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Flashcards in Haemostasis Deck (42)
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1

What is haemostasis?

The arrest of bleeding and maintenance of vascular patency

2

Outline the 4 main requirements of haemostasis.

* Permanent state of readiness
* Prompt response
* Localised response
* Protection against unwanted thrombosis

3

Outline the 4 components of the normal haemostasis system.

* Formation of platelet plug – primary haemostasis – platelets that are circulating in the blood come together and stick to form a plug

* Formation of fibrin clot - secondary haemostasis

* Fibrinolysis – this starts as soon as the clot is formed as the body knows that the clot cannot occlude the lumen and blood flow must continue

* Anticoagulant Defences

4

What is primary haemostasis?

Formation of the platelet plug

Platelets that are circulating in the blood come together and stick to form a plug

5

What is secondary haemostasis?

Formation of the fibrin clot

6

When does fibrinolysis start? Why?

As soon as the clot has formed

The body knows that the clot cannot occlude the lumen and blood flow must continue so it starts to break down the clot as soon as it has been made

7

If someone has a very minor injury e.g a paper cut, what is needed?

Just primary haemostasis as the platelet plug is strong enough here

8

Describe a platelet.

Small + anucleate (no nucleus) discs

9

What is the lifespan of a platelet?

7-10 days

10

How are platelet formed?

Formed in the bone marrow from budding of megakaryocytes

11

Where are megakaryocytic seen?

Megakaryocytes aren’t seen in the blood (only the bone marrow) as they are so big

12

How long does the effects of aspirin on a platelet last?

The entire lifespan of the platelet

13

What is primary haemostasis/platelets activated by?

Endothelial (vessel wall) damage exposes collagen and releases Von Willebrand Factor (VWF), and other proteins to which platelets have receptors

* Platelet adhesion at the site of injury
* Secretion of various chemicals from the platelets leads to aggregation of the platelets at the site of injury

14

What does VWF do?

This lets platelets know where they need to come and adhere to

15

Where releases VWF?

Platelets and endothelial cells

16

Outline the 3 main causes of failure of the platelet plug formation.

* Vascular – older people have weak vessels, HSP in young children
* Platelets – reduced number or reduced function
* VWF – commonest inherited bleeding disorder

17

Most common causes is someone with low platelets from being put on Aspirin or Clopidogrel

T

18

How does purpura come about?

Due to the effects of gravity, the platelets leak out of vessel walls and this leaves the skin with a purple discolouration

19

Outline some of the consequences of failure of the platelet plug to form.

* Spontaneous bruising and purpura
* Mucosal bleeding – epistaxis, GI, conjunctival, menorrhagia
* Intracranial haemorrhage
* Retinal haemorrhages

20

What causes senile purpura?

Lack of collagen in the vessel walls

21

What is the main screening tool for primary haemostasis?

Platelet count

There usb really a screening test - it is more a diagnosis of exclusion

22

What is secondary haemostasis?

Formation of the fibrin clot

It occurs on the surface of platelets

23

Outline the events that occur during secondary haemostasis.


1. Platelets are full of phospholipid which is negatively charged
2. They are also full of Ca2+ which is positively charged
3. Calcium on surface makes the surface of platelets positively charged
4. Clotting factors have a negative charge, so are attracted to surface of platelets.
5. Clotting factors start off inactivated, but become activated

24

Outline the process of fibrin clot formation.

1. Initiation

* Tissue factor (TF) is released from endothelial cell, and activates clotting factor VII
* TF/VIIa then go on to activate factors V/Xa

2. Propagation

* V/Xa break down prothrombin to thrombin
* Thrombin then cleaves fibrinogen to form fibrin

3. Amplification

* Thrombin activates factors VIII/IX
* VIII/IXa then activated factors V/X which produces more thrombin  amplification

25

Outline some of the potential causes for failure of fibrin clot to form.

* Single clotting factor deficiency – usually hereditary e.g haemophilia
* Multiple clotting factor deficiencies – usually acquired e.g DIC
* Increased fibrinolysis – usually part of complex coagulopathy

26

What are the most common factor deficiencies which lead to failure of the fibrin clot to form?

Factor 8 and 9

* Haemophilia A - 8
* Haemophilia B – 9

27

Blood clotting factors are produced in the liver, if someone has liver disease then this means they cannot form clotting factors

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28

What is DIC?

Patient gets clots everywhere, then get so much activation that all of the clotting factors are used up, resulting in a severe bleeding tendency

29

What are the 2 reactions which occur leading to fibrinolysis?

* Plasminogen is converted to plasmin by tissue plasminogen activator (tPA)
* Plasmin then converts fibrin to FDPs (fibrin degradation products)

30

What are d-dimers?

Fibrinogen breakdown products