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BMS Exam 6 > Hemostasis and Blood Coagulation > Flashcards

Hemostasis and Blood Coagulation Flashcards

1
Q

Hemostasis refers to the process by which _____

A

active bleeding is stopped.

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2
Q

Hemostasis occurs in four general steps:

A

○ Constriction/spasm of the damaged blood vessel
○ Formation of a Platelet Plug
○ Blood clot formation via coagulation
○ Reinforcement of clot with Fibrin

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3
Q

Primary hemostasis occurs at the level of the _____

A

Platelets

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4
Q

Seconday hemostasis occurs at the level of the ______

A

Coagulation factors

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5
Q

Platelet lifespan

A

7-10 days

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6
Q

Platelets contain mitochondria, smooth endoplasmic reticulum, and many _____

A

granules filled with clotting factors and cytokines.

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7
Q

Platelet Granules secrete various substances:

A

○ Adenosine Diphosphate (ADP)-
○ von Willebrand Factor (vWF)-
○ Fibrinogen-

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8
Q

Adenosine Diphosphate (ADP)- binds to receptors on other platelets, _____

A

activating/recruiting.

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9
Q

von Willebrand Factor (vWF)- Also secreted by damaged endothelium, binds ____

A

exposed collagen to platelet surface glycoproteins.

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10
Q

Fibrinogen- Already present in
plasma as well, precursor to ____

A

Fibrin.

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11
Q

Granule glycoproteins

A

Glycoprotein Ib-
Glycoprotein IIb/IIIa-

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12
Q

These glycoproteins bind to plasma Thrombospondin and Fibrinogen, which contribute to Platelet Aggregation

A

Glycoprotein IIb/IIIa-

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13
Q

A cell surface protein that vWF is able to bind, adhering the platelet to the endothelium.

A

Glycoprotein Ib-

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14
Q

Formation of the platelet plug involves several steps:

A

1) Endothelial injury
2) Exposure and Adhesion
3) Activation (of platelets)
4) Aggregation (of platelets)

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15
Q

Describe process of platelet plug

A

See slide 16-19

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16
Q

The platelet plug is fairly _____

A

unstable

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17
Q

Last step in primary hemostasis

A

Thrombospondin and Fibrinogen cross-link
together, clumping one platelet to a nearby platelet. (E)

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18
Q

Coagulation via the Coagulation Cascade/Network converts the Platelet Plug into _____

A

a more stable clot.

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19
Q

Extrinsic Pathway is Activated by the presence of a protein called _____.

A

Tissue Factor

20
Q

Tissue Factor binds to _____, activating it
(VIIa); This complex then catalyzes the activation of Factor X.

A

Factor VII

21
Q

Intrinsic Pathway is Activated by exposure to _____ located around damaged endothelium.

A

collagen fibers

22
Q

there is some cross activation of ____ as well from both pathways.

A

Factor IX

23
Q

Ultimately, the end result or goal of both the Intrinsic and Extrinsic Pathways is to activate ______.

A

Factor X (Xa)

24
Q

In the Common Pathway, The activated Factors IX (IXa) and VII (VIIa) help to facilitate
the activation of _____

A

Factor X.

25
Q

Activated Factor X helps to convert ____ to _____.

A

Prothrombin; Thrombin

26
Q

Thrombin facilitates the conversion of the inactive ____ to ____.

A

Fibrinogen; Fibrin

27
Q

Once activated, ____ monomers are then stabilized in polymers by ____ and cross-linked together.

A

Fibrin; Factor XIII

28
Q

Nearly all clotting factors are formed in the
liver. ____is essential to help these factors to
mature.

A

Vit K

29
Q

Vit K is continually _____ in the
intestinal tract by bacteria.

A

synthesized

30
Q

Vit K is a key component for the
formation of:

A

○ Factor II
○ Factor VII
○ Factor IX
○ Factor X
○ Protein S
○ Protein C

31
Q

T/F TOO MUCH of either bleeding or clotting can be deadly

A

T

32
Q

Factors that inhibit Primary Hemostasis (Platelet Aggregation)

A

○ Smoothness of the undamaged endothelial lining.
○ Mucosal layer of the endothelium (Glycocalyx) repels clotting factors.
○ Prostacyclin and Nitric Oxide released from uninjured endothelium
that vasodilate healthy endothelium and prevent excessive platelet
aggregation.
■ Keep platelet plug localized to injury

33
Q

Factors that inhibit Secondary Hemostasis (Coagulation Cascade)

A

○ Protein C
○ Protein S
○ Antithrombin III

34
Q

Protein ___ is activated by
Thrombin.

A

C

35
Q

Activated Protein C, with the help of Protein S, inactivates _____.

A

Factor VIII and Factor V

36
Q

_____ is a protein circulating in the plasma and in vascular endothelium, and serves as a coagulation regulator.

A

Antithrombin III

37
Q

Enzymatic breakdown of fibrin in blood clots is called

A

Fibrinolysis

38
Q

Factors involved in Fibrinolysis

A

○ Plasminogen: Inactive protein in the plasma.
○ Tissue Plasminogen Activator (tPA): Present in endothelial cells and minimally in the plasma. Activates Plasminogen into
Plasmin
○ Plasmin: Over time, Plasmin in a clot will degragrades fibrin.

39
Q

Disorders of Primary Hemostasis (Platelets) involve

A

Low platelet count or some form of platelet dysfunction.
Examples:
○ Thrombocytopenia
○ von Willebrand’s Disease
○ Immune (Idiopathic)
Thrombocytopenic Purpura (ITP)
○ Thrombotic Thrombocytopenic
Purpura (TTP)
○ Hemolytic Uremic Syndrome (HUS)

40
Q

Disorders of Secondary Hemostasis (Clotting Factors) involve

A

Factor deficiencies or dysfunctions within the Coagulation Cascade.
Examples:
○ Hemophilia A (VIII)
○ Hemophilia B (IX)
○ Liver Disease-Induced
○ Vitamin K Deficiency

41
Q

In order to evaluate for these disorders of
hemostasis, we generally order a ____

A

Coagulation Panel

42
Q

Coagulation panel items

A

○ CBC (for the Platelet Count)
■ Additional platelet function tests are
available if required
○ Prothrombin Time (PT/INR)
■ Primary evaluates Extrinsic and
Common Pathways
○ Partial Thromboplastin Time (PTT)
■ Intrinsic and Common Pathways

43
Q

Hemophilia A is hereditary bleeding disorder that is considered _____

A

X-Linked Recessive.

44
Q

Pathophysiology of Hemophilia A

A

○ Deficiency in Coagulation Factor VIII.
○ Factor IX is unable to activate Factor X, so coagulation is dysfunctional.

45
Q

Characteristic Signs and Symptoms of hemophilia A

A

○ Experiencing hemorrhages in deep tissue is characteristic.
○ Spontaneous Hemarthrosis – essentially diagnostic!
■ Most common joints are knees, ankles, and elbows
○ Big spontaneous bleeds occur only in severe disease.
○ Mild disease requires a little trauma.

46
Q

definitive diagnosis for hemophilia A

A

Coagulation Factor VIII Assay will show decreased levels.

47
Q

Treatment for Hemophilia A

A

○ Repeated hemarthrosis may lead to joint deformities.
○ Avoid any contact sports, Aspirin, and IM injections.
○ IV infusion of Factor VIII concentrate during acute bleed.
■ Severe cases get 2-3 x / wk prophylactically

BMS Exam 6 (6 decks)

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