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Session 5 Flashcards

1
Q

Define thrombosis

A

Formation of a solid mass of blood within the circulatory system during life

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2
Q

In which vessels can thrombosis occur?

A

Any vessels - arteries or veins

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3
Q

What is the name given to the formation of solid mass of blood in a test tube/a cut?

A

Clotting

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4
Q

Thrombosis can occur due to abnormalities of… (3)

A

The vessel wall
Blood flow
Blood components

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5
Q

What three things can cause abnormalities of the vessel wall and therefore thrombosis?

A

Atheroma
Direct injury
Inflammation

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6
Q

What two abnormalities of blood flow can result in the formation of thrombi?

A

Stagnation

Turbulence

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7
Q

What three things can result in abnormalities of the components in blood that cause thrombosis?

A

Smoking
Pregnancy
Post-op

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8
Q

Name 4 features of arterial thrombi

A

Pale
Granular
Lines of Zahn
Lower cell content

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9
Q

Name 4 features of venous thrombi

A

Soft
Gelatinous
Deep red
Higher cell content

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10
Q

Name 5 outcomes of thrombosis

A 
Lysis 
Propagation 
Organisation 
Recanalisation 
 Embolism
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11
Q

What occurs in lysis of a thrombus? What happens to the blood flow? For which type of thrombi does this occur?

A

There is complete dissolution of the thrombus by the fibrinolytic system

Reestablished

When thrombi are small

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12
Q

What is propagation of a thrombus?

A

Progressive spread/enlargement of a thrombus in the direction of blood flow

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13
Q

In which direction does propagation occur in the arteries?

In which direction does propagation occur in the veins?

A

Propagates distally

Propagates proximally

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14
Q

What happens when there is organisation of a thrombus?

A

There is ingrowth of fibroblasts/capillaries to repair the vessel but the lumen remains obstructed

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15
Q

What happens during recanalisation of a thrombus? What happens to blood flow?

A

One or more channels is formed through the organising thrombus

Blood flow is reestablished but incompletely

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16
Q

In which direction do emboli travel in the arteries?

In which direction do emboli travel in the veins?

A

Away from the heart

Towards the heart

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17
Q

The effects of thrombosis in the arterial system depends on the __________ of the thrombus and the ________________ circulation

A

Site

Collateral

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18
Q

Name two effects of thrombosis in the arterial system

A

Ischaemia

Infarction

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19
Q

Name 4 effects of thrombosis in the venous system

A

Congestion
Oedema
Ischaemia
Infarction

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20
Q

Define embolism

A

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

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21
Q

Over 90% of emboli are…

A

Thrombi-emboli

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22
Q

Name 5 other types of emboli excluding thrombo-emboli

A 
Air
Amniotic fluid 
Nitrogen 
Medical equipment 
Tumour cells
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23
Q

Roughly how much air is needed to cause an air embolism?

What effect does an air embolism have on the blood?

A

~150ml

Makes the blood ‘frothy’

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24
Q

When might nitrogen embolism occur? What happens in nitrogen embolism?

