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Hematology 2 > (P) Lesson 3: Secondary Hemostasis > Flashcards

(P) Lesson 3: Secondary Hemostasis Flashcards

1
Q

Hemostasis is mainly triggered by what?

A

Tissue Injury

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2
Q

This is a physiological process that maintains blood in liquid state.

A

Hemostasis

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3
Q

Rearrange the following steps of hemostasis

A. Platelet Adhesion
B. Platelet Plug Formation
C. Platelet Aggregation
D. Fibrin Stabilization
E. Vasoconstriction
F. Fibrin Dissoloution

A

E, A, C, B, D, F

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4
Q

All are part of Primary Hemostasis EXCEPT?

A. Vasoconstriction
B. Platelet Plug Formation
C. Platelet Aggregation
D. Fibrin Dissolution

A

D

Both fibrin stabilization and fibrin dissolution are part of secondary hemostasis.

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5
Q

Fibrin dissolution is also known as?

A

Fibrinolysis

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6
Q

What are the three (3) important functions of hemostasis?

A
  1. Stop bleeding
  2. Localize the site of injury
  3. Tissue repair
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7
Q

If an individual has a problem with the sequence of hemostasis, it results in what?

A

Unbalanced hemostasis

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8
Q

An unbalanced hemostasis can result in which two (2) phenomena?

A
  1. Excessive bleeding (hemorrhage)
  2. Pathological clotting (thrombosis)
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9
Q

Pathological clotting means there is problem with an individual’s what?

A

Dissolution

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10
Q

What is the goal of primary hemostasis?

A

To form a primary platelet plug

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11
Q

What is the goal of secondary hemostasis?

A

To form a stable fibrin clot

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12
Q

The formation of a stable fibrin clot is triggered by what?

A

Tissue injury

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13
Q

Stable fibrin clots are formed with the help of what?

A

Plasma proteins

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14
Q

Also known as:
* Procoagulants
* Clotting Factors
* Coagulation Factors
* Blood Clotting Factors

A

Plasma Proteins

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15
Q

They promote the formation of fibrin clots.

A

Plasma Proteins

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16
Q

T or F: Platelets do not have roles in secondary hemostasis.

A

False

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17
Q
  • Proteins in nature (produced in the liver)
  • Named by their numerical designation based on the year of discovery
  • Has 16 in total but only 14 have a direct effect on secondary hemostasis
A

Plasma Proteins

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18
Q

Clotting factors must be written properly in what form?

A

Roman Numerals

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19
Q

T or F: There are 16 plasma proteins in total that have an effect on an individual’s secondary hemostasis.

A

False

There are 16 in total, but only 14 have an effect on secondary hemostasis.

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20
Q

The numerical designation of the clotting factors are based on what?

A

Their year of discovery

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21
Q

What are the four (4) exceptions to the naming of clotting factors with their numerical designations?

Clue: Those more commonly known using their common name.

A
  1. Factor I - Fibrinogen
  2. Factor II - Prothrombin
  3. Factor III - Tissue Factor
  4. Factor IV - Calcium
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22
Q

These are the two (2) clotting factors that have no numerical designations.

A

Pre Kallikrein (PK) and High Molecular Weight Kininogen (HMWK)

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23
Q

When you are deficient in clotting factors, you are more prone to problems in what?

A

Bleeding

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24
Q

If a person is deficient in clotting factors, why are they more susceptible to problems with bleeding?

A

They have unfinished secondary hemostasis.

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25
Q

This clotting factor has no recorded incidence of deficiency.

Essentially, it is impossible to be deficient.

A

Factor III (Tissue Factor)

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26
Q

This clotting factor is the reason why secondary hemostasis can be triggered regardless of the site of injury.

A

Factor III

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27
Q

This non-existent clotting factor was removed because it was discovered to just be a subset of Factor V.

A

Factor VI

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28
Q

This clotting factor has several other nomenclatures and is often found attached to VWF.

A

Factor VIII (Antihemophilic Factor -AHF)

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29
Q

Match the preferred name to the clotting factor.

  1. Fibrinogen
  2. Proaccelerin
  3. Proconvertin
  4. Stuart-Prower Factor
  5. Hagemen Factor

A. V
B. VII
C. XII
D. X
E. I

A
  1. E
  2. A
  3. B
  4. D
  5. C
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30
Q

Match the preferred name to the clotting factor.

