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Summer 2020 - APA Foundations 2 - Other > Hemostasis - Midterm Wrapup > Flashcards

Hemostasis - Midterm Wrapup Flashcards

1
Q

What is Hemostasis?

A

Balance b/t Bleeding & Clotting

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2
Q

What’s involved in the Process of Hemostasis?

A

Vessel Wall

Platelets

Coag. Cascade

Fibrinolytic System

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3
Q

What are the different layers of Arteries & Veins?

A

Tunica Adventitia

Tunica Media

Tunica Intima

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4
Q

What are Capillaries made of?

A

Single Endothelial Layer

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5
Q

Which Endothelial layer forms a barrier b/t fluid within the blood vessel & thrombogenic material in the Tunica Media?

A

Tunica Intima - Endothelial Layer

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6
Q

Which factors are considered Procoagulants?

A

Von Willebrand Factor (vWF) - how platelets stick to subendothelium

&

Tissue Factor - Activates clotting cascade during injury

&

Vitamin K (Nonherbal Dietary)

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7
Q

Which Endothelial Factors cause Vasoconstriction?

A

Thromboxane A2

ADP

Serotonin

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8
Q

Which Endothelial Cells cause Vasodilation?

A

Nitric Oxide

&

Prostacyclin

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9
Q

Which Endothelial Layer is Thrombogenic, Active, and contains Collagen & Fibronectin?

A

Tunica Media - Subendothelial

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10
Q

What is the function of the Tunica Adventitia?

A

Controls blood flow by Vasodilation via Nitric Oxide & Prostacyclin

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11
Q

What are the Mediators in the Endothelial Layer or Tunica Intima?

A

vWF

Tissue Factor

Prostacyclin

Nitric Oxide

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12
Q

______ are round, disk-like, and are formed in the Bone Marrow.

A

Platelets - important part of clotting response - homeostasis impossible w/o them

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13
Q

What does the Platelet Cell contain?

A

Mitochondria

Glycogen Stores

Proteins

Calcium

Enzymes

Alpha Granules

Dense Granules

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14
Q

Which factors are part of the Platelet’s Alpha Granules?

A

vWF

Fibrinogen

Fibronectin

Platelet Factor 4

Platelet Growth Factor

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15
Q

What are considered part of the Platelet’s Dense Granules?

A

Serotonin

ADP

ATP

Histamine

Epinephrine

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16
Q

Platelets produce ______, which activate coag factors & influences platelet recruitment

A

Platelets produce thrombin, which activate coag factors & influences platelet recruitment

Platelets only activated & active w/ tissue trauma

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17
Q

True/False: Platelet contain a Nucleus & DNA, but no RNA.

A

False - Platelets have no nucleus, RNA, or DNA

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18
Q

What is involved in the Formation of a Plug for Vessel Injury?

A

Adhesion

Activation

Aggregation

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19
Q

What happens when there is a Disruption of Endothelial Lining?

A

Autonomic Vessel Contraction w/ Thromboxane A2 & ADP

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20
Q

How does Adhesion work when Forming a Plug?

A
  1. vWF moves to Endothelial Lining
  2. Glycoprotein Ib (GpIb) Receptors emerge from Platelets
  3. GpIB attaches to vWF, attracting more platelets & making them sticky
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21
Q

How does Activation happen in the Formation of a Plug?

A

Tissue factors activate Platelets & 2 more Glyycoproteins (IIb & IIIa) emerge from platelets

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22
Q

What is the name of the Cell Feet that shows in Activated Platelets?

A

Pseudopodia

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23
Q

How does Aggregation happen w/ the formation of a plug?

A

Gp IIb & Gp IIIa sticks platelets together to Seal & Heal injured site

&

Platelets release Alpha, Dense, and Contractile Granules, Thrombin, & Procoags

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24
Q

What activates Cofactors/Zymogens?

A

Tissue/Organ Damage

Normally circulates in an Inactive State until Activated

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25
Q

Cofactors in the Clotting Cascade are enzymes w/ the exception of Factor ___ & Factor ___.

A

Cofactors in the Clotting Cascade are enzymes w/ the exception of Factor V & Factor VIII

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26
Q

What is Factor I?

A

Fibrinogen from the Liver that forms clot w/ No Vit. K Dependency

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27
Q

What is Factor II?

A

Prothrombin from the Liver w/ Vit. K Dependency.

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28
Q

What is Factor III?

A

Tissue Factor/Thromboplastin from the Vascular wall & cell membranes.

Factor VII Cofactor

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29
Q

What is Factor IV?

A

Calcium from Diet that promotes clotting reactions

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30
Q

What is Factor V?

A

Proaccelerin from the Liver that forms a Prothrombinase Complex

Factor X Cofactor

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31
Q

What is Factor VII?

A

Proconvertin from the Liver w/ Vit. K Dependency

32
Q

What is Factor VIII?

A

Antihemophiliac from the Liver w/ No Vit. K Dependency

Factor IX Cofactor

33
Q

What is Factor IX?

A

Christmas Thromboplastin from the Liver w/ Vit. K Dependency

34
Q

What is Factor X?

A

Stuart from the Liver that Forms Prothrombinase Complex w/ Factor V and is Vit. K Dependent

35
Q

What is Factor XII?

A

Hageman from the Liver w/o Vit. K. Dependency

36
Q

What is Factor XIII?