A

During decompression - e.g. Bends

Dissolved nitrogen becomes gaseous nitrogen

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25
Where do thrombi-emboli from systemic veins end up?
In the lungs
26
Where do thrombi-emboli from the heart usually pass through?
The aorta to renal, mesenteric and other arteries
27
Thrombo-emboli from atheromatous carotid arteries pass to the... Resulting in...
Brain Stroke
28
Thrombo-emboli from atheromatous abdominal aorta pass to... Resulting in...
The arteries of the legs Ischaemic limbs
29
Thrombo-emboli that pass to the brain usually enter from which vessels?
Carotid arteries
30
Thrombo-emboli that end up in the arteries of the legs usually enter through which vessel?
Abdominal aorta
31
Name a few predisposing factors of deep vein thrombosis The factors result in an increased risk of deep vein thrombosis and therefore...
``` Immobility/Bed Rest Post-Op Pregnancy Disseminated Cancer Cardiac Failure ``` Pulmonary embolism
32
Give an example of a preventative measure against DVT used in hospitals
Flowtron boots
33
How do Flowtron boots work?
Intermittently inflate mimicking the muscle pump of the calves and assisting venous return to the heart
34
Name two drugs that are used in the treatment of DVT Do they dissolve the existing thrombus?
IV heparin type drugs Oral warfarin No, only prevent their propagation
35
What reduction in blood flow will be seen in a massive PE? What prognosis does this have for the patient?
> 60% reduction Rapidly fatal
36
What blood vessels are blocked in a major PE? What symptoms may be seen in a patient?
Medium sized blood vessels are blocked Shortness of breath Cough Blood stained sputum
37
Which vessels are blocked in a minor PE? What symptoms can this cause?
Small peripheral pulmonary arteries Asymptomatic/Minor Shortness of Breath
38
Recurrent minor PEs can lead to...
Pulmonary hypertension
39
Fat embolism usually occurs as result of...
Long bone fracture
40
What happens in fat embolism?
There is the release of fat and marrow into the blood (usually as a result of a long bone fracture)
41
What is haemostasis?
Stopping of a flow of blood
42
What are the aims of haemostasis?
To prevent bleeding and prevent unnecessary coagulation to allow blood to flow
43
What cells are platelets produced from? Where in the body?
Megakaryocytes Bone marrow
44
In which way are platelets produced from megakaryocytes?
They bud off their cytoplasm
45
What is the typical platelet count? What is the typical platelet life span?
150-400 7-10 days
46
What causes platelet adhesion to take place? How do they adhere?
Damage to the vessel wall Damage to the wall ---> Exposure to underlying tissues. Platelets adhere to collagen via vWF receptor.
47
Which receptor do platelets bind to in their adherence to collagen?
vWF receptor
48
How do platelets activate other platelets and the clotting cascade to some extent after they adhere?
Secrete ADP, thromboxane and others to become activated and activate other platelets
49
What do platelets secrete to activate other platelets? What else do they secrete?
ADP, thromboxane etc. Some coagulation factors from internal stores
50
How is a platelet plug formed?
There is aggregation and cross-linking of platelets to form a platelet plug
51
Describe the clotting cascade
Amplification activation of precursor proteins to generate thrombin Thrombin converts soluble fibrinogen to insoluble fibrin Strengthens initial platelet plug to make the stable clot
52
How is fibrin formed in the clotting cascade?
Thrombin converts fibrinogen to fibrin
53
What is the clotting cascade controlled by? (2)
Natural anticoagulants | Clot destroying proteins
54
Clotting factors are produced in which part of the body?
Liver
55
Give two examples of coagulation factors
Fibrinogen | Prothrombin
56
Give two examples of natural anticoagulants
Protein C | Protein S
57
What is used to measure the extrinsic pathway and common pathway? What is used to measure the intrinsic and common pathway?
PT APPT
58
What coagulation factors does PT mainly measure?
Factor VII
59
What coagulation factors does APPT mainly measure?
Factors VIII, IX, XI and XII
60
Which coagulation factors does both PT/APPT measure?
Factors V, X Prothrombin Fibrinogen
61
Name three functions of Von Willebrand Factor
Platelet adhesion Platelet aggregation Carries Factor VIII
62
What three things occur in the vessel wall during injury?
Vasoconstriction Production of vWF Exposure of collagen and tissue factor which initiates activation of clotting factors
63
What is fibrinolysis?
The process of breaking down a clot
64
Describe the process of fibrinolysis
Plasminogen activator converts plasminogen to plasmin which breaks down fibrin clot into D-dimers
65
What is the name of the molecule that converts plasminogen to plasmin?
Plasminogen Activator
66
What enzyme breaks down a fibrin clot to D-dimers?
Plasmin
67
What is the function of natural anticoagulants?
Stop further coagulation of blood
68
Give three examples of natural anticoagulants
Protein C Protein S Anti-thrombin
69
