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Pathology Exam 3 > Hemostasis and Coagulation > Flashcards

Hemostasis and Coagulation Flashcards

1
Q

Components of Hemostasis and Coagulation? (4)

A

Endothelial Cells
Platelets
Coagulation Cascade
Clot dissolution

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2
Q

Coagulation cascade forms what?

A

Fibrin

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3
Q

Platelets form what?

A

Primary, secondary platelet plugs

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4
Q

Purpose of endothelial cells in hemostasis?

A

Reversal of antithrombotic properties

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5
Q

Antithrombotic properties of Endothelial cells? (3)

A

Anti platelet effects
Anti coagulant effects
Fibrinolytic effects

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6
Q

In resting state an intact endothelium inhibits what?

A

Binding and coagulation factor activation

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7
Q

In endothelial cells anticoagulation effects are mediated by what?

A

Heparin like molecules associated with the membrane

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8
Q

How do the heparin like molecules associated with endothelial membrane work?

A

They interact with antithrombin 3 to inactivate thrombin

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9
Q

What does Thrombomodulin do?

A

Binds thrombin to activated protein C

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10
Q

What does Protein C do?

A

Inactivates factor 5a and 8a

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11
Q

What cofactor does Protein C need to inactive factors 5a and 8a?

A

Protein S

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12
Q

Tissue factor pathway inhibitor can inhibit what?

A

Factor 10a

Factor 7a tissue factor complex

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13
Q

What vasodilators does endothelial cells produce? (2)

A

Prostacyclin

Nitric Oxide

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14
Q

What are the anti platelet effects of Endothelial cells? (3)

A

Coverage of underlying ECM
Vasodilator production
Adenosine diphosphatase

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15
Q

Adenosine diphosphatase functions how?

A

Degrades ADP

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16
Q

Fibrinolytic effects of Endothelial cells?

A

Synthesizes tissue type plasminogen activator

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17
Q

How does tissue type plasminogen activator work?

A

Promotes fibrinolysis

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18
Q

Initiation of blood clotting is done by what steps? (4)

A

Exposure of ECM (Collagen)
Release of tissue factor
Activation of endothelium by bacterial products and cytokines
Stasis

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19
Q

Platelet plug formation results from what? (2)

A

Activation of platelets

Overcoming the anti-trombotic effects of the endothelium

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20
Q

What are the endothelial cells prothrombotic properties? (3)

A

Production of VonWillebrand factor
Formation of tissue factor
Secretion of plasminogen activator inhibitors

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21
Q

Von Willebrand Factor does what?

A

Binds platelets to ECM

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22
Q

Deficiency in Von Willebrand Factor results in what?

A

Bleeding

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23
Q

What counts as Tissue Factor? (2)

A

Bacterial Endotoxin

Cytokines (IL-1, TNF)

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24
Q

Platelet plug stabilized by what?

A

Fibrin

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25
Q

How does the platelet plug bind to exposed collagen?

A

Von Willebrand Factor bridging

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26
Q

Where is Von Willebrand Factor stored?

A

Weibel Palade bodies

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27
Q

Via what receptor does VWF bind platelet to collagen?

A

gp1b receptor

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28
Q

Bernard-Soulier syndrome is a defect of what?

A

VWF or its receptor gp1b

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29
Q

Platelet activation and secretion requires what?

A

Ca++

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30
Q

Platelet activation results in the secretion of what?

A

Thromboxane from a.a. release

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31
Q

Platelets contain what type of granules that express P-selectin?

A

Alpha granules

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32
Q

Stimulators of Platelet aggregation? (3)

A

ADP
TxA2
Thrombin

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33
Q

ADP is a highly potent mediator of what?

A

Platelet aggregation

34
Q

Thromboxane A2 cause what in blood vessels?

A

Vasoconstriction

35
Q

Thrombin is formed by activation of what?

A

Activation of coagulation cascade

36
Q

Where does thrombin bind?

A

Thrombin receptors on platelets

37
Q

How do platelets bind to each other?

A

Bidirectionally through binding of fibrinogen to Gp2b-3a

38
Q

At which stage is platelet aggregation reversible and when is it irreversible?

