Hemostasis - Midterm Wrapup Flashcards by Donny Le

What is Hemostasis?

Balance b/t Bleeding & Clotting

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What’s involved in the Process of Hemostasis?

Vessel Wall

Platelets

Coag. Cascade

Fibrinolytic System

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What are the different layers of Arteries & Veins?

Tunica Adventitia

Tunica Media

Tunica Intima

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What are Capillaries made of?

Single Endothelial Layer

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

Tunica Intima - Endothelial Layer

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Which factors are considered Procoagulants?

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

Tissue Factor - Activates clotting cascade during injury

Vitamin K (Nonherbal Dietary)

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Which Endothelial Factors cause Vasoconstriction?

Thromboxane A₂

ADP

Serotonin

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Which Endothelial Cells cause Vasodilation?

Nitric Oxide

Prostacyclin

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

Tunica Media - Subendothelial

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What is the function of the Tunica Adventitia?

Controls blood flow by Vasodilation via Nitric Oxide & Prostacyclin

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

vWF

Tissue Factor

Prostacyclin

Nitric Oxide

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

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

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What does the Platelet Cell contain?

Mitochondria

Glycogen Stores

Proteins

Calcium

Enzymes

Alpha Granules

Dense Granules

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

vWF

Fibrinogen

Fibronectin

Platelet Factor 4

Platelet Growth Factor

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

Serotonin

ADP

ATP

Histamine

Epinephrine

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

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

Platelets only activated & active w/ tissue trauma

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

False - Platelets have no nucleus, RNA, or DNA

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

Adhesion

Activation

Aggregation

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What happens when there is a Disruption of Endothelial Lining?

Autonomic Vessel Contraction w/ Thromboxane A₂ & ADP

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How does Adhesion work when Forming a Plug?

vWF moves to Endothelial Lining
Glycoprotein Ib (GpIb) Receptors emerge from Platelets
GpIB attaches to vWF, attracting more platelets & making them sticky

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How does Activation happen in the Formation of a Plug?

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

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

Pseudopodia

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

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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What activates Cofactors/Zymogens?

Tissue/Organ Damage

Normally circulates in an Inactive State until Activated

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

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

What is Factor I?

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

What is Factor II?

Prothrombin from the Liver w/ Vit. K Dependency.

What is Factor III?

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

What is Factor IV?

Calcium from Diet that promotes clotting reactions

What is Factor V?

Proaccelerin from the Liver that forms a Prothrombinase Complex Factor X Cofactor

What is Factor VII?

Proconvertin from the Liver w/ Vit. K Dependency

What is Factor VIII?

Antihemophiliac from the Liver w/ No Vit. K Dependency Factor IX Cofactor

What is Factor IX?

Christmas Thromboplastin from the Liver w/ Vit. K Dependency

What is Factor X?

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

What is Factor XII?

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

What is Factor XIII?

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

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

Prekallikrein

What Activates the Extrinsic /Tissue Factor Pathway?

Crushing Injury or Organ Trauma Outside the Vessel Wall

What activates the Intrinsic / Contact Activation Pathway?

Damage to Actual Blood Vessel Initated by Prekallikrein & HMWK

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

Factors 8, 9, 11, 12

How does the Common Pathway Work?

1. Factor X (Stuart) + Factor V(Proaccelerin) = Factor X_V (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

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

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

Why is the Conversion of Prothrombin to Thrombin essential?

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

How does Thrombin act as an Anticoagulant

Prevents Runaway Clots by Releasing tPA Stimulates Proteins C & S Works w/ Antithrombin III to stop coagulation

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

Calcium

What are the 3 Stages of Cell Based Coagulation

1. Initiation 2. Amplication 3. Propagation

What happens in Cell Based Coagulation Amplication?

More Thrombin More Factor 9 on Platelet Surface vWF promotes Aggregation

What happens in Cell Based Coagulation Propogation?

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

What is the First Step of the Fibrinolytic System?

Increase Blood Flow to Injured Site & Remove Procoags, ADP & Thromboxane from vessel

What does Antithrombin III do?

Removes factors from the Clotting Cascade to Disrupt Clotting

What controls the Fibronolysis Process?

Plasma Proteins

What is Plasminogen?

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

What does Plasmin do?

Degrades Fibrin

What stops the Fibrinolysis Process when the Clot is Digested?

Alpha-Antiplasmin & tPA Inhibitor

What are some Antiplatelets?

NSAIDs Persantine Plavix Ticlid

What are some Antifibrinolytics?

Amicar & Tranxemic Acid

What are some Nonherbals that Affect Coagulation?

Vit. E Vit. K CoQ 10 Zinc Omega 3 Fatty Acids

What Herbal Medications can increase Bleed?

Ginko Garlic Ginger Feverfew

What is the Normal Prothrombin Time?

12 - 14 seconds Altered by Coumadin

What is the Normal ACT?

80 - 150 seconds

What is the Normal Fibrinogen Levels?

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

What is the Normal D-Dimer?

\< 500 mg/mL

What are normal Fibrinogen Degradation Product Levels?

\< 10 mcg/mL

What determines Bleeding Time?

Microvascular Contraction & Platelet Function

What is considered Thrombocytopenia?

Platelets \< 100k \< 50k = bleed \< 20k = spont. bleed

Which Pathways are associated with PT/INR?

Extrinsic & Common Pathways

Which Pathways are associated w/ PTT?

Intrinsic & Common Pathways

When should Platelets be given?

Low Risk Sx: \<20k Average Risk Sx: \< 50k CNS Sx: \< 100k

When should FFP be given?

Unable to obtain Pt/INR/PTT Urgent Warfarin Reversal Factor Deficiencies

When should Cryoprecipitate be given?

Fibrinogen deficiency

What is the most common Inherited Coagulation Disease?

Von Willebrand Disease

What causes bleeding in Hemophilia?

Incomplete Clot

What is DIC?

Thrombocytopenia & Depletion of Clotting Factors

How is DIC treated?

Underlying Cause Heparin Supportive Therapy Blood Products

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

**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_