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Coagulation Flashcards

1
Q

What happens when MTHFR decreases?

A

Homocystine increases

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2
Q

Steps of hemostasis

A

Primary hemostasis
Secondary hemostasis
Fibrinolysis

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3
Q

Steps in primary hemostasis

A

Vasoconstriction
Platelet adhesion
Platelet aggregation - to form primary hemostatic plug at injury site

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4
Q

Steps of secondary hemostasis

A
  • Interaction of coag factors to produce fibrin (secondary hemostatic plug)
  • Fibrin stabilization by FXIII
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5
Q

Steps in fibrinolysis

A
  • Release tissue plasminogen activator
  • Plasminogen —> plasmin
  • Fibrin —> fibrin degradation products
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6
Q

What are the quantitative plt disorders?

A

Thrombocytopenia
Primary thrombocytosis
Secondary or reactive thrombocytosis

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7
Q

Thrombocytopenia

A

Decrease production, increase destruction

<30x10^9/L: petechiae, menorrhagia, spontaneous bruising

<10x10^9/L: severe spontaneous bleeding

Lab tests: Plt <150 x 10^9/L

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8
Q

Primary thrombocytosis

A

Unregulated production of megakaryocytes in BM (like ET)

Thrombosis (blood clots) or hemorrhage (damaged blood vessel)

Lab tests: >1000 x 10^9/L

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9
Q

Secondary or reactive thrombocytosis

A

Increased plt due to another condition (like hemorrhage, surgery, splenectomy)

No thrombosis or hemorrhage

Lab tests: 450-1000 x 10^9/L

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10
Q

Qualitative Platelet Disorders

A

Inherited: Bernard-Soulier syndrome, Glanzmann’s thrombasthenia, delta-storage pool disorder
Acquired

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11
Q

Bernard-Soulier syndrome

A

Lack of GP Ib/IX/V on plt surface —> no plt interaction w/ VWF —> abnormal adhesion to collagen

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12
Q

Glanzmann’s thrombasthenia

A

Deficiency or abnormality of plt membrane GP IIb/IIIa —> fibrinogen can’t attach to plt surface —> cannot do plt aggregation

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13
Q

delta-storage pool disorder

A

Dense granule deficiency —> no ADP released —> abnormal secondary aggregation with ADP & epinephrin

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14
Q

Acquired plt disorder

A

Functional plt disorder (occurs with renal failure, aspirin, etc) —> abnormal plt aggregation

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15
Q

Tests for platelet function

A

Platelet aggregation
Platelet function assay (PFA)
VWF:Ag

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16
Q

Platelet aggregation (plt function test)

A

Aggregating agent (ADP, collagen, ristocetin, epinephrine) added to plt suspension

Time it takes for plts to aggregate = increase in light transmittance

Curve = time vs % transmittance

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17
Q

Platelet function assay (PFA) - plt function test

A

Citrated WB in a capillary tube coated with ADP/collagen or epinephrine/collagen

Plts adhere and aggregate when exposed to collagen

Closure time = time it takes for plts to form a plt plug and close aperture of capillary tube

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18
Q

VWF:Ag

A

Immunologic test (ex: EIA) using monoclonal Abs to VWF

VWF needed for plts to connect to collagen (plts don’t function properly if decreased VWF — like in VWD)

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19
Q

Factor I

A

Fibrinogen

Fibrinogen —thrombin—> fibrin

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20
Q

Factor II

A

Prothrombin

Prothrombin —> thrombin

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21
Q

Factor III

A

Tissue factor (in extrinsic pathway)

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22
Q

Factor IV

A

Ca2+

With 8a and 5a

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23
Q

Factor V

A

Labile factor (proaccelerin)

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24
Q

Factor VII

A

Stable factor (proconvertin)

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25
Factor VIII
Antihemophilic factor Deficiency = Hemophilia A FVIII + VWF
26
Factor IX
Christmas factor Deficiency: Hemophilia B
27
Factor X
Stuart factor
28
Factor XI
Plasma thromboplastin antecedent Deficiency: Hemophilia C (rare) - may or may not cause bleeding
29
Factor XII
Hageman factor (contact factor) Deficiency: no bleeding
30
Factor XIII
Fibrin stabilizing factor (stabilizes fibrin clot)
31
HMWK (high molecular weight kininogen) + PK (prekallikrein)
Fitzgerald factor & Fletcher factor, respectively Used with (F12 and F11) to activate the intrinsic pathway
32
What is a substrate? And what is the factor?
Substance changed by an enzyme Factor: fibrinogen (F1)
33
What is a cofactor? And factors associated?
Protein that accelerates enzymatic reactions Factors: 5 (cofactor for 10a) and 8 (cofactor for 9a)
34
What is an enzyme? And factors associated?
Protein that catalyzes a change in specific substrate Serine proteases: 2a (thrombin), 7a, 9a, 10a, 11a, 12a, prekallikrein (PK) — (1972 + 11 + 12) Transglutaminase: XIIIa
35
Contact group
Factors involved in initiation of intrinsic pathway HMWK, PK, F12, F11
36
Prothrombin group
Vitamin K dependent factors 1972 (10, 9, 7, 2)
37
Fibrinogen group
Factors acted on by thrombin 1, 13, 5, Consumed in clotting (not in serum) Increased in acute phase (pregnancy and inflammation)
38
Extrinsic pathway factors
TF (F3) & F7
39
Intrinsic pathway factors
F12, 11, 9, 8, HWMK, PK
40
Common pathway factors
1, 2, 5, 10
41
Extrinsic tenase complex
VIIa/TF Acts on X
42
Intrinsic tenase complex
9a/8a Acts on X
43
Prothrombinase complex
10a/5a Acts on prothrombin
44
Factor VIII complex
FVIII:C & VWF VIII:C = procoagulant VWF = carrier protein
45
All factors are produced in what organ?
Liver
46
What factors are affected by coumadin/warfarin?
Factors that need Vitamin K (1972)
47
What factors are consumed during clotting?
1, 13, 5, 8, 2 (basically all of the fibrinogen group ones + 2)
48
Labile factors
5, 8
49
INR (international normalized ratio)
[patient PT/mean normal PT]^ISI
50
Aspirin
Platelet inhibitor Destroys cyclo-oxygenase —> inhibits plt release
51
Clopidogrel (Plavix)
Plt inhibitor Blocks ADP receptor (P2Y12) — prevents plt aggregation
52
Eptifibatan, Abciximab, Tirofiban (EAT)
(Plt inhibitor) GP IIb/IIIa receptor inhibitor
53
Warfarin
Inhibits Vit K (1972) Requires monitoring with PT/INR Eliminated by liver
54
Dabigatran
Thrombin inhibitor Eliminated by kidneys
55
Rivaroxaban & Apixaban
Factor Xa inhibitor
56
Heparin (unfractionated)
Inhibits active serine protease factors via anti-thrombin Monitor with anti-Xa assay
57
Low Molecular Weight Heparin (LMWH)
Targets Factor Xa & 11a Monitor with anti-Xa assay
58
Zymogens
Inactive coagulation forms (like XII before it becomes XIIa)
59
Acquired hemophilia vs inherited hemophilia
Acquired: inhibitor Inherited: deficiency
60
Defective clot retraction caused by
Defect in GP IIb/IIIa

ASCP (10 decks)

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