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1 BLOOD COAGULATION Flashcards

1
Q

What is Hemostasis?

A

Process of stopping blood loss, stops bleeding and keeps the blood inside the damaged vessel.

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2
Q

What is the opposite to hemorrhage?

A

Hemostasis

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3
Q

What is the first step in wound healing?

A

Hemostasis, it involves the change of blood form liquid into a gel

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4
Q

What is Blood coagulation?

A

Principle mechanism of hemostasis

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5
Q

What is a Blood Clot?

A

A mash of protein filaments that traps blood’s formed elements to form a red gelatinous mass

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6
Q

What does a blood clot consist of?

A

4 components. RBC, WBC, Platelets, and Cross linked Fibrin strands.

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7
Q

What are the 4 components of blood clot called (RBC, WBC, Platelet, and Fibrin strands)?

A

Clotting Factors

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8
Q

What are fibrin threads?

A

Threads that holds the blood cells together and they seal the wound to prevent blood loss

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9
Q

What are Platelets?

A

Circulate in blood and form a platelet plug over damaged vessels

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10
Q

Are platelets part of secondary or primary system?

A

PRIMARY

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11
Q

What are the primary functions of platelets?

A

1) Platelet adherence
2) Platelet aggregation
3) Providing support for coagulation cascade and healing

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12
Q

What is platelet adherence ?

A

Sticking to the injured vessel

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13
Q

What is platelet aggregation?

A

Attaching to other platelets to enlarge plug

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14
Q

Clotting factors are primary or secondary system?

A

Secondary

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15
Q

What are Clotting Factors?

A

Group of proteins that act with platelets in the clotting cascade

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16
Q

What are clotting factors produced by?

A

The liver

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17
Q

Are clotting factors present in the blood?

A

Yes, they are always present, but they are an inactive form

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18
Q

When do clotting factors become activated?

A

Activation upon injury through the extrinsic and intrinsic pathways

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19
Q

When clotting factors are active, what do they work to produce?

A

A fibrin clot

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20
Q

What is required to produce clotting factors?

A

Vitamin K

Source: Gut Flora, or from external sources

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21
Q

What is Clotting Factor I?

A

Fibrinogen

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22
Q

What is Clotting Factor II?

A

Prothrombin

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23
Q

What is Clotting Factor V?

A

Preaccelerin

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24
Q

What is Clotting Factor VII?

A

Proconvertin

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25
Q

What is Clotting Factor VIII?

A

Antihemophilic Factor

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26
Q

What is Clotting Factor IX?

A

Christmas Factor

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27
Q

What is Clotting Factor X?

A

Stuart Prower Factor

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28
Q

What is Clotting Factor XI?

A

Plasma Thromboplastin Antecedent

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29
Q

What is Clotting Factor XII?

A

Hageman Factor

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30
Q

What is Clotting Factor XIII?

A

Fibrin-Stabilizing Factor

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31
Q

What does Coagulation result from?

A

Fibrin (fibrinogen in tissue).

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32
Q

Is Fibrinogen normally active or inactive?

A

Normally inactive in the blood and gets activated by the presence of thrombi

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33
Q

What is the most important constituent of coagulation?

A

Thrombi

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34
Q

What activates prothrombin to Thrombin?

A

Clotting Factor X (stuart-power factor)

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35
Q

What are the 2 Factors of (Process of Blood Coagulation)?

A

1) Extrinsic Pathway (aka tissue factor pathway)

2) Intrinsic Pathway

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36
Q

Where is the damage that activates the Extrinsic Pathway?

A

Damage to cell BOTH within blood vessels and outside the vessels

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37
Q

What is the goal of the Extrinsic Pathway (aka tissue factor pathway)?

A

Cause a Thrombin Burst (fast release of thrombin)

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38
Q

Tissue Factor aka

A

Tissue Thromboplastin

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39
Q

What is Tissue Factor aka Tissue Thromboplastin released by?

A

Injured cells, both injured blood vessel cells and injured tissue cells, activates clotting factors

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40
Q

What is the Extrinsic Pathway steps?

A

1) Tissue Thromboplastin
2) Proconvertin (CF 7)
3) Stuart-Prower factor (CF 10)
4) Prothrombin
5) Thrombin
6) Fibrinogen
7) Fibrin

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41
Q

What is the Intrinsic Pathway?

A

Exposure of collagen fibers of sub endothelial cells of blood vessels to blood flow activates clotting factors

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42
Q

Where does the Intrinsic Pathway occur?

A

ONLY inside injured blood vessels

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43
Q

What are the steps of the Intrinsic Pathway?

