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Principles of Physiopathology > Hemostasis and Thrombosis > Flashcards

Hemostasis and Thrombosis Flashcards

1
Q

What is hemostasis?

A

Maintenance of clot-free blood within the vascular system while allowing for the formation of a solid plug of blood under conditions of vessel wall injury (ie. thrombosis)

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2
Q

What are the “key players” in hemostasis?

A
  • Vascular endothelium
  • Platelets
  • Coagulation system
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3
Q

What are some anti-platelet effects of intact endothelium?

A
  • Insulate platelets from subendothelial collagen
  • Prostacyclin (PGI2) synthesis
  • ADPase synthesis
  • Nitric oxide synthesis
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4
Q

What is the function of prostacyclin (PGI2)?

A

Inhibits platelet aggregation

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5
Q

What is the function of ADPase?

A

ADP activates platelets, increased ADP leads to less ATP, platelet aggregation is inhibited

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6
Q

What is the function of nitric oxide?

A

Vasodilation and inhibits platelet aggregation

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7
Q

The intrinsic pathway with CF XII and the extrinsic pathway with tissue factor join in the common pathway to make…

A

fibrin which allows for clot

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8
Q

Does ADP or ATP activate platelets?

A

ADP (not ATP)

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9
Q

What is an anti-coagulant effect of intact endothelium?

A

Heparin-like molecule synthesis

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10
Q

Heparin-like molecule synthesis activates…

A

anti-thrombin III (degrades thrombin)

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11
Q

Without thrombin, fibrinogen cannot join with it to form…

A

fibrin

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12
Q

Normally, thrombin and fibrinogen form…

A

fibrin

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13
Q

Normally, plasminogen and tPA will form…

A

plasmin

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14
Q

Normally, fibrin and plasmin form…

A

fibrin split products

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15
Q

Without plasmin or fibrin, what cannot be formed?

A

Fibrin split products

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16
Q

What is a fibrinolytic property of intact endothelium?

A

Tissue plasminogen activator (tPA) synthesis

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17
Q

What is the function of tPA?

A

Converts plasminogen to plasmin (plasmin degrades fibrin)

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18
Q

What are some pro-thrombotic properties of damaged endothelium?

A
  • von Willebrand’s factor synthesis
  • Tissue factor synthesis
  • Platelet activating factor (PAF)
  • tPA inhibitor synthesis
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19
Q

What is tPAi?

A

Tissue plasminogen activator inhibitor

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20
Q

von Willebrand’s factor is essential for…

A

platelet adhesion

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21
Q

What is the significance of tissue factor synthesis?

A

Glycoprotein activates coagulation system

22
Q

What are considered the “brick” of a thrombus?

A

Platelets

23
Q

What is secreted by platelets when they are activated?

A
  • Thromboxane (TXA2)
  • ADP
  • Factor V
  • Factor VIII
  • Calcium
24
Q

Activated platelets bind to…

A

exposed collagen (vWF)

25
Q

Activated platelets are involved in initiation of…

A

coagulation cascade (role of calcium and phospholipid complex)

26
Q

A temporary “plug” of platelets becomes definitive with…

A

formation of fibrin from thrombin (leads to fused mass of platelets)

27
Q

What activates the coagulation system?

A

Factor XII or tissue factor

28
Q

What is the end product of the coagulation system?

A

Formation of fibrin monomers

29
Q

What is the “cement” of a thrombus?

A

Fibrin

30
Q

Is thrombosis normal or pathological?

A

Pathological

31
Q

What is thrombosis?

A

An aggregate of platelets, fibrin, and blood cells within the non-interrupted vascular system (clot should not be there)

32
Q

Thrombus is adherent to…

A

the vascular endothelium

33
Q

Where may thrombosis arise?

A

Arterial or venous circulation

34
Q

Surgery anywhere increases the risk of…

A

deep vein thrombosis

35
Q

What are the predisposing factors to arterial thrombi?

A

Virchow’s triad:
* Damage to endothelium
* Alterations in blood flow
* Increased coagulability of blood

36
Q

Which aspect of Virchow’s triad is most predisposing to arterial thrombi?

A

Damage to endothelium

37
Q

What are three types of damage to endothelium?

A
  • Ischemic damage to endocardium
  • Valvular damage
  • Free-radical induced damage
38
Q

What are some causes of free-radical induced damage?

A
  • Hemodynamic stress (increased blood pressure)
  • Radiation
  • Trauma
  • Chemicals
  • Microbes
39
Q

Alterations in normal blood flow refer to…

A

role of stasis and turbulence

40
Q

What are the alterations in normal blood flow when endothelium is physically damaged?

A
  • Disrupts laminar flow
  • Prevents renal clearance of coagulation proteins
  • Slows flow of anticoagulants to site of injury
41
Q

What is Leiden Factor V?
What does its defect lead to?

A

A coagulant protein
Factor V can’t shut off coagulation leading to increased risk of thrombosis

42
Q

What are causes of increased coagulability of blood?

A
  • Genetic defect in anticoagulant proteins or coagulant proteins Leiden factor V
  • Inherited hypercoagulability
43
Q

What is the most common genetic hypercoagulability disorder?

A

Activated protein C resistance

44
Q

APC resistance accounts for up to 65% of patients with…

A

venous thrombosis

45
Q

What is activated protein C resistance?

A

A point mutation in the factor V gene (factor V Leiden) renders it resistant to inhibition by APC (can’t turn off coagulation)

46
Q

What is the effect of homocysteine?
What gene prevents metabolization of homocysteine?

A

Homocysteine produces free radicals in the blood
MTHFR gene: can’t metabolize homocysteine

47
Q

When a patient has the MTHFR gene and can’t metabolize homocysteine, what is the effect?

A

Inherited hypercoagulability

48
Q

How does neoplasia lead to hypercoagulability?

A

Releases procoagulants

49
Q

What is the effect of polycythemia vera leading to hypercoagulability?

A

Increased RBC and viscosity

50
Q

How does smoking lead to hypercoagulability?

A

Free radical damage to endothelium

51
Q

How does obesity lead to hypercoagulability?

A

Increased fat increases viscosity

Principles of Physiopathology (36 decks)

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