Lecture - Module 3 Flashcards
1
Q
Involves the activation of plasma proteins (serine proteases) in the coagulation system to form a fibrin meshwork.
A
Secondary Hemostasis
2
Q
A process whereby, on vessel injury, plasma proteins, tissue factors, and calcium interact on the surface of platelets to form a stable fibrin clot. Platelets also interact with fibrin to form a stable platelet-fibrin clot.
A
Coagulation
3
Q
Factor I
A
Fibrinogen
4
Q
Factor Ia
A
Fibrin
5
Q
Factor II
A
Prothrombin
6
Q
Factor IIa
A
Thrombin
7
Q
What type of proteins are Factor I and II
A
glycoprotein
8
Q
Factor III
A
Tissue Factor
9
Q
Factor III when activated is called
A
Thromboplastin
10
Q
What type of protein is thromboplastin
A
lipoprotein
11
Q
Factor IV
A
Calcium
12
Q
Factor V
A
Proaccelerin
13
Q
Factor V is also called as
A
labile factor
14
Q
Also known as Christmas factor
A
Factor IX
15
Q
Stable factor
A
Factor VII
16
Q
Labile factor
A
Factor V
17
Q
Factor VII
A
proconvertin
18
Q
Proconvertin is also known as
A
serum prothrombin conversion accelerator
19
Q
Factor VIII
A
AHF (anti hemophilic factor)
20
Q
AHF is also known as
A
AHG (anti hemophilic globulin)
Anti hemophilic factor A
21
Q
Factor IX
A
PTC (plasma thromboplastin component)
22
Q
PTC is also known as
A
Anti hemophilic factor B
Christmas factor
23
Q
Factor X
A
stuart-prower factor
24
Q
Factor XI
A
PTA (plasma thromboplastin antecedent)
25
PTA is also known as
Anti hemophilic factor c
26
Factor XI is what type of protein
Beta/gamma globulin
27
Factor XII
Hageman factor
28
Hageman factor is also known as
Contact or glass surface
29
Factor XII is what type of protein
sialoglycoprotein
30
Factor XIII
FSF (fibrin stabilization factor)
31
FSF (fibrin stabilization factor) is also known as
Fibrinase
| Laki lorand factor
32
Factor XIII is what type of protein
beta/gamma glycoprotein
33
Prekallikrein is also known as
Fletcher factor
34
High molecular weigh kininogen (HMWK) is also known as
Fitzregald/William/Flaujeac factor
35
Prekallikrein and HMWK is what type of proteins
plasma protein
36
Inactivated form of the coagulation factor
zymogens
37
Substances needed by the enzyme to proceed with the reaction.
Cofactors
38
Activated form of the coagulation factor.
Enzymes/Serine Protease
39
Classifications According to hemostatic function
Zymogens
Cofactor
Enzymes/Serine proteases
40
Requires Vitamin K for its production in the liver.
Prothrombin group/Vit. K dependeng group
41
Factors consumed during the clotting process.
Fibrinogen group/Labile group
42
First factors that are activated during the coagulation process. (Intrinsic pathway)
Contact group
43
Classifications According to Physical properties
Prothrombin/vitamin k dependent group
Fibrinogen/labile group
Contact group
44
Activated by contact with S.E.C.
Intrinsic pathway
45
Activated by contact with Tissue thromboplastin
Extrinsic pathway
46
A cascade that results in the activation of prothrombin that is needed to convert fibrinogen to fibrin.
Common pathway
47
Extrinsic pathway composed of
Factor VII
48
Activated by the release of Tissue factor from the injured vessel into the plasma.
Extrinsic pathway
49
capable of binding to Factor VII, converting it to Factor VIIa
Tissue factor
50
Factor VIIa will then activate
Factor X to Factor Xa
51
Intrinsic Pathway composed of
VIII, IX, XI, XII, HMWK and Prekallikrein
52
Activated when the S.E.C. comes into contact with the coagulation factors
Intrinsic Pathway
53
Negatively charged surfaces are capable of activating
Factor XII
54
Collagen, Elastin
| in vivo or in vitro
in vivo
55
Glass, Kaolin
| in vivo or in vitro
in vitro
56
Starts with the activation of Factor X to Factor Xa by either intrinsic or extrinsic pathway.