A

1) Collagen Fibers Exposed
2) Hageman Factor (CF XII)
3) Plasma Thromboplastin Antecedent (CF XI)
4) Christmas Factor (CF IX)
5) Stuart-Prower Factor (CF X)

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44
Q

What ion plays an important role in Coagulation?

A

Calcium

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45
Q

What are patients with severe blood loss given to help coagulate blood?

A

Calcium Chloride injections

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46
Q

What is the main “Role of Platelets?”

A

Platelet activation and the Platelet Plug

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47
Q

Platelets aka

A

Thrombocytes

48
Q

Where do the platelets occur?

A

ONLY inside injured blood vessels

49
Q

What is the 3 step process to “Role of Platelets?”

A

1) Exposure of Collagen Fibers of sub endothelial cells of blood vessels to blood flow
2) Activation of Von Willebrand Factor
3) Platelets become activated

50
Q

What happens during the Activation of Von Willebrand Factor (2nd step of Platelet process)?

A

It becomes activated when it attaches to the exposed collagen fibers, and this stops the movement of platelets. Platelets then form a single layer on top of the exposed collagen

51
Q

What happens when Platelets become Activated (3rd step of Role of platelets)?

A

Platelets become activated and then a 2nd layer of platelets attach, then another, etc., and the platelet plug forms

52
Q

Platelet activation results in the formation of _____

A

Platelet plug

53
Q

What does the Platelet plug do?

A

Physically (mechanically) blocks the damaged blood vessel

54
Q

What does Stasis result from?

A

Platelet activation (platelet plug) and coagulation (blood clotting via CF cascade) through 2 independent and simultaneous processes

55
Q

Where can blood clots be formed?

A

Inside and Outside vessels

56
Q

Where can Platelet plugs be formed?

A

Only inside a blood vessel

57
Q

Platelets activated via Von Willebrand factor also undergo _____

A

DEGRANULATION

58
Q

Activated Platelets release what 3 components?

A

1) ADP (adenosine diphosphate)
2) Thromboxane A2 (TxA2)
3) Growth Factors

59
Q

What does ADP (adenosine diphosphate) promote?

A

Platelet activation

60
Q

What is the main function of Thromboxane A2 (TxA2)?

A

Vasoconstriction to narrow the lumen to prevent blood loss

61
Q

What do Growth Factors promote?

A

Wound Healing (enhances contracture) if there is injury by attracting fibroblast (chemotaxis)

62
Q

What competes with the coagulation to keep safe limits?

A

Anticoagulation system

63
Q

What prevents excess or uncontrolled blood clotting?

A

Anticoagulation system

64
Q

What are the 3 major components of the Anticoagulation system?

A

1) Hemodynamics
2) Endothelial Mediation
3) Fibrinolytic System

65
Q

What is Hemodynamics?

A

Slows blood flow. Important for coagulation otherwise activated CF’s get washed out and a clot cannot be formed

66
Q

What is Endothelial Mediation?

A

As a result of injury, platelet plug is formed, surrounding uninjured endothelial cells release Prostacyclin (PGI2)

67
Q

What does Prostacyclin (PGI2) do?

A

Prevents extra or excess platelet activation and aggregation

68
Q

What does the Fibrinolytic System do?

A

Specific Fibrinolytic cascade:

69
Q

What does CF 12 activate in the Fibrinolytic system?

A

Plasminogen activator, which converts plasminogen into plasmin

70
Q

What does activation of plasminogen activator (plasminogen to plasmin) result in?

A

Degradation of activated CFs.

71
Q

What does Plasmin do in the Fibrinolytic system?

A

Destroys the blood clot, exercise and physical activity strengthens this fibrinolytic system

72
Q

What are the Anticoagulation System steps?

A

1) CF XII
2) Plasminogen
3) Plasmin
4) Destruction of blood clot

73
Q

What is Petechiae?

A

Pinpoint hemorrhages

74
Q

What disease is associated with Petechiae (Petechial Rash)?

A

Scurvy

75
Q

What is Purpura?

A

When hemorrhage is larger than a pinpoint, but < 2

76
Q

What is Purpura?

A

When hemorrhage is larger than a pinpoint, but < 2 cm

77
Q

What disease is associated with Purpura?

A

Systemic Autoimmune disease, Example: Lupus

78
Q

What is the aka of bruises?

A

Ecchymoses, if hemorrhages are > 2 cm

79
Q

What 3 diseases are associated with Ecchymoses aka bruises?

A
  • Raccoon sign
  • Battle sign
  • Cushing’s Syndrome
80
Q

What is Cushing’s Syndrome due to?

A

Overproduction of corticosteroids (cortisol) from adrenal cortex, causes overproduction of cortisol and aldosterone.

