thrombosis and fibrinolysis

Question 1

thrombosis pathologic event (3)

Answer 1

1. disruption of blood flow
2. platelet fibrin mass
3. occlusion of the blood vessel

Question 2

virchow’s triad

Answer 2

1. blood flow
2. coagulation factors
3. blood vessel

Question 3

fibrinogen to fibrin and
feedback to activate and amplify
this process to form the
fibrin clot.

Answer 3

thrombin burst

Question 4

inhibitor of coagulation

Answer 4

protein C

Question 5

tissue factor pathwaay inhibitor (TFPI)

Answer 5

regulates TF/FVIIa pathway

Question 6

anti-thrombin III (AT-III)

Answer 6

inhibits thrombin, FIXa, FXa, FXIa

Question 7

protein C and co-factor Protein S

Answer 7

are vit. K dependent and inhibit FVa and FVIIIa

Question 8

Very ill patient with skin necrosis –

Answer 8

disseminated intravascular coagulation (DIC)

Question 9

New onset neurologic symptoms –

Answer 9

stroke or cerebral vein thrombosis

Question 10

Frequent miscarriages/fetal loss –

Answer 10

placental thrombosis

Question 11

thrombophilia:

congenital deficiency states (3)

Answer 11

1. AT-III
2. Protein C
3. Protein S

Question 12

thrombophilia:

genetic mutations 4

Answer 12

1. activated protein C resistance or factor Vleiden
2. hyperhomocysteinemia- MTHFR
3. prothrombin gene mutation
4. PAI- mutations- affects fibrinolysis

Question 13

other causes of thrombophilia (2)

Answer 13

1. elevated levels of FVIII, IX, XI

2. elevated levels of lipoproteins

Question 14

Immune mediated disorder with production of antibodies (IgG, IgM, IgA) against proteins (β2-glycoprotein 1 and prothrombin) which interact with phospholipid within cell membranes (endothelial cells and platelets)

Answer 14

Antiphospholipid Antibody Syndrome

Question 15

Antiphospholipid Antibody Syndrome

1. what do we see
2. what is it
3. occurs in females/males
4. age?
5. clinical
6. _________ due to binding to phospholipid and prothrombin in vitro in the assays
7. assays detect antibodies against
8. despite prolonged PTT, it does not cause
9. treatment

Answer 15

1. venous/arterial thrombosis (recurrent fetal loss)
2. immune mediated
3. females>males
4. any age
5. clinical-thrombosis, livido reticularis, thrombocytopenia, migraine headaches
6. Prolongation of clotting assays
7. cardiolipin and B2 glycoprotein 1
8. bleeding
9. treat underlying disease process and prevent further thrombosis

Question 16

protection against thrombosis (6)

Answer 16

1. inactivation of activated coagulation factors
2. decrease platelet activity
3. increase blood flow
4. activation of thrombomodulin
5. fibrinolytic system dissolves clot
6. RES clears soluble fibrin complexes

Question 17

involves the vascular endothelium, vW protein and plateltets

Answer 17

primary hemostasis

Question 18

involves the progressive activation and amplification of the various clotting factors in the coag. cascade and results in the production of thrombin and a fibrin clot

Answer 18

secondary hemostasis

Question 19

dissolution of the fribrin clot as a part of the wound healing process

Answer 19

fibrinolysis

Question 20

nitric oxide inhibits

Answer 20

platelet activation

Question 21

Alpha2-antiplasmin binds with plasmin to form the alpha2-AP/plasmin complex, which prevents

Answer 21

plasmin from breaking down fibrin within the fibrin clot (fibrinolysis).

Question 22

Missense mutation of Arginine 506 to Glutamine 506 (Arg-506-Gln)

Answer 22

Activated Protein C resistance (Factor V Leiden)

Question 23

G to A substitution of nucleotide 20210 in 3’ untranslated portion of the gene

Answer 23

Prothrombin Gene Mutation

Question 24

Mutation in the gene for methylene tetrahydrofolate reductase (MTHFR)

Answer 24

Hyperhomocysteinemia