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ESA 2 - MoD > Session 5 - Haemostasis + Thrombosis > Flashcards

Session 5 - Haemostasis + Thrombosis Flashcards

1
Q

What four things does successful Haemostasis depend on?

A
  • The vessel wall
  • Platelets
  • Coagulation system
  • Fibrinolytic system
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2
Q

How can blood vessels ensure successful Haemostasis?

A

They constrict to limit blood loss

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3
Q

How can platelets help to ensure successful Haemostasis?

A
  • adhere to damaged vessel walls + to each other

- form a platelet plug

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4
Q

How can Coagulation help to ensure successful Haemostasis?

A
  • cascade series of the conversion of inactive -> active components
  • Fibrinogen -> Fibrin
  • balance of procoagulant and anticoagulant forces
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5
Q

How can the formation of thrombin have an effect on the Coagulative system?

A

It positively feeds back on factors V, VIII and XI causing the number of active molecules to increase

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6
Q

Name some thrombin inhibitors (4)

A
  • Anti-thrombin III
  • Alpha 1 anti-trypsin
  • Alpha 2 macroglobulin
  • Protein C/S
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7
Q

What do the inherited disorders in Anti-thrombin III and Protein C/S cause?

A

Thrombophilia and Thrombosis

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8
Q

What is fibrin broken down by?

A

Plasmin

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9
Q

In clot busters, what is the active ingredient and give two examples of when they may be used?

A

Active ingredient - Streptokinase which actives plasminogen

Uses:

  • Coronary artery occlusion
  • Thrombus cutting off circulation to a limb
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10
Q

What is thrombosis?

A

The formation of a solid mass of blood within the circulatory system during life

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11
Q

Name the three components of Virchow’s Triad, give examples for each

A
  1. Change in blood flow (Stagnation, turbulence)
  2. Changes in vessel wall (atheroma, injury, inflammation)
  3. Changes in blood components (smokers, pregnancy)
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12
Q

Name some features of an arterial thrombus

A
  • pale
  • granular
  • lines of zahn
  • lower cell content
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13
Q

Name some features of a Venus thrombus

A
  • deep red
  • soft
  • gelatinous (jelly like)
  • higher cell content
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14
Q

What are the effects of thrombosis in arteries?

A
  • Ischaemia
  • infarction
  • depends on site + collateral circulation
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15
Q

Name some effects on a venous thrombus

A
  • congestion
  • oedema
  • Ischaemia and infarction (only if tissue pressure > arterial pressure)
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16
Q

Name the five possible outcomes of thrombosis

A
  • Lysis - (most likely with small thrombi)
  • Propagation (distal in arteries, proximal in veins)
  • Organisation (reparative process, in-growth of fibroblasts + capillaries, lumen remains obstructed)
  • Recanalisation (channels through thrombus form, limited blood flow)
  • Embolism
17
Q

Define an embolism

A

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

18
Q

Name the different types of emboli

A
  • Thrombo-emboli (most common - 90%)
  • air
  • amniotic fluid
  • nitrogen (the bends)
  • medical equipment
  • tumour cells
19
Q

Where will a thrombus embolise if it forms in a systemic vein?

A

It will pass to the lungs forming a pulmonary emboli

20
Q

Where will a thrombus embolise if it forms in the heart?

A

Pass via the aorta to renal, Mesenteric and other arteries

21
Q

Where will a thrombus embolise if it forms in the atheromatous carotid arteries?

A

To the brain causing a stroke

22
Q

Where will a thrombus embolise if it forms in the atheromatous abdominal arteries?

A

To the arteries of the legs

23
Q

What can recurrent minor pulmonary embolisms cause?

A

Pulmonary hypertension

24
Q

If a pulmonary embolism cuts off blood supply to >60% of the lungs, what is the most likely outcome?

A

Death

25
Q

What are some likely causes of a deep vein thrombosis?

A
  • immobility
  • post-op or postpartum
  • oral contraceptives
  • severe burns
  • cardiac failure
  • disseminated cancer
26
Q

What two ways do we treat DVT?

A
  • intravenous Heparin - anticoagulant, co-factor for anti-thrombin III
  • oral Warfarin - interferes with synthesis of Vit K dependent clot factors, slower acting
27
Q

How can atrial fibrillation cause a cerebral embolism?

A
  • AF leads to stasis and then a thrombus

- if in left heart, can go to brain + cause a stroke or transient Ischaemic attack

28
Q

What is and what can cause an Iatrogenic embolism?

A
  • embolism due to medical treatment

- air embolism from an injection

29
Q

What can cause a nitrogenic embolism?

A

The bends

Nitrogen bubbles form in the blood with rapid decompression

30
Q

What causes a fat embolism?

A
  • fractures of long bones
  • lacerations of adipose tissue
  • causes a rash, shortness of breath and confusion
31
Q

What is a disseminated Intravascular coagulation?

A

Pathological activation of coagulation mechanisms that happens in response to a variety of diseases.
Small clots form throughout the body using up all the clotting factors
Results in abnormal bleeding from the skin

32
Q

What may trigger a disseminated Intravascular coagulation?

A

Infection, trauma, liver disease, obstetric complications

33
Q

What is Haemophilia and what does it cause?

A
  • X-linked recessive disorder causing a nonsense point mutation
  • Factor VIII (type A) or Factor IX (type B) deficiency
  • causes haemorrhage in retroperitoneum/ urinary tract
  • haemorrhage into major joints, synovial Hypertrophy = pain
  • muscle bleeding causes pressure and necrosis of nerves occurs
34
Q

How is haemophilia treated?

A

Self-administered factor replacement therapy

35
Q

Define Haemostasis

A

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

36
Q

What is the defect in Thrombocytopenia?

A

The platelet count is way below below reference range

37
Q

What three things may cause the defect in thrombocytopenia?

A 
- failure in platelet production
Or 
- increase in platelet destruction 
Or 
- sequestering of platelets

ESA 2 - MoD (7 decks)

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