Lecture 3- Coagulation Flashcards
Primary hemostasis is … … formation
platelet plug
Seconday hemostasis is … … formation
fibrin clot
Response sequence of platelets
adhesion
activation
aggregation
Platelet adhesion involves membrane receptor …. and the adhesive protein…. and the appropriate surface ….
Glycoprotein Ib
von Willebrand Factor (vWF)
Subendothelial matrix (collagen)
In platelet activation, they secrete …. that brings fibrinogen and … which provide ionized calcium and ADP
alpha-granules
dense bodies
Platelet leads to activation of …. receptor and … reorganization and the platelet …. changes
GP IIb/IIIa
phospholipid
shape (rounded discs to flat planes- increased surface area)
3 molecules that counter primary hemostasis (platelets)
NO
Prostacyclin (PGI2)
ADPase
3 molecules that counter secondary hemostasis (coag pathways)
Serine protease inhibitors (antithrombin)
Protein C pathway (controls Va and VIIIa)
Fibrinolytic system (removes excess clot)
Activated … plus …. serve to inactivate factors Va and VIIIa
Protein C (APC)
Protein S
Protein C or Protein S deficiencies result in …
hypercoagulable states
Factor V Leiden mutation promotes…. because of resistance to enzymatic inactivation by the Protein C/S complex
coagulation
In the presence of heparin, ATIII will bind and inactivate….
thrombin (IIa)
and other serine proteases:
IXa, Xa, XIa, XIIa
Regulation of coag:
Antithrombin inhibits….
Protein C inhibits….
Plasmin removes…
serine proteases
cofactors (Va, VIIIa)
excess clot
In the presence of fibrin, … can bind to plasminogen and convert it to plasmin to break down previously cross-linked fibrin monomers into FDP
tPA (tissue plasminogen activator)
Prothrombin time (PT) screens for activity of proteins in the … pathway ( factors 5,7,2,10 and fibrinogen)
extrinsic
In a PT test, … and … are added to patients plasma with…
phospholipid
tissue factor
calcium
PT time is time it takes to form a clot which should be …
11-13 seconds
PT forms the basis of …
which should have a value of … if normal
INR (International Normalized Ratio) patient/control
0.8-1.2
INR is used to monitor patients on…
warfarin
Partial thromboplastin time (PTT) screens for activity within the … pathway (5, 2, 9, 10, 11, 12 and fibrinogen)
intrinsic
PTT often used to monitor patients on…
heparin
In a PTT test, addition of … to patient serum together with calcium
negatively charged activator of Factor XII (kaolin)
In a PTT test, clot is formed after … seconds
28-35
The 3 classifications of vWD are
type 1: quantitative deficiency (partial)
type 2: qualitative deficiency
type 3: quantitative deficiency (total)
Hemophilia is a … … disorder and is a deficiency of …
symptoms are recurrent soft tissue bleeding and symptoms that start in early childhood
X-linked recessive
factor VIII
lab abnormalities in hemophilia A
prolonged PTT
decreased factor VIII
… is a disorder characterized by immune-mediated destruction of platelets.
What are the common targets?
Immune Thrombocytopenic Purpura (ITP)
GPIb/IX and IIb/IIIa
bone marrow and blood findings in ITP
megakaryocytes normal to increased
no microangiopathic changes on blood smear review
ITP therapy (4)
corticosteroids
IV Ig
Immunosuppression
splenectomy
… acute disorder is characterized by intravascular platelet activation with formation of platelet-rich microthrombi throughout the circulation.
Thrombotic Thrombocytopenic Purpura (TTP)
TTP is due to deficiency of… which is a … that normally degrades very high MW vWF
ADAMTS 13
metalloproteinase
