Hemostasis and Related Disorders Flashcards
Release of urokinase activates plasmin
Radical prostectomy
Reduced production of @2-antiplasmin
Cirrhosis of liver
Disruption in blood flow, Endothelial cell damage, Hypercoagulable state
Virchow Triad
Blocks exposure to subendothelial collagen and underlying tissue factor
Endothelial cells
Produces PGI2 and NO
Endothelial cells
Secretes heparin-like molecules
Endothelial cells
Heparin-like molecules
augment ATIII, which inactivates thrombin and coagulation factors
Secretes tPA
Endothelial cells
tPA
converts plasminogen to plasmin
Plasmin
cleaves fibrin and serum fibrinogen, destroys coagulation factors, blocks platelet aggregation
Secretes thrombomodulin
Endothelial cells
Thrombomodulin
REDIRECTS thrombin to activate protein C
Protein C
inactivates FV and FVIII
high homocysteine levels with homocystinuria, vessel thrombosis, mental retardation, lens dislocation, long slender fingers
Cystathionine Beta Synthase Deficiency. Converts homocysteine to cystathionine, without it you get homocysteine build-up.
recurrent DVTs or DVTs at a young age
Hypercoagulable state
mutated form of factor V that lacks the cleavage site for deactivation by protein C and S
Factor V leiden
inherited point mutation in prothrombin that results in increased gene expression
Prothrombin 2010A; excess production of thrombin. Promotes thrombin formation
PTT does NOT rise with standard heparin dosing
ATIII deficiency (need HIGH doses to activated limited ATIII; coumadin then given to maintain anticoag state).
estrogen induces increased production of coagulation factors
Oral Contraceptives
cholesterol clefts in embolus
Atherosclerotic plaque
dyspnea with petechiae on skin overlying chest
Fat embolus
multifocal ischemic necrosis of bone due to nitrogen gas
Caisson Disease (chronic form of decompression sickness: joint and muscle pain ‘bends’ and respiratory symptoms ‘chokes’ due to Nitrogen gas that precipitates out of blood due to rapid ascent by diver.)
Labor or delivery, SOB, neurological sxs, DIC
Amniotic fluid embolus: characterized by squamous cells and keratin debris; tissue thromboplastin in amniotic fluid activates coagulation cascade in mother.
PE in patient with preexsiting cardiopulmonary compromise
Pulmonary infarction (V/Q lung scan shows mismatch where perfusion is abnormal; elevated D-dimer). Hemorrhagic wedge-shaped infarct on gross examination.