81
Q

Cushing’s Syndrome has what 2 signs?

A

Constant stress (fight or flight state) and High BP from the aldosterone

82
Q

What happens to the skin during Cushing’s Syndrome?

A

Atrophy of the skin (acne) and increases brittleness of blood vessels = not being able to do wound healing (easy subcutaneous bruising)

83
Q

What happens to the bones during Cushing’s Syndrome?

A

Severe Osteoporosis. Activates osteoclasts (proteolysis of bone matrix)

84
Q

How does the sugar metabolism present in Cushing’s Syndrome?

A

Hyperglycemia (gluconeogenesis, decreases glucose use). As a response, body secretes insulin, there’s too much cortisol which = Insulin resistance

ADRENAL DIABETES

85
Q

Obesity is associated with what disease?

A

Cushing’s syndrome

86
Q

What can have symptoms similar to Cushing’s Syndrome?

A

Prolonged steroid medication (easy bruising).

87
Q

What is Hematoma?

A

Leak of blood into cavities or into (or a muscle belly)

88
Q

What happens during a Hematoma?

A

Rupture of middle meningeal artery will cause –> epidural hematoma (epidural space = abnormal)

89
Q

What are the 4 Hemorrhagic Disorders?

A

1) Thrombocytopenia
2) Von Willebrand’s Disease
3) Hemophilia
4) Hemoarthrosis

90
Q

What is Thrombocytopenia?

A

Decreased number of platelets

91
Q

What is the normal platelet count in blood?

A

250,000 - 300,000 mm3

92
Q

What is the platelet count in Thrombocytopenia?

A

100,000 or less, no proper coagulation -> prone to hemorrhage

93
Q

What rashes are seen in Thrombocytopenia?

A

Petechial or Purpural (both less than 2cm)

94
Q

Where are thrombocytopenia diseases seen?

A

Immunological diseases and Leukemia

95
Q

Is Von Willebrand’s Disease genetic?

A

YES, Patient has sick parents

96
Q

What is the problem in Von Willebrand’s Disease?

A

Patient does not produce Von Willebrand Factor

97
Q

What does no production of Von Willebrand factor lead to?

A

Leads to NO platelet activation, no platelet plug, and no coagulation

98
Q

What can happen during Von Willebrand disease?

A

Periodic Leakage of blood from mucosa of the stomach and duodenum (common)

Hemorrhagic Gastroduodenitis = BLACK STOOL (Malena)

99
Q

Menorrhagia is associated with what disease?

A

Von Willebrand’s Disease

100
Q

What is Menorrhagia?

A

Increased amount of blood lost during menstruation - heavy and prolonged menses related to abnormal coagulation

101
Q

What is Metrorrhagia?

A

Similar to menorrhagia but NOT related to Von Willebrand’s disease. Usually from Uterus Cancer

102
Q

What does Metrorrhagia result in?

A

Loss of blood BETWEEN menstrual periods

103
Q

What is Hemophilia?

A

Non Production of certain clotting factors

104
Q

Can Hemophilia be Genetic?

A

YES, children with this disease have parents that DO NOT have the disease

105
Q

Who is the carrier of Hemophilia?

A

A woman, but women very rarely have this disease, they pass it onto their sons (pt does not have sick parents)

106
Q

What is Hemophilia linked?

A

X - Linked

107
Q

What is the main problem in Hemophilia?

A

Lack of certain clotting factors, no convergence of fibrinogen to fibrin, no BLOOD CLOT

108
Q

What are the 2 major types of Hemophilia?

A

Hemophilia A and B

109
Q

What is happening in Hemophilia A?

A

Non production of CF 8 VIII (Antihemophilic Factor)

110
Q

What is Hemophilia B aka

A

Christmas disease

111
Q

What is happening during Hemophilia B?

A

Non production of CF 9 IX (Christmas factor) = Affects the intrinsic coagulation pathway

112
Q

What is Hemoarthrosis caused by?

A

A problem caused by small traumas that may lead to severe blood loss

113
Q

What disease is Scurvy related to?

A

Hemoarthrosis

114
Q

What does Trauma in Hemoarthosis lead to?

A

Blood in Joint spaces (knee joint)

115
Q

What must happen during Hemoarthrosis for it to get better?

A

Blood removed from joint space to prevent degeneration

116
Q

What happens in Hemoarthrosis?

A

Iron is released from heme groups into blood, destroys the joint cartilage, degeneration (NON inflammatory) of the joint aka OSTEOARTHROSIS

(Secondary OA)

117
Q

Is Hemarthrosis related to Ankylosis?

A

NO, ankylosis is an inflammatory joint disease OA is degenerative

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