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SUMPHYS2 > VOP Coagulation > Flashcards

VOP Coagulation Flashcards

1
Q

What is hemostasis?

A

Prevention of blood loss

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2
Q

What are the stages of clotting?

A

1] Vascular constriction, 2] Platelet plug aggregation- while fibrin comes- 3] Fibrin clot, 4] Clot retraction/vessel repair, 5] Clot dissolution

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3
Q

What happens before vascular constriction?

A

Vasodilation. HISTAMINE release causes dilation–> excess bleeding at first (to wash out the wound)

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4
Q

Is vessel repair perfect?

A

No, this is mostly a fibrotic process, you’re scarring

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5
Q

What is the mechanism of vascular constriction?

A

1] Mostly from myogenic response to injury,proportional to damage, 2] In small vessels, thromboxane A2 produced causes vasoconstriction to prevent blood loss.

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6
Q

What is process of platelets are formation?

A

when megakaryocyte gets really big and the pieces of membrane fall off to form vesicles that contain the contents of the megakaryocytes (which are largely clotting factors)

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7
Q

Do megakaryocyte leave the bone marrow?

A

No

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8
Q

Are platelets cells?

A

No: contain no nucleus or metabolic machinery, they do have surface proteins that adhere to the membrane serve to adhere the platelets during vessel injury

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9
Q

What is the function of platelets?

A

Binding to injured vessel wall or tunica media (collagen) through surface proteins

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10
Q

What is the half life of platelets?

A

Half life of 8-12 days

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11
Q

List the platelet receptors?

A

1] GPIb/IX, 2] GIIb/IIIa, 3] Clotting factor/Ca++ complex

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12
Q

What is GPIb/IX?

A

glycoprotein adhesion molecule-binds subendothelium through vWF, , important in clotting and platelet plugging. Important to platelet adhesion

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13
Q

What is the subendothelial layers?

A

inner wall of the blood vessel membrane. That could be basement membrane & collagen, tunica media.

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14
Q

What is GIIb/IIIa?

A

fibrinogen binding protein

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15
Q

What is Clotting factor/Ca++ complex?

A

Xa/Va complex limits activation of thrombin to site of injury, this is so you don’t have widespread clotting in the system

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16
Q

What are the steps in platelet plugging?

A

1] Exposure to tissues beyond intima causes platelet activation, 2] Swelling, 3] Formation of Pseudopodia-feet, 4] Contraction causes release of clotting factors, 5] Adherence to von Willebrand factor, 6] Thromboxane A2 formation activating others platelets

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17
Q

What does clotting depend on?

A

balance between blood factors

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18
Q

What starts clotting?7

A

Process begins with formation of complex called prothrombin activator which converts prothrombin, much bound to platelets, to thrombin

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19
Q

What is the formation of Prothrombin?

A

made by liver requires Vit K

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20
Q

What is the MOA of warfarin?

A

a vit K analog, disrupts the process of formation of vit K dependent factors such as prothrombin

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21
Q

What is the function of thrombin?

A

removes fibrin proteins from fibrinogen -made in liver, floats freely in bloodstream

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22
Q

What is the function of fibrin?

A

form reticulum of clot to trap blood cells and circulating elements to form a firm clot

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23
Q

How is fibrin formed?*

A

in order to form fibrin from fibrinogen, you have to break disulfide bridges bonds to release monomers then fibrin forms when you remove fibrinopeptides (A&B) Subunits will self aggregate once they are liberated to form long fibrin fibers

24
Q

What is function of fibrinopeptides?

A

*A/B peptides provide polarity charge that keeps fibrinogen from self aggregating/clumping

25
Q

What removes fibronpeptide?

A

Thrombin separating fibrin
monomers and removing that polarity so
they will self-aggregate

26
Q

What is the early clot?

A 
Unstable because only hydrogen bonds. 2. Thrombin is converting fibrinogen to fibrin while it’s activating
thestabilizing factor (Factor XIII)
27
Q

What is Fibrin stabilizing factor?

A

1] activated by thrombin, 2] causes those hydrogen bonds to be converted to covalent bonds (stronger) and cross linking to form
3] Clot will constrict & contract squeeze fluid/cells out and dry it out

28
Q

What is factor VIII?

A

activated by thrombin so that its ready for factor 9, which is needed to activate factor 10

29
Q

What is the signifcance of factor VIII

A

MC factor involved/Deficient in hemophilia A

30
Q

What does Thrombin activate?

A

1] Factor XIII, 2] Fibronogen, 3] Factor V, 4] Factor VIII, 5] Factor XI, 6] Factor VII (extrinsic)

31
Q

What clotting factor causes constriction of the clot

A

activation of fibrin 13a

32
Q

What is calcium and phospholipids (cell membrane) required to form?

