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Coagulation Flashcards

Coagulation (82 cards)

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1
Q

Platelets:

…in blood
… sequestered in spleen

Live…
Contain…
Plt adhesion: Change shape in contact with…

A

80% blood
20% spleen

Live 7-10 days
Contain mitochondria and specific granules
Change shape in contact with collagen.

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2
Q

Normal platelet adhesion requires….

Once adhered, plts become activated and release…

A

Von willebrands factor and Plt glycoprotein.

Once adhered, plts become activated and release: ionized calcium + glycoprotein complex GP IIb/IIIa

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3
Q

Coagulation…

1.)Vasoconstriction:
compressed by skeletal muscle contraction

2.)Plt adhesion:
Collagen helps plts adhere.

3.)Plts are activated:
After adhere, plts release ionized CA and GPIIb/IIIa from granules and change shape

4.)Plts aggregate:
Spiny plts react together to aggregate.
Requires ionized CA and fibrinogen.

5.)Plt plug, stabilize clot:
Plug is stabilized by fibrin strands.
Plts form plug, stabilize clot and release factor V and PF3.

A

Coagulation factors…

Plasma substances to form fibrin. Mostly proteins except calcium and mostly made in liver.

Coverts prothrombin to thrombin and fibrinogen to fibrin.

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4
Q

Factors needed for conversion of prothrombin to thrombin…

A

PF3

Va

CA2+

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5
Q

Factor needed for conversion of fibrinogen to fibrin….

A

Thrombin

Splits fibrinogen into two peptides, leaving a fibrin monomer. These monomers aggregate to make the final polymerized fibrin clot

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6
Q

Fibrinolysis…

  1. )
  2. )

Kept in check by…
1.)

2.)

A

Fibrinolysis…
1.)Plasminogen (inactive plasmin) to plasmin:
Activated by tPA released by endo cells

2.)Plasmin:
Breaks down fibrinogen and fibrin.
Making FDPs, XDPs, D-dimers

Kept in check by…
1.) alpha 2 antiplasmin

2.)TAFI:
Thrombin activatable fibrinolysis inhibitor

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7
Q

Factor I

A

Fibrinogen

  • Precursor to fibrin
  • Made in liver, doesn’t require vitK for it’s production
  • 200-400mg/dl
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8
Q

Factor II

A

Prothrombin

  • Precursor to thrombin
  • made in liver, needs vit K
  • little remains in serum
  • 8-15mg/dL
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9
Q

Factor III

A

Thromboplastin, tissue factor TF

  • name given to any substance capable of converting prothrombin to thrombin
  • hmw lipoprotein

-brain, lung, vascular endothelium, liver, placenta, kidneys

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10
Q

Factor IV (no longer in use)

A

Ionized CA++

  • essential for clotting, bridge between phospholipid surface of plts and factors
  • needed to activate thromboplastin
  • needed to convert prothrombin to thrombin
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11
Q

Factor V

A

Labile factor/Proaccelerin/AcG

Prothrombin accelerator

  • needed to convert prothrombin to thrombin
  • globulin made in liver, def in liver disease
  • labile: activity destroyed in clotting process; most unstable, half-life 25hrs
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12
Q

Factor VII

A

Proconvertin/Stable Factor
SPCA (serum prothrombin conversion accelerator)

  • stable factor: not destroyed or consumed
  • requires vit K, made in liver, in plasma and Serum
  • only used in extrinsic pathway
  • activates tissue thromboplastin
  • accelerates thrombin from prothrombin
  • monitored by PT, half life 4-6hrs
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13
Q

Factor VIII:C

A

Antihemophilic factor/AHF/AHG

  • ability to correct coag issues in hemophilia A
  • Combination of VIII:C and VIII:vWF.
  • VIII/vWF unit measured VIII assay and APTT
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14
Q

Factor IX

A

PTC (plasma thromboplastin component)

Christmas factor
AHB

  • Stable protein factor, liver, needs vitK
  • Not consumed so in plasma and Serum
  • Helps in making Intrinsic thromboplastin
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15
Q

