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Foundations II > Hemostasis > Flashcards

Hemostasis Flashcards

1
Q

Layers of the Vessel wall

A
  1. Tunica Intima (vWF, Tissue factor, Prostacyclin, Nitric oxide)
  2. Tunica Media (collagen, fibronectin)
  3. Tunica Adventitia

inner to outer

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2
Q

Endothelial Cell Procoagulants

A

Von Willebrand factor- necessary cofactor for adherence of platelets to the subendothelial layer

tissue factor- activates clotting cascade pathway

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3
Q

Endothelial Cell Vasodilators

A

Nitric Oxide

Prostacyclin

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4
Q

Endothelial Cell Vasoconstrictors

A

Thromboxane A2

ADP

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5
Q

Tunica Media

A

Subendothelial Layer

  • Collagen- potent stimulus for plt attatchment to vessel wall
  • Fibronectin

Very thrombogenic portion of vessel, once exposed coagulation occurs

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6
Q

Endothelial Coagulation Inhibitor

A

Tissue Factor Pathway Inhibitor

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7
Q

Tunica Adventitia

A

Controls blood flow by influencing the vessels degree of contraction

Via: Nitric oxide and prostacyclin

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8
Q

Platelet

A
  • Formed in bone marrow
  • Survives 1-2 weeks
  • Daily platelet use 7.1x10^3
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9
Q

How long does aspirin affect platlets

A

For the life of the platelet

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10
Q

How long should you discontinue plavix

A

~1 week

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11
Q

What type of metabolism do platelets use

A

Anaerobic metabolism via glycogen stores

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12
Q

What substance do platelets produce

A

Thrombin (activates coagulation factors and influences the recruitment of platelets)

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13
Q

Steps of the Clot Formation

A
  1. Disruption of endothelial lining
  2. Vessel wall contraction- Immediate
    • ANS reflex
    • Thromboxane A2
    • ADP
  3. Adhesion
  4. Activation
  5. Aggregation

*Formation of primary plug steps 3-5*

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14
Q

Formation of Primary Plug- Adhesion, Activation, Aggregation

A

Adhesion

  • vWF moblize from the endothelial cells
  • Glycoprotein Ib receptors emerge from platelet
  • GpIb attatches to vWF
  • vWF makes platelets “sticky” all allows them to adhere

Activation

  • Tissure factor activates platelet and two additional glycoproteins emerge (IIb, IIIa)
         \*legs that stick out and start sticking to eachother\*

Aggregation

  • GpIIb-IIIa links activated platelets together (aggregation), platelets mound together and form a plug
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15
Q

Which cofactors are not enzymes

A

Factor V and VIII

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16
Q

What activates zymogens (cofactors)

A

Tissue/ organ damage leading to major blood loss

*clotting cascade seperate from platelet plug formation

17
Q

Extrinsic clotting pathway is activated by what

A

Injury OUTSIDE the vessel wall (organ trauma)

Trauma–> Factor III (tissue factor) –> Factor VII (procovertin) –> Factor X (Start of common pathway)

“For 37 cents you can purchase the extrinsic pathway”

18
Q

What factors activate Intrinsic pathway

A

Initiated when damage occurs to the blood vessel

Factor XII, XI, IX, VIII

“If you can’t buy the intrinsic pathway for 12$ you can get it for $11.98”

19
Q

Common Pathway

A

Formation of X (always the beginning of Common pathway)

Activation of Factor II- prothrombin –> THROMBIN

Activation of Factor I - Fibrinogen–> Fibrin

Activation of Factor XIII- Fibrin Stablizing

*Stable clot*

[Factors V, X, I, II, III, XIII]

“The final common pathway can be purchase at the five and dime for one, two, or three dollars on the 13th of the month”

20
Q

Prothrombin gets converted to what?

A

Thrombin

This is an important step for both pathways

Thrombin activates Factors V, VIII, I XIII

Recruits platelets to injured area

*Adequate thrombin must be present to activate sufficient fibrin to form a stable or secondary clot

21
Q

Purpose of the Fibrinolytic System

A

Increase blood flow to area and degrade fibrin to break down the clot

22
Q

Main component of the Fibrinolytic System

A

Thrombin (was a coagulant but now acts as an anticoagulant)

*Prevents runaway clot formation by release of tissue plasminogen activator (tPA) from endothelial cells

Other:

Protein C and Protein S (inhibit III, V, VIII)- extinsic and intrinsic factors

Antithrombin III

Inhibits thromin activity by sequestering factors (XII, XI, IX, and X) Disrupts clot formation

*Heparin enhances antithrombin*

Tissue Factor Pathway Inhibitor (stops the action of tissue factor)

23
Q

Plasminogen

A

In the presence of tPA and urokinase it becomes activated into plasmin

Plasmin degrades fibrin into fibrin degredation products

24
Q

Most common inherited coagulation disorder

A

Von Willebrand Disease

vWF has 2 functions- facilitate platelet adhesion and behave as a plasma carrier of factor VIII

25
Q

Hemophilia symptoms

A

Bleeding into joints, swelling into joints

26
Q

Sickle Cell Management

A

AVOID sickling crisis

Hydration, at least 50% oxygen, Ventilate for normocapnia, maintiain o2 sat 95% at all times, Transuse if necessary but avoid Hb > 11, maintain normothermia

Foundations II (2 decks)

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