Common Pathway
57
Factor Xa, with the help of ____________ will activate ______ to ________
Calcium, PF3 and Factor V
| prothrombin to thrombin
58
Thrombin will then activate
Fibrinogen to become Fibrin
59
Upon the action of ________, Fibrin monomers will be strengthened and produce a stable fibrin clot.
factor XIII
60
Tests the composite action of all plasma factors acting simultaneously
Coagulation Time
61
Clotting time is a measure of the ability of the blood to clot and is not influenced by the platelet functions other than
PF3
62
It also measures only the time required for the formation of the traces of thrombin sufficient to produce a visible clot.
Coagulation Time
63
Types of coagulation time
micromethods
| macromethods
64
2 types of micromethods in coagulation time
SLIDE OR DROP METHOD
| CAPILLARY or DALE AND LAIDLAW’S METHOD
65
Puncture the ring/middle finger
Start timer then transfer blood to slide every 30 seconds.
Observe for fibrin string.
SLIDE OR DROP METHOD
66
Collect non-heparinized blood
Start timer and fill 3 capillets
After 30 secs, break the capillet
Observe for fibrin string.
CAPILLARY or DALE AND LAIDLAW’S METHOD
67
Superior for there is less contamination of the plasma with tissue fluids when blood is drawn from a vein.
Macro Methods
68
Test in macromethods of coagulation time
Lee-White Method or Whole Blood Clotting Time
69
Wash the test tube using sterile NSS
Collect 3 ml of blood and transfer it to the test tube
Every 30 secs, tilt the tube and observe for clot.
Lee-White Method or Whole Blood Clotting Time
70
Normal value in Lee-White Method or Whole Blood Clotting Time
5-10 minutes
71
More sensitive method than the coagulation time of whole blood because there is an activator added.
Plasma Recalcification Time
72
May reveal abnormality which is not detectable by the determination of the clotting time of venous blood.
Plasma Recalcification Time
73
The activated recalcification time makes use of
0.025 M CaCl2
74
NORMAL VALUE in plasma recalcification time
Less than 50 seconds
75
Test for the INTRINSIC and COMMON pathways of coagulation
Partial Thromboplastin Time
76
Calcium ions and phospholipids that substitute for platelet phospholipids are added to blood plasma.
Partial Thromboplastin Time
77
Partial Thromboplastin Time Detects deficiencies in
Factors XII, XI, IX, VIII
78
Measures the EXTRINSIC and COMMON pathway of coagulation
Prothrombin Time
79
It is used to monitor oral anticoagulant therapy
Prothrombin Time
80
Used to detect VII deficiency.