Factor X

A

Stuart-Prower factor

  • not consumed, in plasma and Serum
  • needs vitK
  • intrinsic pathway, helps make thromboplastin
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16
Q

Factor XI

A

Plasma thromboplastin antecedent
PTA

  • Circulates as a complex with HMWK
  • Helps with making thromboplastin
  • Doesn’t need vit K
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17
Q

Factor XII

A

Hageman factor/contact factor/glass factor

  • active when in contact with glass
  • not consumed, in serum and plasma
  • doesn’t need vitK
  • def not at risk for bleeding
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18
Q

Factor XIII

A

Fibrin stabilizing factor, fibrinase

Made by megakaryocytes
Enzyme catalyzes polymerization of fibrin
Needed for tissue growth and repair

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19
Q

Fitzgerald factor other name…

A

High molecular weight kininogen/HMWK

A cofactor that Yields kinin, Precursor of bradykinin
Doesn’t need vitK

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20
Q

prekallikrein/Fletcher factor other name…

A

Prokallikrein

  • activates Plasminogen
  • recruits phagocytes
  • doesn’t need vitK
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21
Q

Fibrinogen: factor…

A

I

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22
Q

Prothrombin: factor…

A

II

  • Precursor to thrombin
  • made in liver, needs vit K
  • little remains in serum
  • 8-15mg/dL
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23
Q

Thromboplastin, tissue factor TF:

factor…

A

III

  • name given to any substance capable of converting prothrombin to thrombin
  • hmw lipoprotein