  1. Calcium
  2. Prothrombin
  3. Plasma Thromboplastin Component (PTC)
  4. Fibrin-Stabilizing Factor

A. II
B. IV
C. XIII
D. IX

A
  1. B
  2. A
  3. D
  4. C
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31
Q

Match the preferred name to the clotting factor.

  1. Tissue Factor
  2. Antihemophilic Factor (AHF)
  3. Plasma Thromboplastin Antecedent
  4. Fitzgerald Factor
  5. Fletcher Factor

A. III
B. XI
C. VIII
D. HMWK
E. Pre Kallikrein

A
  1. A
  2. C
  3. B
  4. D
  5. E
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32
Q

This clotting factor is involved mostly in primary hemostasis.

A

VWF (Von Willebrands Factor)

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33
Q

Platelet Factor 3 is a procoagulant also known as what?

Give the preferred name.

A

Phospholipid Phosphotidylserine

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34
Q

What is the clotting factor that has several nomenclatures?

A

Factor VIII

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35
Q

Nomenclature of Factor VIII

  • Refers to the entire molecule present in the plasma
  • The entire molecule as it circulates in the plasma
  • Composed of VIII:C and VIII:vWF
A

VIII/vWF

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36
Q

Nomenclature of Factor VIII

  • Found in platelet adhesion in primary hemostasis
  • Portion of molecule responsible for binding to endothelium and supporting normal platelet adhesion and function
  • Tested by bleeding time
A

VIII:vWF

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37
Q

Nomenclature of Factor VIII

  • Found in secondary hemostasis
  • Portion of molecule acting in intrinsic system as cofactor to factor IXa (with Ca2+) in the conversion of factor X to Xa
  • Tested by APTT
A

VIII:C

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38
Q
  • Used in serological testing concerning factor VIII
  • Antigenic property of procoagulant portion as measured by immunologic monoclonal antibody techniques
A

VIIIC:Ag

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39
Q

Nomenclature of Factor VIII

  • Used in serological testing concerning vWF
  • Factor VIII-related antigen, which is a propert of the large vWF portion of the molecule and measured by immunologic techniques of Laurell rocket or immunoradiometeric assay
A

VIIIR:Ag

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40
Q

Nomenclature of Factor VIII

  • A differentiation test used to assess if the patient has a factor VIII deficiency or vWF deficiency
  • Ristocetin cofactor activity, which is a factor VIII-related activity required for aggregation of human platelets with ristocetin in in-vitro aggregation studies
A

VIII:RCo

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41
Q

An antibiotic no longer used therapeutically

A

Ristocetin

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42
Q

What are the three (3) different classifications of clotting factors based on their functions?

A
  1. Substrate
  2. Cofactor
  3. Enzyme
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43
Q

Enumerate what clotting factors are under the category stated.

Substrate

A
  1. Factor I - Fibrinogen
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44
Q

Enumerate what clotting factors are under the category stated.

Cofactor

A
  1. Factor III - Tissue Factor
  2. Factor IV - Calcium
  3. Factor VIII
  4. Factor V
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45
Q

The enzyme category of clotting factors is further separated into what two (2) subcategories?

A
  1. Transaminoglutamase
  2. Serine Proteases
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46
Q

Enumerate what clotting factors are under the category stated.

Transaminoglutamase (Enzyme)

A
  1. Factor XIII
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47
Q

Enumerate what clotting factors are under the category stated.

Serine Proteases (Enzyme)

A
  1. Factor II
  2. Factor VII
  3. Factor IX
  4. Factor X
  5. Factor XI
  6. Factor XII
  7. PK
  8. HMWK
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48
Q

What are the three (3) different classifications of clotting factors based on their physical/physiological properties?

A
  1. Fibrinogen Group
  2. Prothrombin Group
  3. Contact Group
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49
Q

Classification based on their Physical Properties

  • Largest molecular weight
  • Thrombin-sensitive (reacts directly with thrombin)
  • Totally consumed in coagulation
  • Absent in serum samples
  • Calcium-dependent
  • Vitamin K-independent
A

Fibrinogen Group

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50
Q

Classification based on their Physical Properties

What clotting factors are classified under the fibrinogen group?