Prothrombin Time
81
Prothrombin Time NORMAL RANGE
10-14 seconds
82
The prothrombin time is therefore prolonged if there is a deficiency of
Factors V, VII or X
| severe defieciency of Factor I and II
83
Prothrombin Time NORMAL RANGE
10-14 seconds
84
Similar to PTT test but with the addition of activators to hasten the production of a visible result
Activated Partial Thromboplastin time
85
Activators in aPTT
silica or ellagic acid, kaolin, and phospholipids
86
normal range in aptt
25-35 seconds
87
Measures the time of the conversion of fibrinogen to fibrin clot
Thrombin time
88
Evaluation of a prolonged thrombin time (TT)
| It is mainly used to confirm or exclude the presence of heparin in the specimen or specimen type
Reptilase time
89
Reptilase time uses Reptilase from the snake venom of
Bothrops atrox
90
Reptilase time normal range
18-20 secs
91
What coagulation factor deficiency
Afibrinogenemia
Hypofibrinogenemia
Dysfibrinogenemia
Factor I
92
What coagulation factor deficiency
| Prothrombin deficiency
Factor II
93
What coagulation factor deficiency
| Prothrombin deficiency
Factor II
94
What coagulation factor deficiency
| Hypoprothrombinemia
Factor II
95
What coagulation factor deficiency
| Owren’s Disease
Factor V
96
What coagulation factor deficiency
| Owren’s Disease
Factor V
97
What coagulation factor deficiency
| Parahemophilia
Factor V
98
What coagulation factor deficiency
| Hypoproconvertinemia
Factor VII
99
What coagulation factor deficiency
| Classic Hemophilia
Factor VIII
100
What coagulation factor deficiency
| Hemophilia A
Factor VIII
101
What coagulation factor deficiency
| Royal’s disease
Factor VIII
102
What coagulation factor deficiency
Christmas factor disease
HemoPhilia B
Factor IX
103
What coagulation factor deficiency
| Stuart-Prower disease
Factor X
104
What coagulation factor deficiency
| HemoPhilia C
Factor XI
105
What coagulation factor deficiency
| Rosenthal Disease
Factor XI
106
What coagulation factor deficiency
| Associated with Poor wound healing
Factor XIII
107
Stypven Time also known as
russel's viper venom time
108
Used to distinguish deficiencies of Factor X and those of Factor VII.
Stypven Time (Rusell’s viper venom Time)
109
It is also used to detect deficiencies in prothrombin, fibrinogen and factors V and X.
Stypven Time
110
It differs from prothrombin time in that deficiencies in factor VII are not detected.
Stypven Time
111
Used to detect deficiency in Factor XIII
Duckert’s Test
112
A test used to pinpoint the exact coagulation factor that is deficient
Mixing Studies/Substitution Test
113
inhibitor that inhibits the cascade.
Warfarin
114
In Mixing Studies/Substitution Test, If one or both of the results become normal, what does it indicate
a coagulation factor deficiency is suggested
115
In Mixing Studies/Substitution Test, If the results remain the same, what does it indicate
there might be a presence of an inhibitor eg. Warfarin,
116
Plasma that contains all coagulation factors
fresh plasma
117
Aged plasma does not contain
V
| VIII
118
Adsorbed plasma does not contain
II
VII
IX
X
119
Fresh serum does not contain
I
V
VIII
XIII
120
Fresh serum does not contain
I
V
VIII
XIII
121
Aged serum does not contain
```
I
II
V
VIII
XIII
```
122
most prominent pathway
intrinsic
123
the most important factor according to salvage theory
TF
| VII
124
- induce formation of stable fibrin clot
| - factors that induce coagulation
Procoagulants
125
Stable fibrin clot in vivo, in laboratory it is called
fibrin polymer
126
- first one to be discovered, most abundant of all the coagulation factors
Fibrinogen
127
Most prominent coagulation factor is
thrombin
128
Most coagulation factors came from
liver
129
coagulation factor that is active in intrinsic pathway
| *??