A

Reversible when initial aggregation forms primary hemostatic plug
Irreversible when platelet plug contracts to form secondary hemostatic plug

39
Q

Platelet plug stabilized by what?

A

Fibrin

40
Q

Where does fibrin bind on platelet plug?

A

Fibrin binds Gp 2b/3a

41
Q

What cleaves fibrinogen?

A

Thrombin (End result of coagulation cascade)

42
Q

Fibrin split products formed by what? What do they cause?

A

Formed by action of plasmin

Results in further chemotaxis of neutrophils

43
Q

Coagulation factors circulate as what?

A

Inactivated serine proteases

44
Q

Difference between extrinsic and intrinsic system?

A

Extrinsic has factor 7, intrinsic has factor 9

45
Q

What factors can activate factor 10?

A

7a or 9a

46
Q

What activates prothrombin (factor 2)?

A

10a and activated co-factor 5

47
Q

What activates fibrinogen to fibrin?

A

Thrombin

48
Q

What factor cross links Fibrin?

A

Factor 13

49
Q

Inhibitors of thrombin? (4)

A

Thrombomodulin
Factor C
TFPI
Antithrombin

50
Q

What activates factor 7?

A

Tissue factor released from tissue or endothelial cell injury

51
Q

Hereditary absence of factor 8 or 9 results in what?

A

Hemophilia

52
Q

The two different cascades meet at what point in cycle?

A

Activation of Factor 10

53
Q

Factor 10a needs what to make prothrombin into thrombin

A

co factor 5a

54
Q

thrombin activates which co-factors? (3)

A

8
5
13

55
Q

Thrombin binds to what to inhibit further thrombin synthesis?

A

Thrombomodulin to activate protein C

56
Q

How doe Thrombin affect the protease activated receptors on cells?

A

Clips the end of the receptor to result in conformational change

57
Q

Thrombin binding to receptor results in whaT?

A

Local inflammatory cell effects

58
Q

What degrades fibrin?

A

Plasmin

59
Q

Plasmin is a good measure of what?

A

Ongoing activation of coagulation system (DIC)

60
Q

Antithrombin 3 inhibits what? (2)

A

Thrombin

Serine Proteases

61
Q

What activates antithrombins?

A

Binding heparin like molecules on endothelial cells

62
Q

Proteins C and S are what?

A

Natural Anticoagulants

63
Q

Proteins C and S dependent on what?

A

Vitamin K

64
Q

Protein C and S inactivates what?

A

Co-factors 5a and 8a

65
Q

Tissue factor pathway inhibitor inactivates what? (2)

A

Factor 10a and tissue factor (7a)

66
Q

What activates plasmin? (3)

A

Plasminogen
Urokinase like plasminogen activators
Tissue type plasminogen activators

67
Q

When does urokinase like plasminogen activators activate plasminogen?

A

Fluid phase

68
Q

When is tissue type plasminogen activators activated?

A

When bound to Fibrin

69
Q

What are the platelet antagonists? (3)

A

Aspirin
Clopidogrel
Gp2b-3a blockers

70
Q

What does aspirin inhibit?

A

Cyclo-oxygenase

Thromboxane synthesis

71
Q

Aspirin effect on platelets reversible or irreversible?

A

Irreversible, takes several days to replace platelets

72
Q

What dose do you want to give aspirin in?

A

Low dose, high dose inhibits prostacyclin

73
Q

How does Clopidogrel work?

A

Inhibits binding of ADP to low-affinity platelet receptor and subsequent activation to Gp2b/3a

74
Q

Gp2b-3a blockers used to prevent what?

A

Secondary thrombosis

75
Q

Abciximab does what?

A

Binds to Gp2b-3a receptor

76
Q

Which heparin weight works better?

A

Low molecular weight works better than unfractionaled heparin

77
Q

Fondaparinux is a selective inhibitor of what?

A

Factor 10 inhibitor

78
Q

Coumadin and warfarin prevents what?

A

Carboxylation of factors 2, 7, 9, and 10

79
Q

what are some of the Fibrinolytic enzymes? (4)

A

Streptokinase
Urokinase
tissue plasminogen activator
Third generation agents

80
Q

Reteplase preferentially activates what?

A

Fibrin bound plasminogen

Pathology Exam 3 (10 decks)

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