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DISEASE - endocrine and haem > Haemostasis and thrombosis > Flashcards

Haemostasis and thrombosis Flashcards

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1
Q

in primary haemostasis what is the process of platelet adhesion?

A

unactivated platelets bind to vWF in subendothelial matrix

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2
Q

what on the platelets binds to vWF in the vessel walls?

A

GP1b receptors

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3
Q

what happens when platelets are activated?

A

they release their granules

the express phospholoipid and GPIIb and GPIIIa

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4
Q

what do activated platelets express?

A

phospholipid
GPIIb
GPIIIa

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5
Q

where is vWF produced?

A

liver

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6
Q

apart from in the vessel wall where else is vWF in the body?

A

in the blood

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7
Q

what factor is carried by vWF?

A

FVIII

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8
Q

WRT primary haemostasis - what do endothelial cells store?

A

FVIII and vWF

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9
Q

WRT secondary haemostasis, what is the extrinsic pathway initiated by?

A

tissue factor

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10
Q

WRT secondary haemostasis - what is the intrinsic pathway initiated by?

A

phospholipid expressed on platelets

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11
Q

very briefly, what is are the 4 steps of fibrin formation?

A

1 - extrinsic pathway
2 - thrombin formation
3 - intrinsic pathway
4 - fibrin formation

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12
Q

which pathway is activated first - intrinsic or extrinsic?

A

extrinsic

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13
Q

which pathway is initiated by tissue factor?

A

extrinsic

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14
Q

which pathway is initiated by phospholipid on platelets?

A

intrinsic

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15
Q

which 2 factors are involved in the extrinsic pathway?

A

tissue factor

FVII

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16
Q

which 4 factors are involved in the intrinsic pathway?

A

FXII
FXI
FIX
FVIII

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17
Q

the activation of which 2 factors depends on the meeting of the intrinsic and extrinsic pathways?

A

FX

FV

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18
Q

which 3 factors are activated by thrombin?

A

VIII
IX
XI

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19
Q

which factor in the intrinsic pathway starts the pathway but isn’t actually an important factor?

A

XII

why - the rest of the chain are activated by thrombin and the pathway initiated by platelet phospolipid

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20
Q

what is the pathway from prothrombin to cross linked fibrin?

A

prothrombin (FII) - thrombin - fibrinogen (FI) - cross linked fibrin

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21
Q

what are FI and FII AKA?

A

FI - fibrinogen

FII - prothrombin

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22
Q

which ion in the plasma is essential in secondary haemostasis?