Proconvertin
130
labile, doesn’t swim alone, partners with VWF
Factor VIII
131
antihemophilic factor C, milder than hemophilia A
Factor XI
132
- products of liver, inactive, they are in blood but has no roles unless there is tissue injury
Zymogen or proenzyme
133
4 cofactors/accelerators, will act on the next step for only few seconds
V
III
TF
HMWK
134
Prothrombin group
II, VII, IX, X
135
inhibitors under prothrombin group
protein C and S
136
Prothrombin group - II, VII, IX, X, inhibitors - protein C and S, not procoagulants they are anticoagulant, has same characteristics physically and all of these will be absorbed by
aluminum hydroxide
| barium sulfate
137
major anticoagulant or regulator/inhibitor
Protein C
138
cofactor of Protein C
protein S
139
What factors are not found in adsorbed plasma-
prothrombin or vitamin k dependent group
140
- process in which aluminum hydroxide/barium sulfate are placed to let factors be absorbed, centrifugate is called adsorbed plasma
adsorption
141
Fibrinogen group/labile group consists of what factors
I
V
VIII
XIII
142
elevated amount during pregnancy and other inflammatory conditions
Fibrinogen group
143
not that sensitive to temperature so they are not destroyed at once
contact group
144
Enumerate those under contact group
XI
XII
prekallikrein
high molecular weight kininogen
145
tests that replaced clotting time
PT
| aPTT
146
Deficiency or Inhibitors for intrinsic pathway and common pathway can be detected through
aPTT
| PTT
147
Deficiency or Inhibitors for extrinsic pathway and common pathway can be detected
through
Prothrombin time
148
What assays is APTT
clot-based assays
149
will happen when tissue factor/juice/thromboplastin is released then will activate FVII - FVIIa, then together with FIXa (serine proteases) will activate FX-FX
Extrinsic pathway
150
When factor X becomes Xa and V becomes Va (serine protease) in the presence of calcium and ppl/platelet factor 3 they will now form
PROTHROMBINASE COMPLEX
151
Prothrombinase - prothrombin to thrombin, Factor II-IIa will act on fibrinogen to form fibrin clot but will not happen without what factor
Factor XIII (Transglutaminase)
152
what phase where there activation of factor X - Xa or common pathway
Contact phase
153
Why we don’t like tissue factor/juice to contaminate our blood sample during collection
hasten/make reaction fast, result will be erroneously short
154
what factor has feedback loop mechanism
XIIa (contact factor)
155
Saan unang umaaksyon sa intrinsic pathway ang calcium? -
XIa to convert IX to IXa
156
Routine hema uses what anticoagulant tube
EDTA
157
Anticoagulant for special hema
- heparin
158
Anticoagulant for hemostatic and coagulation test
sodium citrate
159
most used anticoagulant
3.2% buffered sodium citrate
160
what plasma is used in almost all routine test
ordinary plasma
161
prolongs clotting time, slower result
Plastic or siliconized container
162
Factor XIII will become XIIIa because of the presence of
thrombin
163
most abundant, acute phase protein
Fibrinogen
164
abundant hemophilia c is common in
Jewish people
165
more accurate method
| macro or micro
macro
166
In doing Dale and laidlaw’s method what will you be using
| non-heparinized or heparinized
- non heparinized (blue)
167
- anti thromboplastin
Heparin
168
Reagent in PT
complete thromboplastin made up of lypoid/lipoprotein (lungs and brain)
169
reptilase time replace what previous method
thrombine time
170
substrate in TT
fibrinogen
171
for measuring oral anticoagulant, more accurate than PT, derived from a computed formula where we incorporate international sensitivity index there is no unit, able to standardized results between laboratories.
INR - international normalized ratio
172
inferential. used for patients with prolonged pt/aptt to identify which factors are deficient.
Mixing/substitution
173
Patients with prolonged pt/aptt to identify which factors are deficient.
V and VIII -
174
Activated when placed in refrigerator for long time
VII, XI
175
how will you process Aged plasma
plasma from blue tube incubate for 24 hrs at 37 degC
176
4 STAGES IN BLOOD COAGULATION : WATERFALL OR CASCADE THEORY
1. Contact phase
2. activation of common pathway
3. conversion of prothrombin to thrombin
4. formation of stable fibrin clot
177
activated form; enzymes; denoted with subscript small letter “ a”
Serine proteases - Factors IIa, VIIa, IXa, Xa, Xia, XIIa
178
hastens the coagulation factors’ activity
Cofactors/ Accelerators- Factor III, Factor V, Factor VIII, HMWK
179
acted by enzymes/ serine proteases
Substrate- Factor I ( fibrinogen)
180
Transamidase/ Transglutaminase
Factor XIII
181
Preferred anticoagulant
0.109 M ( or 3.2% ) buffered sodium citrate and is with 1:10 dilution (1 part anticoagulant plus 9 parts blood)
182
All tubes for coagulation studies should be
“non-contact” surface, meaning plastic and siliconized container
183
Blood specimens with a hematocrit of 55%, what formula should be done
Amount of sodium citrate = 100 - hematocrit / 595-hematocrit x amount of blood used
184
.Specimen should be centrifuged within
1 hour of obtaining the sample
185
After centrifugation, blood should be removed immediately with what type of pipette and container
plastic or siliconized pipette and stored to a plastic or siliconized container.