A

Fibrin Stabilizer from the Liver that Crosslinks Fibrin w/o Vit. K

37
Q

Which factor is known as Fletcher & Activates Factor XII and Cleaves HMWK

A

Prekallikrein

38
Q

What Activates the Extrinsic /Tissue Factor Pathway?

A

Crushing Injury or Organ Trauma Outside the Vessel Wall

39
Q

What activates the Intrinsic / Contact Activation Pathway?

A

Damage to Actual Blood Vessel

Initated by Prekallikrein & HMWK

40
Q

Which Factors are involved in the Intrinsic / Contact Activation Pathway?

A

Factors 8, 9, 11, 12

41
Q

How does the Common Pathway Work?

A
  1. Factor X (Stuart) + Factor V(Proaccelerin) = Factor XV (Prothrombinase Complex)
  2. Factor II (Prothrombin) –> Factor IIa (Thrombin)
  3. Factor I (Fibrinogen) –> Factor Ia (Fibrin)
  4. Factor XIII Activation (Fibrin Stabilizing)
  5. All amounts to a stable clot
42
Q

There are the Intrinsic, Extrinisic, and Common Pathways. Which pathway is considered the Terminal pathway?

A

Common Pathway

As the secondary plug leaves, it heals the vessel by weaving the edges together

43
Q

Why is the Conversion of Prothrombin to Thrombin essential?

A

Thrombin recruits Platelets & is necessary for Fibrin to form a stable clot

44
Q

How does Thrombin act as an Anticoagulant

A

Prevents Runaway Clots by Releasing tPA

Stimulates Proteins C & S

Works w/ Antithrombin III to stop coagulation

45
Q

Which Mineral is involved in many parts of the Common Pathway?

A

Calcium

46
Q

What are the 3 Stages of Cell Based Coagulation

A
  1. Initiation
  2. Amplication
  3. Propagation
47
Q

What happens in Cell Based Coagulation Amplication?

A

More Thrombin

More Factor 9 on Platelet Surface

vWF promotes Aggregation

48
Q

What happens in Cell Based Coagulation Propogation?

A

All Factors work together to finally Activate Prothrombin making A LOT of Thrombin, which then promotes Fibrinogen to Fibrin making a secondary plug

49
Q

What is the First Step of the Fibrinolytic System?

A

Increase Blood Flow to Injured Site

&

Remove Procoags, ADP & Thromboxane from vessel

50
Q

What does Antithrombin III do?

A

Removes factors from the Clotting Cascade to Disrupt Clotting

51
Q

What controls the Fibronolysis Process?

A

Plasma Proteins

52
Q

What is Plasminogen?

A

Liver enzyme that is activated and converted to Plasmin by tPA & Urokinase

53
Q

What does Plasmin do?

A

Degrades Fibrin

54
Q

What stops the Fibrinolysis Process when the Clot is Digested?

A

Alpha-Antiplasmin & tPA Inhibitor

55
Q

What are some Antiplatelets?

A

NSAIDs

Persantine

Plavix

Ticlid

56
Q

What are some Antifibrinolytics?

A

Amicar & Tranxemic Acid

57
Q

What are some Nonherbals that Affect Coagulation?

A

Vit. E

Vit. K

CoQ 10

Zinc

Omega 3 Fatty Acids

58
Q

What Herbal Medications can increase Bleed?

A

Ginko

Garlic

Ginger

Feverfew

59
Q

What is the Normal Prothrombin Time?

A

12 - 14 seconds

Altered by Coumadin

60
Q

What is the Normal ACT?

A

80 - 150 seconds

61
Q

What is the Normal Fibrinogen Levels?

A

> 150 mg/dL or 200 - 350 mg/mL

62
Q

What is the Normal D-Dimer?

A

< 500 mg/mL

63
Q

What are normal Fibrinogen Degradation Product Levels?

A

< 10 mcg/mL

64
Q

What determines Bleeding Time?

A

Microvascular Contraction & Platelet Function

65
Q

What is considered Thrombocytopenia?

A

Platelets < 100k

< 50k = bleed

< 20k = spont. bleed

66
Q

Which Pathways are associated with PT/INR?

A

Extrinsic & Common Pathways

67
Q

Which Pathways are associated w/ PTT?

A

Intrinsic & Common Pathways

68
Q

When should Platelets be given?

A

Low Risk Sx: <20k

Average Risk Sx: < 50k

CNS Sx: < 100k

69
Q

When should FFP be given?

A

Unable to obtain Pt/INR/PTT

Urgent Warfarin Reversal

Factor Deficiencies

70
Q

When should Cryoprecipitate be given?

A

Fibrinogen deficiency

71
Q

What is the most common Inherited Coagulation Disease?

A

Von Willebrand Disease

72
Q

What causes bleeding in Hemophilia?

A

Incomplete Clot

73
Q

What is DIC?

A

Thrombocytopenia & Depletion of Clotting Factors

74
Q

How is DIC treated?

A

Underlying Cause

Heparin

Supportive Therapy

Blood Products

75
Q

What is the Difference b/t Type I & II Heparin-Induced Thrombocytopenia?

A

Type I
Non-Immune Mediated from High Dose Heparin w/ a 1-4 day onset

Type II
Immune-Mediated from Low Dose Heparin w/ a 5 - 14 day onset
More Serious & Severe

Summer 2020 - APA Foundations 2 - Other (10 decks)

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