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ESA 2 > MOD 5.1 - Haemostasis and Thrombosis > Flashcards

MOD 5.1 - Haemostasis and Thrombosis Flashcards

1
Q

What is haemostasis?

A

The process that stops bleeding

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2
Q

What are the depending factors of haemostasis?

A
  • Vessel wall
  • Platelets
  • Coagulation System
  • Fibrinolytic System
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3
Q

How do blood vessels contribute to haemostasis?

A
  • Constrict

- Decreases blood volume so limits loss

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4
Q

How do platelets contribute to haemostasis?

A
  • Stick to each other and to the walls of the vessels

- Forms a platelet plug

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5
Q

How does the coagulation system contribute to haemostasis?

A
  • Inactive components become activated in a cascade

- Thrombin converts fibrinogen to fibrin for clotting

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6
Q

What is fibrinolysis?

A
  • Breakdown of fibrin i.e. clots

- Done by plasmin

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7
Q

How is the coagulation system regulated?

A
  • Thrombin positively feedbacks on factors 5, 8 and 11 (so increased Thrombin = increase in specific factors)
  • Thrombin is inhibited by:
  • Antithrombin 3
  • Alpha 1 anti trypsin
  • Protein C/S
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8
Q

What is used in fibrinolytic therapy and what does this achieve?

When in fibrinolytic therapy used?

A
  • Streptokinase, activates plasminogen to be convertedto plasmin
  • Serious cases e.g. coronary artery occlusion
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9
Q

What do hereditary deficiencies in antithrombin 3 or protein C/S cause?

A
  • Thrombophilia (blood is more likely to form clots which increases chance of a DVT)
  • Thrombosis
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10
Q

What is thrombosis?

A

The formation of a solid mass of blood within the circulatory system during life

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11
Q

What are the predisposing factors to thrombosis? (Virchow’s Triad)

A

1) Changes in blood flow (stagnation/turbulence)
2) Changes in blood vessel walls (trauma, atheroma, inflammation)
3) Changes in blood components (Post op, post partum, smoking = increase in coagulation factors)

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12
Q

Describe an arterial thrombus (4)

A
  • Pale
  • Granular
  • Lines of Zahn (alternating lines of platelets mixed with fibrin)
  • Lower cell content
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13
Q

Describe a venous thrombus (4)

A
  • Deep red
  • Soft
  • Gelatinous
  • Higher cell content
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14
Q

What are the differences between a thrombus and a clot?

A

Clot =

  • Physiological/normal
  • Outside of blood vessels

Thrombus =

  • Pathological/not normal
  • In blood vessels
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15
Q

What are the arterial effects of thrombosis? (2)

A
  • Ischaemia
  • Infarction

(depends on site and collateral circulation)

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16
Q

What are the venous effects of thrombosis (4)

A
  • Congestion
  • Oedema
  • Ischaemia (tissue pressure due to oedema > arterial pressure)
  • Infarction
17
Q

What are the outcomes of thrombosis? (5)

A
  • Resolution/lysis
  • Recanalisation
  • Embolism
  • Organisation
  • Propagation
18
Q

Describe resolution/lysis of a thrombus

A
  • Complete breakdown of the thrombus

- Re-establishment of blood flow

19
Q

Describe recanalisation of a thrombus

A
  • Channels form through the thrombus

- Results in partial re-establishment of flow

20
Q

Describe embolism of a thrombus

A
  • Part of the thrombus breaks off

- Blocks a different site

21
Q

Describe organisation of a thrombus

A
  • Reparative process
  • Ingrowth of fibroblasts and capillaries
  • Still obstructs lumen
22
Q

Describe propagation of a thrombus

A
  • Thrombus gets bigger in direction of blood flow
  • Arteries = Distal
  • Veins = Proximal
23
Q

What is an embolism?

A

The blockage of a blood vessel by a solid, liquid or gas at a site that is distant from its origin

24
Q

If 90% of emboli are thrombo-emboli, what makes up the other 10%?

A
  • Air
  • Nitrogen
  • Amniotic Fluid
  • Medical equipment
  • Tumour cells
  • Fat e.g. from a long bone fracture
25
Q

What is the passage of an embolism from the heart?

A
  • Via aorta

- Renal, mesenteric or any other arteries

26
Q

What is the passage of an embolism from systemic veins?

A
  • To lungs via the right heart

- Don’t get stuck in large veins near heart

27
Q

What is the passage of an embolism from atheromatous carotid arteries?

A
  • To the brain (cause of a stroke)
28
Q

What is the passage of an embolism from atheromatous abdominal arteries?

A
  • To the arteries of the legs
29
Q

What are the 4 types of pulmonary embolism?

A
  • Massive PE (more than 60% reduction in blood flow = death)
  • Major PE (medium vessels blocked = shortness of breath, coughing bloody sputum)
  • Minor PE (small peripheral arteries blocked = no symptoms/minor shortness of breath
  • Recurrent PE (pulmonary hypertension)
30
Q

What are some of the causes of deep vein thrombosis? (4)

A
  • Immobility
  • Post-op
  • Post partum
  • Oral contraceptives
31
Q

How are DVTs treated?

A
  • Intravenous heparin (co factor for anti-thrombin 3)

- Oral Warfarin (interferes with vit K dependent clotting factors)

32
Q

How is a cerebral embolism caused?

A
  • Atrial fibrillation –> Stagnation of blood –> Thrombus

- Transient ischaemic attack/stroke if from left heart to brain

33
Q

How is a Iatrogenic embolism caused?

A

Embolism due to medical treatment e.g. air from an injection

34
Q

How is a nitrogen embolism caused?

A

Nitrogen bubble form in blood after rapid decompression e.g. the bends in divers

35
Q

What is disseminated intravascular coagulation?

A
  • Activation of coagulation mechanisms due to disease

- Small clots form throughout body and use up all clotting factors = abnormal coagulation

36
Q

What is haemophilia?

A
  • X-linked recessive disorder due to a nonsense point mutation
  • Type A = deficiency in factor 8
  • Type B = deficiency in factor 9
37
Q

What can haemophilia cause?

A
  • Haemorrhage into major joints
  • Synovial hypertrophy
  • Pain
38
Q

What is thrombocytopenia? What can cause this?

A
  • Platelet count is below reference range
  • Platelets not produced OR;
  • Too many platelets destroyed OR;
  • Sequestering of platelets (being taken up by the spleen

ESA 2 (63 decks)

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