186
What fraction of plasma layer should be aspirated.
¾ of the plasma layer should be aspirated
187
For some tests, centrifugation of the sample at a temperature of
2-4degrees Centigrade
188
The buffering effect of red cells is lost when
it is centrifuged and the plasma exposed to air
189
Testing should be done immediately on centrifuged samples or the plasma should be stored at
4 degrees Centigrade for a time not to exceed 2 hours
190
Pipettes, test tubes, and other materials which come in contact with plasma should have a
“non-contact” surface (plastic, siliconized)
191
Specimens should be stoppered always
| TRUE OR FALSE
TRUE
192
Specimens should not be frozen if testing can be done within
2 hours after collection
193
If freezing is necessary, it should be done rapidly at
-20 degrees Centigrade or lower
194
If frozen properly, fibrinogen is stable for at least
4 hours after thawing and survives refreezing and thawing
195
With the exception of platelet function tests, plasma for coagulation testing should be
platelet poor( less than 10X 10 to the 9th/ L)
196
Red cells contain _____ which is released in the plasma may activate the platelets.
ADP
197
automated machines may not be able to detect the
end point on some lipemic or icteric plasma samples
198
platelet-poor plasma (PPP) or ordinary plasma should be stored at
-40 degrees Centigrade or lower
199
platelet-poor plasma (PPP) or ordinary plasma should be initially frozen in
liquid nitrogen or a temperature ofn-80 degrees Centigrade to -40 degrees Centigrade
200
When thawing frozen plasma, it should be
done rapidly in a 37degrees Centigrade incubator or water bath
201
plasma should be stored in
aliquots
202
Normal samples collected collected in evacuated tubes and stored unopened at room temperature for as long as ______ show no significant changes in PT or APTT results.
6 hours
203
If samples are left at room temperature for an extended time, these factors will deteriorate
factors V and VIII
204
factors ___________ will tend to be prematurely activated at refrigerator temperature of ____
Factors VII and XI
| 4 degrees Centigrade
205
Blood preparation for patient's plasma
Mix 4.5 mL blood and 0.5 mL 0.109 M sodium citrate
| Centrifuge at 1500 rpm for 5 minutes
206
Blood preparation for adsorbed normal plasma
Mix 2 mL of plasma and add 0.2 mL adsorbing reagent.
Centriguge at 3,000 rpm for 3 minutes.
Refrigerated plasma should be used within 2 hours.
207
Adsorption – process of removing factors II, VII, IX and X from normal plasma by the use of certain insoluble salts of alkaline earth like
aluminum hydroxide gel, barium sulfate and carbon phosphate.
208
In adsorption, these factors are not adsorbed
Factors XII, V and VIII
209
In adsorbed normal plasma
Mix 2 mL of plasma and add 0.2 mL adsorbing reagent.
Centrifuged at 3,000 rpm for 3 minutes.
Refrigerated plasma should be used within 2 hours.
210
In Aged normal plasma
Collect plasma in the usual manner.
Incubate at 37 degrees Centigrade for 24 hours
Store in aliquots at 20 degrees Centigrade.
211
In Aged normal serum
Collect serum in the usual manner.
Allow to stand at room temperature for 24 hours.
Divide in aliquots and freeze.
212
Preparation for Platelet-poor plasma (PPP)
Mix 9 parts of blood and 1 part of 0.109 M sodium citrate
| Centrifuge at 3,000 for 30 minutes
213
Preparation for Platelet-rich plasma
Centrifuge at 1,500 rpm for 5 minutes
214
Less than 100,000/uL=
abnormally low
215
30,000-50,000=
bleeding possible with trauma
216
Less than 30,000/uL=
spontaneous bleeding possible
217
Less than 5,000/uL=
severe spontaneous bleeding
