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Perio and Path > Overview of Hemostasis and Thrombosis > Flashcards

Overview of Hemostasis and Thrombosis Flashcards

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1
Q

Vascular injury leads to what to events that will both lead to the formation of a hemostatic plug?

A

Platelet activation and Coagulation activation

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2
Q

What are the 3 steps of platelet function?

A

adhesion -> Activation -> Aggregation

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3
Q

What are the 3 steps in coagulation?

A

Activation -> Thrombin Formation -> Fibrin formation, polymerization and Stabilization

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4
Q

What is Primary Hemostasis?

A

Platelet plug formation

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5
Q

What is secondary Hemostasis?

A

Fibrin Clot formation (coagulation cascade) Thrombin -> fibrin, with cross linking of fibrin by factor XIIIa

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6
Q

What is the Membrane receptor for Primary hemostasis?

A

Glycoprotein Ib

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7
Q

What is the adhesive protein for Primary hemostasis?

A

Von willebrand factor

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8
Q

What is the appropriate surface for primary hemostasis?

A

Subendothelial matrix

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9
Q

What are the regulators of Secondary Hemostasis?

A
  • serine protease inhibitors (antithrombin)
  • Protein C pathway (controls Va and VIIIa)
  • Fibrinolytic system (removes excess clot)
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10
Q

What are regulators of Primary Hemostasis?

A
  • NO
  • Prostacyclin (PGI2)
  • ADPase
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11
Q

How do Antithrombins ?

A

they basically bind to serine proteases and thrombin and inhibit their action. (SERPIN and HEPARIN both do this)

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12
Q

How does the Protein C system work as a regulator of Secondary hemostasis?

A

Activated Protein C plus protein S serve to inactivate factors Va and VIIIa.

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13
Q

What happen is there is a deficiency in Protein S or C?

A

Results in hypercoaguable states

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14
Q

______ is resistance to inactivation by Protein S and C.

A

Factor V leiden mutation

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15
Q

How does plasmin regulate secondary hemostasis?

A

Removes excess fibrin clot

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16
Q

What are the screening tests of Hemostasis?

A
  • Prothrombin time
  • International Normalized Ratio
  • Partial Thromboplastin time
  • Platelet count
  • Bleeding time
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17
Q

How does the Prothrombin time test work?

A
  • it screens for activtity of proteins in the EXTRINSIC pathway (Factors V, VII, II, X and fibrinogen)
  • Phospholipid and TF are added to patients plasma with Ca++
  • Time to form clot is noted (11-13 secs)
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18
Q

How does the Partial Thromboplastin time test work?

A

Screens for activity within the INTRINSIC pathway (Factors XII, XI, IX, VIII, X, V, II and fibrinogen)

  • Addition of negatively charged activator of factor XII to patient serum with Ca++
  • Clot is formed after 28-35 seconds
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19
Q

What are the Classifications of bleeding disorders?

A
  • Congenital vs. Acquired
  • Mild vs. Severe
  • Primary vs Secondary
  • Regulatory disorder
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20
Q

What are the clinical and lab findings of bleeding disorders of Primary Hemostasis?

Study These Flashcards
A

Clinical:

  • Mucocutaneous bleeding
  • Excessive bleeding with trauma

Lab:

  • Prolonged BT/PFA-100
  • Thrombocytopenia
21
Q

What are the clinical and lab findings of bleeding disorders of Secondary hemostasis?

Study These Flashcards
A

Clinical:

  • Soft tissue bleeding
  • Excessive bleeding with trauma

Lab:

  • Prolonged PT and PTT
  • Prolonged TT (Thrombin time)
22
Q

What are the clinical and lab findings of Regulatory bleeding disorders of hemostasis?

Study These Flashcards
A

Clinical:

  • Soft tissue bleeding
  • Excessive bleeding with trauma

Lab:

  • Normal PT and PTT
  • Normal Bleeding time
  • Normal platelet count
23
Q

What are the 3 congenital Bleeding Disorders?

Study These Flashcards
A
  • Von Willebrand disease
  • Factor VIII Deficiency
  • Factor IX deficiency
24
Q

Tell me about Von willebrand Disease…

Study These Flashcards
A

Autosomal dominant disorder due to abnormalitles of vW factor.

