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Pathophysiology - Block 2 > Hemostasis > Flashcards

Hemostasis Flashcards

1
Q

Hemostasis

A

Physiologic coagulation of blood in injured vessels to prevent bleeding.

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2
Q

Describe steps in hemostasis

A
  1. Vascular constriction
  2. Formation of platelet plug
  3. Formation of blood clot
  4. Fibrous organization
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3
Q

Cold water step 1 of hemostasis

A

Injured vessels produce thromboxane A2. Vasoconstrict smooth muscles of vessel.

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4
Q

Cold water step 2 of hemostasis

A

Platelets adhere to exposed subendothelial collagen. Recruit other platelets; fibrinogen assists platelet-platelet adhesion.

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5
Q

Cold water step 3 of hemostasis

A

Intrinsic, extrinsic, and combined pathway form blood clot.

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6
Q

Cold water step 4 of hemostasis

A

Fibroblasts complete organization of clot into fibrous tissue in 1-2wks.

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7
Q

Petechiae

A

Small, purplish, hemorrhagic spots on skin (thrombocytopenia, febrile illnesses).

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8
Q

Purpura

A

Rash where blood cells leak into skin or mucous membranes (disorders of coagulation/thrombosis).

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9
Q

Vasculitis

A

Inflammation of blood vessels

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10
Q

Hematoma

A

Swollen mass of extravasated (us. clotted) blood.

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11
Q

Ecchymosis

A

Superficial bleeding under skin or mucous membrane.

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12
Q

Thrombosis

A

Formation or presence of blood clot within vascular system.

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13
Q

Embolism

A

Sudden obstruction of blood vessel by debris (clot, choloesterol plaque, injected substances).

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14
Q

Infarction

A

Death of tissue from blood supply deprivation.

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15
Q

Describe conversion of prothrombin to thrombin

A

Factor Xa; where intrinsic and extrinsic pathways meet.

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16
Q

Describe conversion of fibrinogen to fibrin

A

Thrombin catalyzes. Fibrin stabilized and solidifies aggregates to final thrombus.

17
Q

Describe lysis of blood clot

A

Fibrinolytic system: plasminogen converted to plasmin - breaks up clot; thrombin triggers thromin-activatable fibrinolysis inhibitor - cleaves fibrin clot.

18
Q

Desribe role of vitamin K in formation of blood clots

A

Required by 5 important clotting factors: prothrombin, Factor VII, IX, X, protein C. Insufficiency can lead to serious bleeding.

19
Q

Hemophilia

A

Bleeding disease of varying severity seen with mild to severe trauma. Treated with Factor VIII or IX (depending on type, but expensive). X-linked; males only.

20
Q

DVT

A

Endothelial surface roughened (arteriosclerosis, infection, trauma) initiating clotting process. Flow of blood is slowed (treated with t-Pa or anticoags).

21
Q

Thrombocytopenia

A

Low platelet count. Purpura on skin. Tx include whole blood transfusion or splenectomy.

22
Q

Pulmonary embolism

A

Part of thrombus breaks off (embolus) and travels through right side of heart blocking pulmonary arteries. Tx t-Pa or anticoags.

23
Q

Disseminated intravascular coagulation

A

Dying tissue or trauma causes release of tissue factor initiating widespread clotting mechanism. Can occlude peripheral vessels. Caused by septicemia.

24
Q

Bleeding test

A

Cuts made on forearm and time to stop bleeding measured. Not sensitive nor specific, can be influenced by meds and thrombocythemia; not commonly used.

25
Q

Platelet count

A

Determine concentration of platelets in blood. Normal range 150-450,000/ul. Below 20,000 = mild spontaneous bleeding.

26
Q

Thrombocythemia

A

Elevated platelet count

27
Q

Thrombocytopenia

A

Decreased platelet count

28
Q

Partial thromboplastin time (pTT)

A

Used to screen for deficiencies and inhibitions of factors in intrinsic and common pathway. Used to assess pts response to heparin therapy.

29
Q

Prothrombin time

A

Time clot takes to form after addition of calcium and thromboplastin (Ca activator). Assess extrinsic and common pathway.

30
Q

D-dimer

A

Antigen formed with fibrin degradation. Used to diagnose or rule out thrombosis in pts. Positive test rules in, but no infor on location. Neg test rules out.

31
Q

Platelet function test

A

Measures ability of platelets to aggregate. (Not worrying about warm water shizz)

32
Q

Mechanisms which prevent excessive thrombosis

A

Fibrolytic system dissolves and remodels fibrin clot.
Natural inhibitors: Antithrombin and vitamin K dependent proteins C and S (inhibit thrombin).
Heparin and antithrombin medication: Inhibit coagulation cascades by speeding up process and inactivating Factors, respectively.
Tissue factor pathway inhibitor: Inhibits extrinsic pathway
PG2 and NO: Generated by endothelial wall prevent thrombosis.
Plasminogen activators: Limit platelet aggregation.

33
Q

Describe hereditary causes of thrombosis

A

Factor V Leiden, Prothrombin mutation, anticoagulation deficiencies, fibrinolytic defects (rare).

34
Q

Describe acquired causes of thrombosis

A

Trauma, medications (OCs), malignancy, orthopedic surgery, infection (rare), thrombocytosis and myeloproliferation, antiphospholipid antibodies.

Pathophysiology - Block 2 (7 decks)

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