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Leila's Yr 5 Pathology > Haematology 2S - Coagulation > Flashcards

Haematology 2S - Coagulation Flashcards

1
Q

Anti-coagulant factors

A

anti-thrombin, proteinC/S, tissue factor pathway inhibitor

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2
Q

Vessel injury stimulates three responses…

A
  1. Vasoconstriction (neural)
  2. Platelet aggregation (primary haemostasis)
  3. Activation of coagulation cascade
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3
Q

How is the endothelium involved in haemostasis?

A

It prevents the exposure of all the pro-coagulant subendothelial structures to the blood

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4
Q

What do endothelial cells produce?

A

Prostaglandins, vWF, thrombomodulin, plasminogen activators

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5
Q

Lifespan of a platelet

A

10 days

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6
Q

How long do anti-platelet drugs e.g. aspirin and clopidogrel halt platelet activity for?

A

10 days

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7
Q

How soon before surgery should patients aspirin be stopped?

A

7-10 days

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8
Q

2 methods of platelet adhesion

A

Direct: GlpIa
Indirectly: vWF via GlpIb

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9
Q

Platelet aggregation

A

Once platelets adhered to endothelium, release of mediators such as ADP and TxA2 which promote platelet aggregation. Platelets aggregate using glycoproteins GlpIIb/IIIa + fibrinogen + Ca2+

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10
Q

MOA of clopidogrel

A

ADP receptor inhibitor

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11
Q

Aspirin MOA

A

Irreversibly inhibits COX

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12
Q

2 end products of arachidonic acid pathway and their functions

A

Thromboxane A2 - induces platelet aggregation

PGI2 - Inhibits platelet aggregation

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13
Q

Rate limiting step for fibrin production

A

Factor Xa

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14
Q

4 roles of thrombin (IIa)

A

Fibrinogen –> fibrin
Activates plts
Activates factors 5+8
Activates zymogen (Factos 7,11,13)

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15
Q

What causes the production of thrombin?

A

Prothrombinase complex

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16
Q

What is the most important step in the coagulation cascade

A

Production of thrombin

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17
Q

Final step in the coagulation cascade

A

Thrombin breaks down fibrinogen –> fibrin –> stable fibrin clot

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18
Q

Three phases of clotting

A
  1. initiation
  2. amplification
  3. propagation
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19
Q

Initiation phase

A

Factor Xa binds to factor Va

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20
Q

Extrinisc pathway initiation

A

Damage to vessel wall + tissue factor + factor 7

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21
Q

Initiation phase in people with factor V Leiden

A

Factor Va cannot bind to factor Xa

22
Q

Amplification phase

A

Factor Va and Xa binding –> small production of thrombin, activates platelets, activates factors 8,9,11, activates more factor 5a
These activated factors bind to platelet (5,8,9)

23
Q

What is the propagation phase?

A

The factor 5/8/9 complex on activated platelets will activate factor X –> THROMBIN BURST–> fibrinogen –> fibrin –> stable clot

24
Q

Investigations for extrinsic pathway

A

INR, PT

25
Q

Most common cause of vitamin K deficiency?

A

WARFARIN

26
Q

Fibrinolysis pathway

A

tissue plasminogen activator (tPA) and urokinase convert plasminogen –> plasmin.

Plasmin then breaks down fibrin in to its degradation products

27
Q

What is plasmin inhibited by?

A

alpha-2-anti-plasmin

alpha-2-macroglobulin

28
Q

What is the most thrombogenic condition?

A

Lack of antithrombin III

29
Q

MOA of antithrombins?

A

Directly bind to and inactivate thrombin to be excreted in the kidney

30
Q

How is activated protein C formed?

A

Thrombomodulin (activated by thrombin) binds to protein C –> APC

31
Q

How is APC fully activated?

A

Protein S is the co-factor

32
Q

Function of APC?

A

Inactivates Factors 5a and 8a

33
Q

TFPI - What does it stand for and its function?

A

Tissue factor pathway inactivator (TFPI) - inhibits factor 7a

34
Q

What would immediate bleed suggest?

A

Issue with primary haemostatic plug: platelets, vWF, ednothelium

35
Q

Differentiating platelet and coagulation disorders

A

Platelet: petechiae, purpura, skin and mucous membranes
Coagulation: haemarthrosis, joints, muscles, large and deep echhymosis,

36
Q

Effects of clopidogrel

A

ADP-R blocker, reduce GlpIIb/IIIa crosslinking of platelets

37
Q

Non immune mediated causes of ITP

A

DIC, MAHA

38
Q

Population of people who get chronic or acute ITP

A

Acute: children, follows viral illness, self-limiting and severe
Chronic: adults, F>M

39
Q

Treatment of idiopathic immune ITP

A

Depends on platelet count and bleeding. If bleeding, give steroids + IVIG, if not bleeding –> Steroids

40
Q

Inherited and acquired disorders of coagulation

A

Inherited: haemophilia A/B, vWD

Acquired, liver disease, vitamin K deficiency, warfarin, DIC

41
Q

Coagulation studies in haemophilia

A

Prolonged aPTT, normal PT as intrinsic pathway involved

42
Q

Treatment of haemophilia

A

Clotting factor replacement required for life

43
Q

What is the most common coagulation disorder?

A

vWD

44
Q

Inheritance pattern of vWD

A

AD (Except for type III which is AR)

45
Q

Classification of vWD

A

Type I - low quantity
Type II - Low quality
type III - TOTAL quantitative deficiency

46
Q

Treatment of vitamin K deficiency

A

Vitamin K, FFP

47
Q

Reversal of warfarin

A

PCC (prothrombinase complex concentrate) - prompt reversal, IV vitamin K takes longer

48
Q

DIC pathophysioogy

A

Systemic activation of coagulation –> fibrin deposition in microvasculature (thrombosis) and depletion of platelets and coagulation factors –> bleeding

49
Q

Treatment for low fibrinogen

A

Cryoprecipitate

50
Q

Benefit of warfarin over dOACs?

A

Can rapidly reverse the bleeding

Leila's Yr 5 Pathology (100 decks)

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