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Anatomic And Molecular Pathology > Thrombosis > Flashcards

Thrombosis Flashcards

1
Q

Heamostasis and thrombosis involve three components, which are

A

Endothelium
Platelets
Coagulation Cascade

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2
Q

Discuss the sequence of events in haemostasis

A
  1. Vasoconstriction: mediated by neurogenic mechanisms and endothelin
  2. Primary Haemostasis: exposure of subendothelial ECM causes platelet adherence and activation, release of secretory granules and platelet aggregation
  3. Secondary Haemostasis: exposure of tissue factor III which combines with factor VII to form thrombin. Thrombin converts fibrinogen to fibrin and a permanent platelet plug is formed. Counter-regulatory mechanisms are also at play.
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3
Q

Endothelial cells usually exhibit procoagulant activities under normal conditions.

True or false

A

False.
Antiplatelet, anticoagulant, fibrinolytic properties.

Procoagulant activities follow injury or activation

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4
Q

Mention the factors that may activate endothelial cells

A
  1. Trauma
  2. Infectious agents
  3. Hemodynamic forces
  4. Plasma mediators
  5. Cytokines
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5
Q

The balance between anti-thrombotic and prothrombotic activities of the endothelium determines whether propagation or dissolution will occur.

True or false.

A

True

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6
Q

Mention the antithrombotic properties of the endothelium

A

A. Antiplatelet Effect
•Intact endothelium
•Prostacyclin PGI2 and nitric oxide
•Adenosine diphosphatase

B. Anticoagulant Effect
•Thrombomodulin
•Tissue factor pathway inhibitor-inhibitors factors VIIa and Xa
•Protein S-cofactor of protein C and TFPI

C. Fibrinolytic Effect
•Tissue-type plasminogen activator

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7
Q

Mention the prothrombotic properties of the endothelium

A

A. Platelet Effect
•Endothelial Injury-Von Willebrand factor vWF
•Procoagulant effect- Tissue factor
•Antifibrinolytic effects- Inhibitors of plasminogen activator

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8
Q

Genetic disorders of vWF-Von Willebrand disease or it’s receptor- Bernard Soulier syndrome don’t result in bleeding disorders.

True or false. Why?

A

False.
Platelet adhesion to sub endothelial ECM is mediated by vWF which acts as a bridge between platelet surface receptors and exposed collagen

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9
Q

The secretion that occurs after adhesion of platelets contains?

A

Calcium-required in the coagulation cascade

ADP-activator of platelet aggregation alongside TxA2

Negatively charged phospholipids-bind calcium and complexes containing coagulation factors

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10
Q

Platelet activation by ADP triggers a conformational change in the platelet GpIIa-IIIb receptors

True or false.
What function does it subserve?

A

False
GpIIb-IIIa receptors receptors.
They induce binding to fibrinogen that promote platelet aggregation.

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11
Q

Inherited deficiency of GpIIb-IIIa results in?

A

Glanzmann thrombasthenia

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12
Q

The endothelial damage represents the ___ stage of hemostatic process

A

1st

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13
Q

The Coagulation cascade represents the 2nd arm of the hemostatic process

True or false

A

False

3rd arm

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14
Q

What is the most important coagulation factor?

A

Thrombin, it converts fibrinogen to fibrin

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15
Q

The extrinsic pathway is the most physiologically relevant pathway for coagulation due to vascular damage

True or false

A

True

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16
Q

The clinical assays used to assess the function of the coagulation pathways are?

A
  1. Prothrombin time PT which assess the functions of proteins in the EXTRINSIC pathway
  2. Partial thromboplastin time PTT which assess the functions of proteins in the INTRINSIC pathway
17
Q

Mention the endogenous anticoagulants that control clotting

A
  1. Antithrombins- antithrombin III inhibits the activities of thrombin and serine proteases-factors IXa, Xa, XIa, and XIIa
  2. Proteins C and S(Vit K-dependent) proteins that inactivate factors Va and VIIIa
  3. TFPI inactivates factor VIIa complexes
18
Q

The three abnormalities that lead to thrombus formation are?

A

Virchows triad:

  1. Endothelial Injury
  2. Stasis/Turbulent flow
  3. Hypercoagulability of blood
19
Q

Give settings that could lead to thrombus formation due to endothelial damage

A
  1. Endocardial injury/Myocardial infraction
  2. Ulcerated atherosclerotic plaques
  3. Vascular injury-inflammatory or traumatic
  4. Hypertension
  5. Turbulent blood flow
  6. Bacterial endotoxins
  7. Radiation injury
  8. Metabolic abnormalities/Hypercholesterolemia/Homocysteinemia
  9. Cigarettes smoke toxins
20
Q

How does stasis/turbulence contribute to thrombosis?

A
  1. Promotes endothelial activation
  2. Brings platelets in contact with endothelium
  3. Prevents washout/dilution of clotting factors
21
Q

Give settings that could lead to thrombus formation due to stasis/turbulence

A
  1. Ulcerated atherosclerotic plaques
  2. Aneurysms
  3. Myocardial infarctions
  4. Hyperviscosity e.g Polycythemia Vera
  5. Sickle cell anemia
22
Q

Hypercoagulability is any alteration of the coagulation pathways that predisposes to thrombosis.

True or false

A

True

23
Q

The most common primary/genetic hypercoagulable states are?

A

Common:

  1. Factor V mutation/Leiden
  2. Prothrombin mutation
  3. 5,10-methylenetetrahydrofolate reductase
  4. Increased factors VIII, IX, X, fibrinogen

Rare:

  1. Antithrombin III deficiency
  2. Protein C deficiency
  3. Protein S deficiency
  4. Smoking

Very Rare:

  1. Fibrinolysis defect
  2. Homocystinuria
24
Q

The most common secondary/acquired hypercoagulable states are?

A

High risk:

  1. Immobilization
  2. Myocardial infraction
  3. Atrial fibrillation
  4. Tissue injury
  5. Cancer
  6. Prosthetic cardiac valves

Lower risk:

  1. Cardiomyopathy
  2. Nephrotic syndrome
  3. Hyperestrogenic states
  4. Oral contraceptive use
  5. Sickle cell anaemia
25
Q

What is the morphological difference between an arterial thrombi and a venous thrombi?

A

Arterial thrombi grow retrograde from the point of attachment and venous thrombi extend in the direction of the flow

26
Q

What are the differences between an antemortem and a postmortem clot?

A

Antemortem clots:
Dry,
Granular masses,
Well attached to the walls of the vessels
Lines of Zahn are observed microscopically due to alternating RBC and platelet deposits

Postmortem clots:
Jelly like
Easily detachable masses
They have a reddish and yellowish(plasma) portion

27
Q

Where do mural thrombi occur in the body?

A

Heart chambers

Aortic lumen

28
Q

Arterial thrombi are frequently occlusive while venous thrombi, phlebothrombi, is invariably occlusive.

True or false. Why?

A

True.

Blood moves slower in the veins and tends to contain more enmeshed red cells

29
Q

Thrombi on the heart valves are known as?

A

Vegetation

30
Q

Discuss the fate of the thrombus

A
  1. Propagation
  2. Embolization
  3. Dissolution
  4. Organization and recanalization

Anatomic And Molecular Pathology (14 decks)

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