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ESA2 > MOD S6 - Haemostasis and Thrombosis > Flashcards

MOD S6 - Haemostasis and Thrombosis Flashcards

0
Q

What does successful haemostasis depend on?

A

Vessel wall
Platelets
Coagulation system
Fibrinolytic system

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1
Q

What is haemostasis?

A

The body’s response to stop bleeding and loss of blood

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2
Q

How do blood vessels allow successful haemostasis?

A

They constrict to limit blood loss

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3
Q

How do platelets allow successful haemostasis?

A

Platelets adhere to the damaged vessel wall and to each other
This forms a platelet plug

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4
Q

How does the coagulation system allow successful haemostasis?

A 
Enzyme cascade (in a series of inactive components, one active component can activate the rest)
Tightly controlled (because 1ml of blood can activate enough thrombin to convert all the fibrinogen in the body into fibrin)
Balance of pro coagulant and anticoagulant forces
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5
Q

How is the coagulation system regulated?

A

Thrombin positively feeds back on factors V, VIII and XI

Thrombin inhibitors: alpha 1 antitrypsin, anti thrombin III, alpha 2 macroglobulin, protein c/s

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6
Q

What genetic factors can interfere with coagulation?

A

Deficiencies in anti thrombin III or protein C/S cause thrombophilia and thrombosis

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7
Q

Describe fibrinolysis

A

Breakdown of fibrin by plasmin
Plasminogen is converted to plasmin by activators eg streptokinase
Fibrinolytic therapy widely used (commonly know as clot busting drugs) as a drastic treatment when thrombi block important blood vessels

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8
Q

Define thrombosis

A

The formation of a solid mass of blood in the circulatory system DURING LIFE

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9
Q

What is Virchow’s Triad?

A

Changes in blood flow - stagnation, turbulence
Changes in vessel wall - atheroma, injury, inflammation
Changes in blood components - smokers, pregnancy

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10
Q

What is the difference between thrombi formed in veins and arteries?

A

Colour - arterial thrombi are pale but venous are a deep red
Consistency - arterial thrombi are granular but venous are soft
Structure - arterial thrombi have lines of Zahnm but venous are gelatinous
Cell content - arterial thrombi have a lower cell content and venous have a higher cell content

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11
Q

What are the effects of thrombi in arterial circulation?

A

Depends of site and collateral circulation
Ischaemia
Infarction

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12
Q

What are the effects of thrombi in venous circulation?

A

Congestion
Oedema
+If pressure of oedemaIschaemia
>Infarction

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13
Q

What are the possible outcomes of thrombosis?

A 
Lysis
Propagation
Organisation
Recanalisation
Embolism
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14
Q

Define lysis (as an outcome of a thrombus)

A

Complete dissolution of thrombus
Fibrinolytic system active
Blood flow reestablished
Most likely when thrombi are small

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15
Q

Define propagation (as an outcome of a thrombus)

A

Progressive spread of thrombus
In veins, progresses proximally
In arteries, progresses distally

16
Q

Describe organisation (as an outcome of a thrombus)

A

Reparative process
Involves ingrowth of fibroblasts and capillaries
Lumen remains obstructed

17
Q

Describe recanalastion (as an outcome of a thrombus)

A

Blood flow reestablished (usually incompletely)

One or more channels form through organising thrombus

18
Q

Describe embolism (as an outcome of a thrombus)

A

Part of the clot breaks off and travels via bloodstream to a distant site
If coronary artery, can cause MI (myocardial infarction)
If lungs, can cause PE (pulmonary embolism)

19
Q

What is an embolism?

A

Blockage of a blood vessel by solid, liquid or gas at a site distant from the site of origin

20
Q

What type of emboli can you have?

A 
Many:
Thrombo-emboli are the most common
Air
Amniotic fluid
Nitrogen
Medical equipment
Tumour cells
21
Q

Where is a thromboembolism originating from a systemic vein likely to cause problems?

A

The lungs

Aka pulmonary embolism

22
Q

Where is a thromboembolism originating from the heart likely to cause problems?

A

Pass via the aorta to renal, mesenteric and other arteries

23
Q

Where is a thromboembolism originating from a carotid artery likely to cause problems?

A

In the brain

Causes a stroke

24
Q

Where is a thromboembolism originating from the abdominal aorta likely to cause problems?

A

In the legs

25
Q

Describe the various severities of PE

A

Massive PE - >60% reduction in blood flow, rapidly fatal
Major PE - medium sized vessel blockage. Shortness of breath, cough, bloody sputum
Minor PE - small, periphery vessels blocked. Shortness of breath or asymptomatic
Recurrent PEs - cause pulmonary hypertension

26
Q

What are some risk factors for a DVT?

A 
Extended bed rest/immobility
Post operative
Pregnancy & post-partum
Oral contraceptives
Severe burns
Disseminated cancer
Cardiac failure
27
Q

How are DVTs treated?

A 
IV heparin (anticoagulant and anti thrombin III cofactor)
Oral warfarin (interferes with vitamin k dependent clotting factors, slow effect)
28
Q

Describe fat emboli

A 
>Can be caused by:
-Breakage of a long bone
-Laceration of adipose tissue
>Symptoms:
-Rash
-Shortness of breath
-Confusion
29
Q

What are the causes and effects of cerebral emboli?

A 
>Causes:
-Atrial fibrillation causes stasis which causes thrombus formation. -Travel in blood to brain if in left atria
>Effects:
-CVE/stroke
-Transient ischaemic attack
30
Q

What is an iatrogenic embolism?

A

An embolus caused by medical treatment eg air embolism from an injection

31
Q

What causes nitrogen emboli?

A

Rapid decompression causes nitrogen bubble formation in the blood
Most common in divers
“The bends”

32
Q

What is disseminated intravascular coagulation (DIC)?

A

Pathological activation of clotting mechanisms
Small clots form throughout body, disrupting normal mechanisms as clotting factors are used up
Abnormal bleeding occurs from the skin
Triggers include infection, trauma, liver disease and obstetric complications

33
Q

Describe haemophilia

A

X linked recessive nonsense point mutation (various severities)
Deficiencies in clotting factors cause impaired clotting
Treat with self administered factor replacement therapy
Can cause:
Muscle bleeding, leading to increased pressure, leading to nerve necrosis (painful)
Haemorrhage into joints, causing synovial hypertrophy and pain
Haemorrhage into retroperitoneum (urinary tract)

34
Q

What’s the difference between type A and type B haemophilia?

A

Type A affects clotting factor VIII

Type B affects clotting factor IX

35
Q

What is thrombocytopenia?

A

Platelet count far below the reference range
Usually accompanied by bone marrow dysfunction (eg leukaemia, anaemia)
Due to either:
-Sequestering of platelets (in which case, may be DIC)
-Failure of platelet production
-Increased platelet destruction

ESA2 (39 decks)

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