A
  1. Factor I
  2. Factor V
  3. Factor VIII
  4. Factor X
  5. Factor XIII
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51
Q

Classification based on their Physical Properties

  • Vitamin K-dependent
  • Calcium-dependent
  • Adsorbable in plasma
A

Prothrombin Group

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52
Q

Classification based on their Physical Properties

What are the clotting facrors classified under the prothrombin group?

A
  1. Factor II
  2. Factor VII
  3. Factor IX
  4. Factor X
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53
Q

This is needed for gamma carboxylation which allows for the binding of the factors to their cofactors.

A

Vitamin K

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54
Q

Classification based on their Physical Properties

  • Glass-sensitive group: in vitro, they are activated immediately upon coming into contact with glass
  • Vitamin K and Calcium independent
A

Contact Group

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55
Q

Classification based on their Physical Properties

What are the clotting factors classified under contact group?

A
  1. Factor XI
  2. Factor XII
  3. PK
  4. HMWK
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56
Q
  • First coagulation pathway to be discovered
  • Discovered by Paul Morrawitz
A

Classical Pathway of Coagulation

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57
Q

Classical Pathway

What are the only two (2) clotting factors involved in the classical pathway?

A
  1. Factor II (Prothrombin)
  2. Factor I (Fibrinogen)
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58
Q

Classical Pathway

Prothrombin is converted to thrombin by what?

A

Thrombokinase

59
Q

Classical Pathway. Fill in the blanks.

  1. ____ is converted to thrombin by ____
  2. Thrombin is then converted to ____
  3. ____ is then converted to a ____, which is the end product of the classical pathway
A
  1. Prothrombin is converted to thrombin by thrombokinase
  2. Thrombin is then converted to fibrinogen
  3. Fibrinogen is then converted to a fibrin clot, which is the end product of the classical pathway
60
Q

The coagulation pathway wherein you have a clotting factor that activates another clotting factor and so on

A

Cascade/Domino Effect/Waterfall Pathway

61
Q

What are the three (3) components of the cascade pathway?

A
  1. Extrinsic Pathway
  2. Intrinsic Pathway
  3. Common Pathway
62
Q

The extrinsic pathway is triggered by what?

A

Release of tissue factor (Factor III)

63
Q

Extrinsic Pathway. Fill in the blanks.

  1. The release of ____ triggers the activation of the extrinsic pathway and the activation of ____
  2. The activated form of ____ forms a complex with its cofactor ____, Calcium (Ca2+) and Platelet Phospholipids
A
  1. The release of tissue factor triggers the activation of the extrinsic pathway and the activation of Factor VII
  2. The activated form of Factor VII (VIIa) forms a complex with its cofactor Factor III (Tissue Factor), Calcium (Ca2+) and Platelet Phospholipids
64
Q

This is the complex formed by the extrinsic pathway and is considered as its end product.

A

Extrinsic Tenase Complex

65
Q

Extrinsic Pathway. Match the following terms to their definition.

  1. Cofactor of Factor VII
  2. Cofactor of the entire complex
  3. Secondary cofactor of the complex once the Ca2+ attaches to the complex
  4. Prothrombin Group

A. Calcium (Ca2+)
B. Platelet Phospholipid
C. Tissue Factor
D. Factor VIIa

66
Q

The intrinsic pathway is triggered by what?

A

Collagen Exposure

67
Q

Intrinsic Pathway. Fill in the blanks.

  1. The exposure of ____ leads to the activation of ____
  2. The activated form of ____ binds to HMWK which activates ____
  3. ____ then activates Factor IX
  4. The activated form of ____ then forms a complex with its cofactor ____, Calcium (Ca2+), and platelet phospholipids.
A
  1. The exposure of collagen leads to the activation of Factor XII
  2. The activated form of Factor XII (XIIa) binds to HMWK which activates Factor XI
  3. Factor XI then activates Factor IX
  4. The activated form of Factor IX (IXa) then forms a complex with its cofactor Factor VIII, Calcium (Ca2+), and platelet phospholipids.
68
Q

This is the complex formed by the intrinsic pathway and is considered as its end product.

A

Intrinsic Tenase Complex

69
Q

Intrinsic Pathway. Match the following terms to their definition.