-brain, lung, vascular endothelium, liver, placenta, kidneys

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24
Q

Ionized CA++: former name…

A

Factor IV

  • essential for clotting, bridge between phospholipid surface of plts and factors
  • needed to activate thromboplastin
  • needed to convert prothrombin to thrombin
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25
Labile factor/Proaccelerin/ Prothrombin accelerator: factor...
V - needed to convert prothrombin to thrombin - globulin made in liver, def in liver disease - labile: activity destroyed in clotting process; most unstable, half-life 25hrs
26
Proconvertin/Stable factor/SPCA (serum prothrombin conversion accelerator): factor...
VII - stable factor: not destroyed or consumed - requires vit K, made in liver, in plasma and Serum - only used in extrinsic pathway - activates tissue thromboplastin - accelerates thrombin from prothrombin - monitored by PT, half life 4-6hrs
27
Antihemophilic factor/AHF/AHG: | Factor...
VIII:C - AHG/AHF are terms used to designate procoagulant in normal plasma but deficient in hemophilia - ability to correct coag issues in hemophilia A. Mixing normal plasma with hemophilia A plasma will correct AHF def. - Combination of VIII:C and VIII:vWF. - VIII/vWF unit measured VIII assay and APTT
28
PTC (plasma thromboplastin component) Christmas factor AHB factor...
IX - Stable protein factor, liver, needs vitK - Not consumed so in plasma and Serum - Helps in making Intrinsic thromboplastin
29
Stuart-Prower factor: factor...
X - not consumed, in plasma and Serum - needs vitK - helps make thromboplastin
30
Plasma thromboplastin antecedent/PTA: factor...
XI - Circulates as a complex with HMWK - Helps with making thromboplastin - Doesn't need vit K
31
Hageman factor/contact factor/glass factor: factor...
XII - active when in contact with glass - not consumed, in serum and plasma - doesn't need vitK - def not at risk for bleeding
32
Fibrin stabilizing factor, fibrinase | factor...
XIII Made by megakaryocytes Enzyme catalyzes polymerization of fibrin Needed for tissue growth and repair
33
High molecular weight kininogen/HMWK | other name...
Fitzgerald factor A cofactor that Yields kinin, Precursor of bradykinin Doesn't need vitK
34
prekallikrein/Fletcher factor | Other name...
Prokallikrein - activates Plasminogen - recruits phagocytes - doesn't need vutK
35
Intrinsic pathway: In circulating blood Activated by certain contact surface Factors/Cascade...
Intrinsic pathway: * 1.)12 to 12a (contact factor) 2. )Fitzgerald, Fletcher * 3.)11 to 11a 4. )PF3, CA++ * 5.)9 to 9a (can also be activated by III in extrinsic) 6. )PF3, CA++ * 7.)8 to 8a ...common pathway...
36
Extrinsic pathway Not in circulating blood Factors...
1.)III/Tissue thromboplastin: Cofactor 2.)CA++: From Plt granules 3.)VII to VIIa 4. ) a. Can help activate IX in intrinsic pathway or b. Common pathway
37
PF3:
Plt factor 3 phospholipid released from platelet membranes
38
Common pathway: Factors ..
1. )X to Xa 2. )V to Va (needs PF3, Ca++) 3. ) Prothrombin/II to thrombin 4. ) a. Fibrinogen to fibrin (monomer) b. XIII to XIIIa 5.) Fibrin to stable fibrin clot (polymer)
39
Antithrombin III | Inhibits...
Inhibits thrombin
40
Protein C/S combination: | Inhibits...
Inactives factors 5a and 8a
41
Tissue factor pathway inhibitor/TFPI | Prevents...
Activation of prothrombin by Xa
42
Protein Z | Inhibits...
Factor Xa
43
Warfarin Other name... Inhibits...
Coumadin Inhibits vit K dependent factors
44
Heparin | Inhibits...
Inhibits thrombin and factor X
45
Clopidogrel/Plavix | Inhibits...
Inhibits Plt aggregation
46
Aspirin | Inhibits...
Inhibits Plt aggregation and release of PF3
47
Acquired coagulation disorder...
Vit K def Anticoagulant therapy DIC Autoantibodies to coag factors
48
Inherited coagulation disorders
Hemophilia A, B Def or dys of factors
49
Hemophilia A Other name... Def in... Common in..
Classic hemophilia functional deficiency in VIII:C subunit Most common inherited coag disorder, 85% Sex linked and Mostly males Bleeding but normal VIII:vWF/BT
50
Hemophilia B Other name... Common in .. Factor def ..
Christmas disease Sex linked, mostly males IX
51
Acquired platelet disorders
Aspirin: irreversibly affects aggregation Deceased megakaryocytes made: infection ITP: ab to plts decrease plts TTP: plts used in microthrombi, decreasing number Sequestered in spleen: enlarged spleen
52
Inherited platelet disorders