Bleeding disorders can be as a result of abnormalities in the... (3)
Vessel wall Platelets Coagulation factors
70
Give two examples of congenital coagulation factor disorders
Haemophilia A | Haemophilia B
71
Haemophilia A is as a result of which coagulation factor?
Deficiency of factor 8
72
Haemophilia B is as a result of which coagulation factor?
Deficiency of factor 9
73
Name three acquired conditions that can cause coagulation factor disorders
Liver disease Vitamin K deficiency Use of anticoagulants such as warfarin
74
How do anticoagulants such as warfarin act as anticoagulants?
Inhibit vitamin K
75
Clinical severity of coagulation factor disorder depends on...
The extent of the deficiency
76
In which way is haemophilia A inherited?
X-linked recessive
77
In haemophilia A there is a congenital lack of factor...
8
78
When is haemophilia A diagnosed if congenital?
Pre-natally or soon after birth
79
When is haemophilia A diagnosed if it as a result of a spontaneous mutation?
Infancy
80
What happens as a result of haemophilia A?
Bleeding into muscle and joints | Bleeding post-operatively
81
How is haemophilia A treated? (2)
Recombinant factor 8 | DDAVP
82
How does haemophilia B present compared with haemophilia A?
Similar presentation
83
Which is rarer, haemophilia A or haemophilia B?
Haemophilia B
84
What is the cause of haemophilia B?
Congenital deficiency in factor IX
85
In which way is Von Willebrand's disease inherited?
Autosomal dominant
86
What does Von Willebrand's disease result in? (2)
Abnormal platelet adhesion to vessel wall | Reduced factor 8 amount/activity
87
Name two parts of the clotting cascade that will be seen at low levels in Von Willebrand's disease
Factor 8 | vWF
88
Name two clinical features of someone with Von Willebrand's disease
Skin and mucous membrane bleeding | Prolonged bleeding after trauma
89
Give two examples of skin and mucous membrane bleeding which can take place as a result of Von Willebrand's disease
Nosebleeds | Gum bleeding
90
How does the symptoms of Von Willebrand's disease differ to haemophilia?
In haemophilia there is spontaneous joint/muscle bleeds. There is not in VW disease
91
Vessel wall abnormalities can cause bleeding disorders. What do they typically present with?
Easy bruising
92
Give two examples of congenital conditions that cause vessel wall abnormality
Hereditary Haemorrhage Telangiectasia (HHT) | Ehlers Danlos
93
In what way is HHT inherited?
Autosomal dominant
94
What happens in HHT?
There are dilated microvascular swellings that increase with time
95
Name 3 acquired causes of vessel wall abnormalities
Senile purpura Steroids Scurvy
96
Platelet disorders can be either qualitative or quantitative, what is meant by this?
Qualitative - abnormal platelet activity | Quantitative - thrombocytopenia
97
A low platelet count is either a result of...
Reduced production | Increased removal
98
What can be carried out to discover the cause of thrombocytopenia?
Bone marrow biopsy
99
Give an example of something that can result in increased removal of platelets
Splenic pooling
100
What is the most common way for the immune system to destroy platelets?
Immune thrombocytopenia purpura
101
What happens in immune thrombocytopenia purpura?
Autoantibodies are produced against the glycoproteins on platelets
102
How is immune thrombocytopenia purpura treated?
With immunosupression
103
Can platelet transfusions be given to a patient with immune thrombocytopenia purpura? Why?
No These platelets also get destroyed
104
Give an example of a condition where there is non-immune destruction of platelets
Disseminated Intravascular Coagulopathy (DIC)
105
Name 4 factors that can result in reduced production of platelets in the bone marrow
B12/Folate Deficiency Infiltration of bone marrow by cancer cells/fibrosis Drugs Viruses
106
Give two examples of drugs that can cause reduced production of platelets in the bone marrow
Chemotherapy | Antibiotics
107
Give two examples of viruses that can cause reduced production of platelets in the bone marrow
HIV | EBV
108
Patients with low platelets are generally asymptomatic until platelet count is less than...
30
109
Name 5 symptoms of severe thrombocytopenia
``` Easy bruising Mucosal bleeding Severe bleeding after trauma Intercranial haemorrhage Purpura ```
110
How common are hereditary disorders of platelet function? Give an example
Very rare Bernard Soulier
111
What can cause acquired disorders of platelet function (3)
Aspirin NSAIDS Clopidogrel
112
Disseminated intravascular coagulapthy is a type of...
Microangiopathic haemolytic anaemia
113
What happens in DIC?
Numerous micro thrombi are formed. There is consumption of clotting factors, platelet and haemolytic anaemia.
114
How will PT, APPT, fibrinogen levels and D-dimer levels be affected by DIC?
Raised Raised Low Raised
115
In which sorts of patients is DIC seen?
Severely ill patients - e.g. Cancer, burns, infections
116
How is DIC treated?
Treatment of the underlying cause

Pathological Processes (10 decks)

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