  • Abnormalities may be quantitative or qualitative
  • Mucocutaneous bleeding (nose bleeds) is the dominant clinical manifestation
25
What are the 3 classes of vWD?
Type 1 = Quantitative (Partial) Type 2 = Qualitative Type 3 = Quantitative (total)
26
What are the clinical manifestations of vWD?
- epistaxis - Ecchymoses - mucosal bleeding - Bleeding with trauma or surgery - Symptoms often improve post -adolescence
27
What are the Lab features of vWD?
``` BT/PFA-100 = prolonged PTT = usually prolonged VIII = decrease to normal vWF :ag: = Decreased to normal vWF :Rcof: = Decreased to normal ```
28
What is the Tx for vWD?
- Desmopressin - Antifibrinolytic agents - Factor VIII concentrates - Cryoprecipitate
29
Tell me about Hemophilia A.....
The most serious bleeding disorder... - X linked recessive disorder caused by deficiency of factor VII. * symptoms start in early childhood.
30
What are the clinical manifestations of Hemophilia A?
- Hemarthosis - soft tissue bleeding - Excessive bleeding with trauma - intramuscular hematomas - intracerebral hemorrhage - bleeding into other tissues.
31
What are the Lab features of Hemophilia A?
``` BT/PFA-100 = Normal PTT = prolonged VIII = decrease vWF :ag: = normal vWF :Rcof: = normal Factor IX = normal ```
32
What are the 3 classes of Hemophilia A?
Severe = 5% Factor VIII
33
What is the Tx for Hemophilia A?
- Factor VIII concentrates | - Inhibitors of Fibrinolysis
34
Tell me about Hemophilia B.....
Sex linked recessive disorder caused by deficiency in factor IX. * Clinical and lab manifestations are similar to deficiency of factor VIII. Can also be mild moderate or severe.
35
What are the 3 classes of platelet disorders?
Quantitive Qualitative Combined
36
What is the mechanism of Thrombocytopenia?
- Decreased platelet production (Quantitative) - Increased destruction of platelets - sequestration - Congenital vs aquired
37
How is Thrombocytopenia evaluated?
- Peripheral blood smear - bone marrow examination - platelet antibody determination - Clinical history
38
Tell me about Acute/Childhood Immune Thrombocytopenic purport (ITP)....
- Viral prodrome common - sudden onset - severe thrombocytopenia - Frequently undergoes remission - M:F = 1:1
39
Tell me about Chronic/adult Immune Thrombocytopenic purport (ITP)....
- No antecedent infection - Gradual onset - Moderate Thrombocytopenia - Infrequent remission - More common in females.
40
What is the Pathophysiology of ITP?
Autoantibodies directed at the platelet membrane antigens (GPIb/IX and IIb/IIIa are common targets) *increased IgG bound to the platelet surface promotes increased sequestration/destruction by the reticuloendothelial system.
41
What are the clinical manifestations of ITP?
- Petechial hemorrhages - Ecchymoses (brusing) - Bleeding with trauma or surgery
42
What bone marrow and blood findings would you expect with ITP?
- Megakaryocyte normal to increased | - No Microangiopathic changes on blood smear review.
43
What is the treatment for ITP?
- Corticosteroids - Intravenous immunoglobulin - Immunosuppression - Splenectomy
44
What is Thrombotic Thrombocytopenia Purpura TTP?
An acute disorder characterized by intravascular platelet activation with formation of platelet rich micro thrombi throughout circulation. *can be inherited or acquired
45
What causes TTP?
a deficiency of ADAMS 13, a metalloprotienase that usually degrades very high molecular weight vWF.
46
What is DIC?
Unregulated widespread intravascular activation of the hemostatic system.
47
When does DIC occur?
- Infections - Tissue Injury (trauma, burn, surgery) - Obstetrical complications - Certain malignancies
48
What are the clinical manifestations of DIC?
``` - bleeding from multiple sites Thromboembolic problems - Hypotension and shock - respiratory dysfunction - Hepatic dysfunction - Renal dysfunction - CNS dysfunction ```
49
What is the Tx for DIC?
- remove/reverse the intuiting stimulus Supportive therapy with transfusions of blood products: - FFP: coagulation and regulatory proteins - Cryoprecipitates: fibrinogen, VIII, vWF - Platelets

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