vWD: most common, deceased Plt adhesion Bernard-Soulier syndrome: large plts, deceased adhesion Glanzmanns thrombasthenia: lack GIIIb/a, decreased aggregation
53
Hemophilia A: PT, aPTT, BT, PLT ct
func def in VIII:C aPTT: prolonged PT, BT, PLT: normal
54
Hemophilia B: PT, aPTT, BT, PLT ct
func def in IX aPTT: prolonged PT, BT, PLT ct: normal
55
vWD: | PT, aPTT, BT, PLT ct
deceased Plt adhesion Hereditary, in different subtypes, def in VIII:vWF PT, aPTT, and BT: prolonged PLT ct: normal
56
Warfarin therapy PT, aPTT, BT, PLT ct
Inhibits vitK dependent factors PT, aPTT: prolonged BT, PLT ct: normal
57
Glanzmanns thrombasthenia PT, aPTT, BT, PLT ct
Lack GIIIb/a, deceased PLT aggregation
58
ITP PT, aPTT, BT, PLT ct
Ab to PLTs BT: prolonged PLT: below normal PT, aPTT: normal
59
Prolonged PT in def of factors...
2-5-7, 10 Extrinsic and common pathways
60
Prolonged PT in what therapies/situations...
Warfarin, heparin therapy Liver disease Vit K def
61
PT/protime: most common coag Used for: Monitor warfarin, Presurgery coag screening Tests prothrombin and other factors *Prothrombin is vitK dependent, made in liver
PT test: Commercial tissue thromboplastin and Ca++ Combine anticoagulated plasma (3.2% citrated) with reagent to form fibrin clot. Def in extrinsic or common will be prolonged Time required for fibrin clot to form. Ref range 10-13 secs Use INR due to thromboplastin differing. INR 1.0-1.4 *PT secs/mean of normal of facility secs
62
APTT: Factors in Intrinsic tested:
8, 9, 11, 12 Fitzgerald, Fletcher 89-11-12, Fi-Fl
63
APTT: Factors in common pathway tested:
1,2, 5,10 125-10
64
APTT: Monitor low dose heparin and intrinsic/common def Not influenced by Plt numbers Plasma plus partial thromboplastin and CaCl2
APTT: PT plasma is added to partial thromboplastin to help activate intrinsic pathway mimicking PF3. Then CaCl2 is added. Time for fibrin clot to form after CaCl2 is APTT Varies on whole or citrated. 29-34 secs
65
APTT | Prolonged in ..
1,2,5 8,9,10,11,12 Heparin VitK def
66
BT Ivy ref... ACT ref...
Ivy: 2-9sec ACT: 81-125 sec
67
PT citrated Plasma ref: INR:
Plasma: 10-13sec INR: 1.0-1.4
68
PT- Hemochrom Jr Whole blood... Plasma equivalent... INR...
Whole blood: 20-26secs Plasma equivalent: 8-15sec INR: 0.8-1.5sec
69
APTT: plasma Citrated ref
24-34 secs
70
APTT: Hemochron Jr Whole blood... Plasma equivalent...
Whole blood: 93.2-116.8 sec Plasma equivalent: 20.6-38.6 sec
71
DIC: circulatory thrombosis, hemorrhaging... malfunction to maintain balance of clotting and fibrinolysis Factors and PLTs decrease ``` Lab results for DIC: PLT ct... Serum fibrinogen... PT, aPTT... FDPs, XDPs ```
Lab results for DIC: PLT ct and Serum fibrinogen: deceased PT and aPTT: prolonged FDPs and XDPs: increased
72
Fibrinolysis: Both fibrinogen and fibrin are cleaved by plasmin. FDPs: XDPs: *Contains...
FDPs: fibrin degradation products XDPs: cross linked fibrin degradation products *Contains D-dimers (protein fragments, terminal product). D-dimers only made as a result of cross linked fibrin being lysed. Important to distinguish between FDPs and XDPs because it's more serious to have XDPs (pathological fibrinolysis).
73
VIII:vWF
von Willebrand factor - the other factor in VIII subunit - plt adherence , binging plts to endothelium - not involved in coagulation pathway - antigenic, helps Plt aggregation induced by ristocetin
74
von Willebrand factor | Factor...
VIII:vWF - the other factor in VIII subunit - plt adherence , binging plts to endothelium - not involved in coagulation pathway - antigenic, helps Plt aggregation induced by ristocetin
75
Fibrinogen group
Thrombin sensitive, acts on all below factors Consumed, not in plasma 1, 5, 8, 13 I, V, VIII, XIII
76
Prothrombin group
Vit K dependent Not consumed, in serum and plasma Coumarin type drugs decrease these 2,7,9,10 II, VII, IX, X
77
Contact group
Not consumed, don't need vitK 11,12, Flet, Fit IX, XII, prokallikrein, HMWK
78
Natural anticoagulants...
AT-III: antithrombin III, major thrombin inhibitor AT-III heparin cofactor/HC-II: heparin dependent thrombin inhibitors Protein C: in liver, inactive zymogen Protein S: cofactor
79
Factors only in the extrinsic pathway...
III, VII 3,7
80
Factors only in the instrinsic pathway...
8,9 11,12 | HMWK, PK
81
Factors inhibited by Coumarin/Need VitK
2, 7, 9,10
82
PT measures factors...
1,2, 5, 7, 10 Coumadin therapy

Coagulation (1 decks)

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