Hematology Week 1: Secondary Homeostasis Flashcards
Secondary Hemostasis AKA
Coagulation
Primary hemostasis
- platelet plug formation platelets adhere to collagen in the subendothelium and become activated
- forms surface for coagulation reactions
- localizes fibrin formation at the injury site
Secondary Hemostasis
Coagulation formation
Fibrin Clot formation
Overall system of Vascular injury
1st vasoconstriction
2nd exposure of sub-endothelial (collagen)
3rd exposure of tissue factor
Key points of secondary hemostasis
Without platelets
coagulation reactions cannot occur
Coagulation factors
Factor VI was removed because it is the active form of factor V
Textbook representation of coagulation
Physiologic pathway of coagulation
FVIIa activates
FX
FIX
FXI activates
FIX
Activators of FIX
FVIIa
FXI
FIX in complex with FVIII Activates
FX
massive amplification
FXa in complex with FV activates
Prothrombin to Thrombin
massive amplification
Integrated Mass Activation Process of Hemostasis: First Minute & Second Minute
Integrated Mass Activation Process of Hemostasis: 2-20 minutes and Hours-days
No factor XIII
No crosslinking of fibrin by factor XIII so will clot fine but then the clot will break open
Clinical Signs Associated with bleeding
Platelet and vWD Defects
7 listed
Clinical Signs Associated with bleeding
Coagulation Defects
6 listed
Identify
Hematoma
Identify
Missing FXIII bleeds into muscle and bone space
Identify
bleeding into knees
Identify
Severe knee bleeding
Identify
knee fusion from knee bleeding and not walking or moving it
Identify
bleeding in the abdomen’s surface
Coagulation Lab Values
Pre-Analytical Variables
How the blood is collected, processed and stored can produce erroneous results
Laboratory tests of coagulation
7 listed
Coagulation specific Tests
2 listed
- Specific Factor Assays
- Dependent on abnormal screening results
Global Clotting Assays based on PT and PTT
PT AKA
Pro Time
PT is often used for?
Commonly used to Monitor coumadin and warfarin
Procoagulant Proteins Vitamin K Dependent
- Prothrombin
- Factor 10
- Factor 7
- Factor 9
Anticoagulant proteins vitamin K-dependent
- Protein C
- Protein S
Vitamin K function in dependent coagulation proteins
Vitamin K carboxylates coagulation proteins posttranslationally to allow that molecule to bind to a phospholipid surface in the presence of Ca2+
Warfarin makes them non-carboxylated
Vitamin K deficiency makes non-carboxylated
Warfarin
Must monitor once a month
INR
International Normalized Ratio
PTT AKA
Partial Thromboplastin Time
PTT uses
Mixing Studies
mixing patient plasma with normal plasma
mix it
want to see if it corrects or fails to correct and prolongs
PTT Mixing Studies Interpretations
Coagulation Abnormalities Disorders
Coagulation Levels
Hemophilia
Hemophilia Genetics
Both hemophilia A and B are on X chromosome
Factor 8 Deficiency AKA
Hemophilia A
Factor 8 Deficiency
Factor 9 Deficiency AKA
Hemophilia B
Factor 9 Deficiency
Clinical Classification of Hemophilia
Factor 11 Deficiency AKA
Hemophilia C
Hemophilia C common in this ethnic group
ashkenazi jewish
Factor 11 Deficiency
Laboratory findings of Hemophilia
Genetics of Hemophilia
Causes of death of hemophiliacs
Inhibitor Formation in treatment of Hemophilia
antibody to Factor 8
Inhibitor testing in Hemophilia
Complications of hemophilia
Treatment of Hemophilia
New treatments for hemophilia
New treatments for hemophilia B
Coagulation in liver disease Etiology
Viral
Cirrhosis
Liver Transplant processes
Decreased factor synthesis in liver disease and associated major bleeding risks
Hemostatic system in newborns
Hemostatic system in Children
Hemorrhagic Disease of the newborn
sometimes in home births or vitamin k deficient
Mechanism of hemorrhagic disease of the newborn
4 listed
REMEMBER
Most disease processes are associated with hemostatic complications
