Aggregation

57
Q

What do Clopidogrel, Prasugrel and Ticagrelor inhibit?

A

ADP PY212 Pathway

Prevents aggregation

58
Q

What is inhibited by Abciximab, Tirofiban, Eptifibatide?

A

GPIIb, GP IIIa

Inhibits binding of fibrinogen

59
Q

Name a few conditions in which Antithrombotic drugs would be used

A 
TIA
Stroke
NSTEMI
STEMI
Diabetes
Hypercholesterol
60
Q

Typical management of conditions where there is thrombotic risk

A

Primary and secondary prevention
May combine drugs
Stenting ; combine aspirin and ticagrelor to prevent clot

61
Q

What would happen to a patients antithrombotic medication if surgery was required?

A

Cease medication

62
Q

Which clotting factors does Warfarin inhibit?

A

F II, VII, IX , X

63
Q

What do the clotting factors inhibited by Warfarin have in common?

A

F II, VII, IX , X

All Vitamin K dependent factors

64
Q

Which factor is knocked out by heparin?

A

Factor Xa

65
Q

What has increased activity and is bound by heparin?

A

Antithrombin

66
Q

Rivaroxaban, Apixaban and Edoxaban inhibit which coagulation factor and at which site?

A

Xa

Serine site

67
Q

What is inhibited by Dabigatran?

A

Thrombin

Haematology (7 decks)

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