Principles of coagulation

Question 1

When there is injury to a blood vessel what happens before the formation of the primary hemostatic plug?

Answer 1

vasoconstriction

Question 2

Why does a blood vessel constrict immediately after injury?

Answer 2

to slow down the blood and allows all the coagulation factors time to interact

Question 3

What clotting factor deficiency does a pt possibly have if s/he has:

normal PT and prolong PTT

Answer 3

8, 9, 11, 12, prekalikrein, HMWK

Question 4

What clotting factor deficieincy does a pt possibly have if s/he has:

normal PT and prolong PTT and is bleeding

Answer 4

8, 9, 11 (or vWF)

Question 5

What clotting factor deficieincy does a pt possibly have if s/he has:

normal PT and prolong PTT, is bleeding, low factor VIII

Answer 5

hemophilia or vWF deficiency

Question 6

What clotting factor deficieincy does a pt possibly have if s/he has:

normal PT and prolong PTT, is bleeding, low factor VIII, low vWF

Answer 6

vWF deficiency

Question 7

What clotting factor deficieincy does a pt possibly have if s/he has:

normal PT and prolong PTT, is bleeding, low factor VIII, normal vWF

Answer 7

hemophilia

Question 8

What clotting factor deficieincy does a pt possibly have if s/he has:

normal PT and normal PTT and pt is still bleeding

Answer 8

factor XIII deficiency

Question 9

What clotting factor deficieincy does a pt possibly have if s/he has:

prolong PT and normal PTT

Answer 9

7 deficiency

Question 10

What factors are measured with PT?

Answer 10

7, 5, 10, prothrombin (2), fibrinogen

• extrinsic pathway

Question 11

What factors are measured with PTT?

Answer 11

everything but 7 (and 13)

*intrinsic

Question 12

What clotting factor deficiency does a pt possibly have if s/he has:

prolong PT and prolong PTT

Answer 12

10, 5, prothrombin (is this right?)

Question 13

T or F: antithrombic counter regulation occurs only after the formation on the secondary hemostatic clot

Answer 13

F: it occurs the entire time a clot is forming

Question 14

What clotting factors are serine proteases?

Answer 14

11, 9, 7, prothrombin (2)

Question 15

What clotting factors are cofactors?

Answer 15

12, 8, 5, tissue factor (3)

Question 16

What are the vitamin K dependent clotting factors?

Answer 16

2, 7, 9, 10

protein S and C

Question 17

What is the role of vitamin K in the activity of some of the clotting factors?

Answer 17

it is needed for the carboxylation of glutamic acid residues. Without the carboxylation, these clotting factors canot adhere to the a phospholipid membrane

Question 18

Elevated F1.2 indicates….

Answer 18

elevated thrombin (bc active thrombin makes F1.2)

Question 19

What does von Willebrand’s disease and hemophilia have in common?

Answer 19

low factor 8

Question 20

Where is factor 8 made? What is it bound to?

Answer 20

made in the liver

bound to vWF

Question 21

If a pt does not have vWF, they will have (high, low) factor 8

Answer 21

low

Question 22

What molecule antagonizes thrombin?

Answer 22

anti-thrombin 3

Question 23

How does heparin effect anti-thrombin 3?

Answer 23

changes the shape of anti-thrombin 3 so that it binds up/inhibits thrombin

Question 24

What does active protein C do?

Answer 24

inactivates 5a and 8a (stops clot formation)
inactivates tPAi (enhances fibrinolysis)

Question 25

How does protein C become active?

Answer 25

thrombin binds thromodulin on endothelial surface. This interaction activates protein C (which was bound to a receptor on endothelial surface and released upon activation)

Question 26

What does thrombin cleave off of fibrinogen to make fibrin?

Answer 26

fibrinopeptide A and B

Question 27

What is a D dimer?

Answer 27

product of fibrin cleavage by plasmin | fibrin degradation product

Question 28

T or F: a fibrin degradation product can still form a weak clot

Answer 28

T (fragment Y)

Question 29

T or F: a fibrin degredation product has the ability to negatively regulates clot formation

Answer 29

T: fragment D can inhibit platelets bc they bind it thinking it is fibrin

Question 30

What holds a fibrin polymer together?

Answer 30

Hydrogen bonds

Question 31

What activates factor 13?

Answer 31

thrombin

Question 32

What is the role of clotting factor 13?

Answer 32

crosslinks fibrin polymers with transaminase bonding

Question 33

T or F: Plasmin is circulating freely in our blood

Answer 33

F: it if formed on a fibrin clot

Question 34

How is plasminogen converted to plasmin?

Answer 34

Tissue Plasminogen Activator (TPA) is a serine protease that binds fibrin to activate plasmin locally at the clot

Question 35

What is the role of alpha-2 plasmin inhibitor?

Answer 35

inhibits any local free plasmin (keeps it from getting into circulation)

Question 36

What are the factors involved in the intrinsic activation of plasminogen to plasmin?

Answer 36

12a and Kallikrein

Question 37

What are the factors involved in the extrinsic activation of plasminogen to plasmin?

Answer 37

tPA | urokinase-like A

Question 38

What is streptokinase?

Answer 38

bacterial agent/peptide that complexes with plasminogen which converts other molecules to plasmin

Question 39

What does tissue factor do?

Answer 39

initiate coagulation (extrinsic)

Question 40

What does PGI2 (prostacyclin) do?

Answer 40

vasodilation and inhibit platelet aggregation (activates adenylate cyclase to inc cAMP)

Question 41

What does vWF do?

Answer 41

platelet-collagen adhesion | carriage of factor 8

Question 42

What does protein C and S do?>

Answer 42

inhib coag

Question 43

WHat does TPA do?

Answer 43

fibrinolysis

Question 44

What does alpha1-protease inhibitor act on?

Answer 44

factor 11a to prevent activation of 9

Question 45

What does antithrombin/heparin act on?

Answer 45

9a to prevent formation of Xa

Question 46

What does TFPI-Xa act on?

Answer 46

TF-7a to inhibit Xa and 9a formation

Question 47

What does alpha2-macroglobulin act on?

Answer 47

thrombin

Question 48

What does heparin cofactor II act on?

Answer 48

thrombin