  1. Cofactor of Factor IX
  2. Cofactor of the entire complex
  3. Secondary cofactor of the complex once the Ca2+ attaches to the complex
  4. Prothrombin Group

A. Platelet Phospholipid
B. Calcium (Ca2+)
C. Factor IXa
D. Factor VIII

70
Q

Intrinsic Pathway

What are the two (2) main functions of the complex Factor XIIa + HMWK?

A
  1. To proceed to the kinin system
  2. Continue the secondary hemostasis by activating Factor XI
71
Q

Intrinsic Pathway

One of the reasons why there is inflammation after tissue injury.

A

Kinin System

72
Q

The common pathway is triggered by what?

A

The extrinsic tenase complex and intrinsic tenase complex

73
Q

Common Pathway. Fill in the blanks.

  1. The ETC and ITC activates the ____
  2. The activated form of ____ then binds with its cofactor ____, Calcium (Ca2+), and platelet phospholipids
A
  1. The ETC and ITC activates the Factor X
  2. The activated form of Factor X then binds with its cofactor Factor V, Calcium (Ca2+), and platelet phospholipids
74
Q

This is the complex formed by the common pathway and is considered as its end product.

A

Prothrombinase Tenase Complex

75
Q

The prothrombinase tenase complex activates what?

A

Factor II (Prothrombin) to Factor IIa (Thrombin)

76
Q

This activated form of a clotting factor has a procoagulant function which allows it to finish the coagulation pathway and revert back to the classical pathway.

A

Factor IIa (Thrombin)

77
Q

Fibrin is a ____ in nature

A

Glycoprotein

78
Q

What are the three (3) polypeptides of fibrin?

A
  1. Alpha
  2. Beta
  3. Gamma
79
Q

The alpha and beta polymers constitute ____ which is cleaved by the thrombin.

A

Fibrinopeptides

80
Q

What is cleaved from the fibrinopeptides and is considered a very weak bond in order to form fibrin monomers?

A

Hydrogen bonds

81
Q

Fibrin clots are also called as?

A

Fibrin monomers

82
Q

Thrombin also activates this clotting factor in order to stabilize the fibrin clot (fibrin monomers).

A

Factor XIII (XIIIa)

83
Q

How does Factor XIIIa stabilize the fibrin clot?

A

Converting the hydrogen bonds to covalent bonds

84
Q

When a fibrin monomer’s hydrogen bonds are converted to covalent bonds, it is now known as what?

A

Cross-linked Fibrin

85
Q

T or F: Cross-linked fibrin is regarded as the stable fibrin clot.

86
Q

T or F: All pathways in secondary hemostasis happen sequentially.

A

False

These processes (pathways) happen simultaneously.

87
Q

Match the following.

  1. In vivo
  2. In vitro

A. Cell-based Coagulation
B. Coagulation Pathway (Extrinsic, Intrinsic, Common)

88
Q

Where does cell-based coagulation happen?

A

On a specific cell membrane

89
Q

What are the three (3) phases of cell-based coagulation?

A
  1. Initiation
  2. Amplification (it is no longer used in the latest edition of Rodak’s)
  3. Propagation
90
Q

Initiation Phase

  1. ____ is always combined with its loyal cofactor ____ which will activate small amounts of ____ and ____
A
  1. Tissue Factor is always combined with its loyal cofactor Factor VII which will activate small amounts of Factor IX (IXa) and Factor X (Xa)
91
Q

Initiation Phase

____ has a higher binding capability to its cofactor.

A

Factor X (Xa)

92
Q

Initiation/Amplification Phase

  1. ____ binds with its cofactor ____ to form a small amount of thrombin
  2. The thrombin then activates the ____, separates the ____ from the ____, and produces a small amount of ____ and ____
A
  1. Factor X (Xa) binds with its cofactor Factor V to form a small amount of thrombin
  2. The thrombin then activates the platelets, separates the Factor VIII from the vWF, and produces a small amount of Factor V (Va) and Factor XI (XIa)
93
Q

The propagation phase of the cell-based coagulation happens where?

A

On platelet membranes

94
Q

The platelet membranes in the propagation phase are sourced from which three (3) sources?

A
  1. Platelet activated by thrombin
  2. Platelets from primary hemostasis (priority)
  3. Platelet activated from collagen
95
Q

The platelet membranes that are known to be the sites of propagation are also known as what?