A

Christimas Factor (9) which forms Activated Factor X

33
Q

What is the function of Vitamin K

A

Liver carboxylates factors using vit K, which makes factors able to bind Calcium, these factors are II, VII, IX,X

34
Q

What is the use of Warfarin

A

is a structural analog of vit K (that inhibits that process bc it inhibits clotting factor production) makes pt less likely to throw embolism, but more likely to bleed.

35
Q

What is the activation of intrinsic pathway

A

IN VASCULATURE; trauma within the blood, contact w/in the subendothelium. 2. Collagen exposure 3. Converting factor 7/XII to XIIa,4. then catalyzing
11/XI to XIa via Calcium. 5. Converting factor 9/IX to IXa (
Christmas factor). 6 Require phospholipids AND calcium
for 9 to 9a

36
Q

What is the activation of extrinsic pathway

A

IN TISSUE; trauma outside of the blood vessel 1. Begins with activation of factor 7/VII via exposure to factor 12/XIIa or w/ contact to
wounded surface 2. Factor 7/VII when activated, it is going to work with factor 3/III when it is activated to activate factor X

37
Q

What is invovled in Control of clotting and clot dissolution

A

1] Antithrombin III, 2] Heparin

38
Q

What is Antithrombin III

A

always circulates as control, Inactivates thrombin by irreversible binding

39
Q

What is Heparin

A

binds and concentrates antithrombin III, increases activity, heparin is not good as a clot busting agent bc all it’s doing is preventing the formation of further clots. It does nothing for pre-existing ones.

40
Q

What is the difference between heparin and warfarin?

A

on coumadin inhibit clotting factors, on heparin you are incr anti-clotting activity

41
Q

What is the activation of protein C

A

Protein C - activated by binding to excess thrombin. Activity of Activated Protein C enhanced by binding to protein S, together this complex inactivates factor Va

42
Q

What is the function of protein C+S complex

A

activated complex cleaves creating tPA which dissolves clots

43
Q

What happens if you have a deficiency in protein C

A

more likely to form clots, bc now excess thrombin isn’t being removed

44
Q

What are the pathophysiology behind coagulation disorders

A

1] Failure to clot (this is more common), 2] Inappropriate clotting

45
Q

What is the PTT (aPTT) - activate partial thromboplastin time

A

1] Measures intrinsic system, 2] Used to monitor heparin tx, 3] Factors XII, XI, IX, VIII

46
Q

Why is factor X is tested by PT and aPTT

A

an influence of both intrinsic & extrinsic factors so you use PT & aPTT

47
Q

What is the PT - Prothrombin time and INR

A

1] Extrinsic pathway: Factors I, II, V, VII, X (Vit K dependent factors), 3] Used to monitor, adjust coumadin tx, 4] You want to anticoagulate them, but not too much

48
Q

What is Thrombin time (activated factor II/prothrombin)

A

Tests abnormality affecting conversion of fibrinogen to fibrin

49
Q

What is the testing of fibrinogen

A

Can be measured chemically, Can also measure fibrin breakdown products, as the clot dissolves

50
Q

Why is fibrin/fibrinogen testing important in DIC?

A

it looks like the pt would be unable to clot but in actuality they have clotted extensively so their factors are low. But their breakdown factors are high. So the clotting factors are low, but they have lots of fibrin break down products. Bc they have lots of clots that are dissolving and they’ve chewed up a bunch of clotting factors to create them.

51
Q

List the antiplatelets drugs

A

1] Aspirin - platelet toxin, irreversibly poisons platelets, 2] Clopidogrel/Ticlopidine , 3] Abciximab -mAb, inhibits platelet activity

52
Q

List the Anticoagulants drugs

A

1] Heparin, 2] Warfarin/coumadin

53
Q

List the Thrombolytics drugs

A

1] tPA, 2] Streptokinase, urokinase, alteplase

54
Q

What is the lab findings of disseminated intravascular coagulation (DIC)

A

1] Presence of D-dimer and FBP elevation confirm DIC, 2] Prolonged PT, 3] Prolonged PTT, 4] Prolonged TT, 5] Hypofibrinogenemia (measure of fibrinogen) - low, 6] Thrombocytopenia (platelet levels) - low

55
Q

What is what D-dimer is

A

D-dimer is formed when fibrinogen is converted to fibrin

56
Q

What is what FBP is

A

fibrin breakdown products

57
Q

What is the lab values for measuring platelet function

A

1] Platelet count, 2] Peripheral smear, 3] Bleeding time: induce laceration, time how long they bleed, 4] Clot retraction: vial of blood, measure how long it takes for the clot to retract in a test tube

SUMPHYS2 (27 decks)

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