A

COAT Platelets

96
Q

All materials used in the propagation phase of cell-based coagulation comes from where?

A

The initiation and/or amplification phase (basically, what thrombin has produced)

97
Q

Propagation Phase

  1. Factor VIII will serve as a cofactor to ____
  2. Factor V will serve as a cofactor to ____
  3. ____ serves as the cofactor that activates Factor IX for binding
A
  1. Factor VIII will serve as a cofactor to Factor IX
  2. Factor V will serve as a cofactor to Factor X
  3. Factor XI serves as the cofactor that activates Factor IX for binding
98
Q

What are the two (2) complexes formed in cell-based coagulation that forms thrombin?

A
  1. Factor Xa + Factor V
  2. Factor IXa + Factor VIII
99
Q

This happens due to the many sources of thrombin.

A

Burst of thrombin or thrombin burst

100
Q

What are the three (3) classifications of the functions of thrombin?

A
  1. Procoagulant Function
  2. Anti-coagulant Function
  3. Tissue Repair Function
101
Q

On its own, thrombin has a ____ function.

A

Procoagulant

102
Q

In order for thrombin to possess the anti-coagulant function, it must bind with other agents such as ____ and ____

A

AT-III and thrombomodulin

103
Q

Identify the classification of functions of thrombin.

  • Induces platelet activation and aggregation
  • Activates cofactor VIII to VIIIa
  • Activates factor XIII to XIIIa
  • Converts prothrombin to thrombin via autocatalysis
A

Procoagulant Function

104
Q

Identify the classification of functions of thrombin.

  • Binding of AT-III to inhibit serine proteases
  • Binding to thrombomodulin to activate protein C
  • Promotion of endothelial cell release of t-PA (Tissue Plasminogen Activator)
A

Anti-coagulant Function

105
Q

Identify the classification of functions of thrombin.

  • Induces cellular chemotaxis and stimulation of proliferation of smooth muscle and endothelial cells
A

Tissue Repair

106
Q

Inhibitors of Coagulation

  • Main inhibitor of blood coagulation
  • Its activated form is a strong anticoagulant that degrades factors Va and VIIIa
  • Stimulates fibrinolysis by inactivating plasminogen activator inhibitors
107
Q

Inhibitors of Coagulation

Cofactor with protein C

108
Q

Inhibitors of Coagulation

How many percent of Protein S is free form and active? How about those bound to complement C4 binding proteins and are inactive?

A

40% - free form and active
60% - bound to complement C4 binding proteins and are inactive

109
Q

Inhibitors of Coagulation

  • Main inhibitor of thrombin that is enhanced by heparin
  • Logic behind the green (heparin) tube
A

Antithrombin C (AT-III)

110
Q

Inhibitors of Coagulation

Inhibits thrombin

A

Heparin Cofactor II

111
Q

Inhibitors of Coagulation

Forms a complex with thrombin, kallikrein, and plasmin and inhibits their activity

A

Alpha-2-Macroglobulin

112
Q

Inhibitors of Coagulation

  • Also known as lipoprotein associated coagulation inhibitor
  • Inhibits the VIIa-tissue factor complex
A

Extrinsic Pathway Inhibitor (EPI)

113
Q

Inhibitors of Coagulation

Main inactivator of factor XIIa and plasma kallekrein.

A

C1-Inhibitor

114
Q

Inhibitors of Coagulation

Weak inhibitor of thrombin and factor Xa and XIa

A

Alpha-1 Anti-trypsin

115
Q

Inhibitors of Coagulation

Inhibits the activity of protein C

A

Activated Protein C Inhibitor

116
Q

Inhibitors of Coagulation

Modifies the action of thrombin to act more as inhibitor by inactivating protein C

A

Thrombin + Thrombomodulin (Endothelial Surface)

117
Q

Occurs when plasminogen is converted to plasmin, which dissolves the fibrin or fibrinogen into smaller fragments termed as FDP/FSP

A

Fibrinolysis

118
Q

What is the main goal of fibrinolysis?

A

To digest fibrin clots as they are formed in order to keep the vascular system free of deposited fibrin and fibrin clots (maintains/retains blood flow)

119
Q

Fibrinolysis

Single chain glycoprotein found in the plasma in concentration of 20 to 40 mg/dL and in all other fluids in a lesser amount

A

Plasminogen

120
Q

Fibrinolysis

  • Has a direct role in lysing fibrin clot physiologically
  • Serine protease that systematically digests fibrin polymer by the hydrolysis of arginine-related and lysine-related peptide bond
121
Q

Fibrinolysis

Capable of digesting plasma fibrinogen, factor V, factor VIII, and fibronectin

A

Free plasmin or free form plasmin

122
Q

What does FDP mean?

A

Fibrin/Fibrinogen Degradation Product

123
Q

What does FSP mean?

A

Fibrin/Fibrinogen Split Product

124
Q

Fibrinolysis - Fibrinogen

  • The fibrinogen (fragment X) is split into what two (2) fragments?
A

Fragment D and Fragment Y

125
Q

Fibrinolysis - Fibrinogen

  • Fragment Y is further split into what two (2) fragments?
A

Fragment E and Fragment D

126
Q

What is always he end product of fibrin/fibrinogen dissolution?

A

Fragment E and D

127
Q

Fibrinolysis - Fibrin Clot

The cross-linked fibrin is also known as?

A

Fragment DXnD

128
Q

Fibrinolysis - Fibrin Clot

  • The fibrin clot (DXnD fragment) is separated into what two (2) fragments?
A

Fragment DD/E and Fragment DXY/YXS

129
Q

Fibrinolysis - Fibrin Clot

  • Fragment DXY/YXS is further separated into what two (2) fragments?
A

Fragment DD/E and Fragment DXY/YY

130
Q

Fibrinolysis - Fibrin Clot

  • Fragment DXY/YY is further separated into what two (2) fragments?
A

Fragment DD/E and Fragment YD/DY

131
Q

Fibrinolysis - Fibrin Clot

  • Fragment YD/DY is further separated into?
A

Two Fragment DD/E

132
Q

Fibrinolysis - Fibrin Clot

  • All the Fragment DD/E produced are then separated to what two (2) fragments?
A

Fragment E and D-dimers (DD fragments)

133
Q

Serves as a basis if something is a problem with primary or secondary fibrinolysis and if we are dealing with either fibrin or fibrinogen

134
Q

Primary or Secondary Fibrinolysis

  • Excessive amount of plasminogen activator from damaged cells or malignant cells
  • E.g. malignancy-like prostatic carcinoma
  • No d-dimer, fibrin monomer, and fibrin polymer
  • Normal platelet count
A

Primary fibrinolysis

135
Q

Primary or Secondary Fibrinolysis

  • DIC (uncontrolled)
  • Inappropriate formation of fibrin within the blood vessels
  • E.g. Infection and HTR
  • Has d-dimer, fibrin monomer, and fibrin polymer
  • Decreased platelet count
A

Secondary Fibrinolysis

136
Q

What are the four (4) plasminogen activators?

A
  1. Intrinsic Factors
  2. Tissue Type Urokinase
  3. Therapeutic Activators
  4. Tissue Plasminogen Activator
137
Q

Plasminogen Activators

Factor XIIa, Kallikrein, and HMWK

A

Intrinsic Factors

138
Q

Plasminogen Activators

Secreted by the kidney and activated plasminogen

A

Tissue Type Urokinase

139
Q

Plasminogen Activators

  • E.g. Treatment for thromboemboli
  • Streptokinase, urokinase, tissue-like PA
A

Therapeutic Activators

140
Q

What are the six (6) inhibitors of fibrinolysis?

A
  1. Alpha-2 Antiplasmin
  2. Alpha-2 Macroglobulin
  3. Thrombosponin
  4. Plasminogen Activator Inhibitor 1 (PAI-1)
  5. Plasminogen Activator Inhibitor 2 (PAI-2)
  6. Alpha-1 Antitrypsin
141
Q

Inhibitors of Fibrinolysis

Primary inhibitor of plasmin

A

Alpha-2 Antiplasmin

142
Q

Inhibitors of Fibrinolysis

Released by the platelets and inhibits the activation of fibrin-bound plasminogen

A

Thrombospondin

143
Q

Congrats, nasurvive niyo si Ma’am TJ this week. <3

A

Tulog na lods mwa

Hematology 2 (9 decks)

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