A

Ca2+

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23
Q

which pathway do the following test?
APTT
PT
TT

A

APTT - intrinsic
PT - extrinsic
TT - thrombin

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24
Q

what are the normal values for:
APTT
PT
TT

A

APTT - 32s
PT - 12s
TT - 18s

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25
which coag screen examines fibrinogen quality and quantity?
TT
26
which coag screen measures the extrinsic pathway?
PT - INR
27
which coag screen measures the intrinsic pathway?
APTT
28
which coag screen is prolonged by heparin?
TT
29
which test would you use to diagnose blood coag disorders and the effectiveness of fibrinogen therapy?
TT
30
which coag screen measures factors I, II, V, VII, X?
PT
31
which coag screen measures factors VIII, IX, X, XI, XII?
APTT
32
which coag screen do you use for warfarin dosing?
PT - INR
33
which coag screen would you use for heparin levels and clotting abnormalities such as haemophilia and vWF disease?
APTT
34
what coag test would you use to diagnose thrombosis and DIC?
D dimer
35
what is D dimer?
product of fibrin degredation
36
when would you test for fibrin levels and they would be low?
DIC
37
what is the purpose of fibrinolysis?
removal of clots
38
what is the process of fibrinolysis?
tissue plasminogen activator (urokinase) - plasminogen - plasmin - fibrin - fibrin degradation products
39
which factor is tested by both APTT and PT?
FX - if one pathway is normal then FX will be OK
40
which factor could be the problem if both pathways did not work?
FX
41
what are the 2 naturally occurring inhibitors of blood coagilation?
1 - antithrombin | 2 - protein C system
42
where is antithrombin synthesised?
liver
43
what does antithrombin inhibit?
thrombin | FXa
44
which naturally occurring inhibitor of blood coagulation is affected by heparin?
antithrombin
45
which naturally occurring method of blood coag inhibition is vit k dependent?
protein C system
46
where is protein C synthesised?
liver
47
which factors does the protein C system inhibit?
FVa | FVIIIa
48
how is protein C activated?
endothelial damage - thrombin + thrombomodulin formed - protein C activated
49
what does protein C activate?
protein S
50
what does activated protein S do?
cleaves FVIIIa and FVa to FV and FVIII
51
in primary haemostasis what is exposed when the vessel is damaged?
vWF | collagen
52
problems with primary haemostasis are caused by problems with what?
platelets
53
how can platelet disorders be categorised?
qualitative - inherited/acquired quantitative - dec production/inc destruction
54
what are the 2 inherited platelet disorders?
1 - bernard-soulier disease - lack of GP1b | 2 - glanzmann's thrombasthenia - lack of GPIIb/IIIa
55
what is the difference between bernard-soulier disease and glanzmann's thrombasthenia?
``` BS = abnormal platelets GT = n platelets that fail to aggregate ```
56
what are 2 acquired qualitative problems with 1ry haemostasis?
1 - drugs - asprin, NSAIDS | 2 - renal disease - uraemia inhibits platelet adhesion, activation, aggregation
57
in thrombocytopenia due to dec production, what are 2 possible causes?
1 - BM failure | 2 - rare causes - wiskott-aldrich syndrome, congenital infections - CMV, rubella
58
in thrombocytopenia with inc destruction, what are the 4 possible causes?
1 - splenomegaly 2 - alloimmune 3 - immune thrombocytopenia 4 - intravascular thrombosis
59
intravascular thrombosis causing thrombocytopenia can manifest in 3 ways, what are these?
DIC haemolytic uraemic syndrome thrombotic thrombocytopenic purpura
60
whats the difference between DIC and TTP and HUS?
DIC - all vessels | TTP and HUS - microangiopathic
61
what happens in immune thrombocytopenia?
immunological destruction of platelets, usually post-viral
62
problems wit primary haemostasis can be divided into 2 broad categories, what are they?
vessel problems | platelet problems
63
vessel disorder affecting primary haemostasis can be divided into acquired and inherited, what are the causes for each?
acquired - henoch-schonlein purpura, senile purpura, infections, drug reactions, prolonged steriods, trauma, scurvy inherited - hereditary haemorrhagic telengiectasia (HHT), CTDs - ehlor's-danlos, marfans, pseudoxanthoma
64
what is senile purpura?
bruising with old age - vessel disorder in 1ry haemostasis
65
what is henoch-schonlein purpura?
vessel disorder 1ry haemostasis | vasculitis leading to petichae
66
what causes henoch-schonlein purpura?
allergic vasculitis following infection | usually in children
67
which disorder of primary haemostasis usually presents with epistaxis?
heriditary haemorrhagic telengiectasia
68
``` what would the coag profile of DIC look like? platelets d-dimer PT APTT fibrinogen RBCs ```
``` platelets - dec d-dimer - inc PT - inc APTT - inc fibrinogen - dec RBCs - fragmented ```
69
what are the inherited causes of coagulation disorders - 2ry haemostasis?
haemophilia von willibrand disease also - FXI deficiency, congenital deficiencies of FII, V, VII, X, fibrinogen deficiency, dysfibrogenaemia
70
which factors do haemophilia A and B affect?
A - FVIII | B - FIX
71
which haemophilia is most common?
A
72
how would you diagnose haemophilia?
coag screens - n PT, n/inc APTT | assay for FVIII and IX
73
what do you absolutely not give haemophiliacs?
NSAIDs asprin IM injections
74
how would you treat haemophilia?
coag factors desmopressin tranexamic acid
75
what is the most common coag disorder?
vWD
76
what is the characteristic of vWD?
mucosal bleeding
77
how would you treat vWD?
vWF desmopressin tranexamic acid
78
what acquired coagulation problems can you have?
``` liver disease vit k deficiency anticoags - iatrogenic massive blood transfusion DIC inhibitors to coag factors ```
79
what could cause vit K deficiency?
``` malabsorption malnourished CF IBD liver disease new borns ```
80
what would the levels of the following be in - liver disease ``` bleeding time TT PT APTT fibrinogen ```
``` bleeding time - n TT - inc PT - inc APTT - inc fibrinogen - dec ```
81
what would the levels of the following be in - haemophilia ``` bleeding time TT PT APTT fibrinogen ```
``` bleeding time - n TT - n PT - n APTT - inc fibrinogen - n ```
82
what would the levels of the following be in - vWD ``` bleeding time TT PT APTT fibrinogen ```
``` bleeding time - inc TT - n PT - n APTT - inc fibrinogen - n ```
83
what would the levels of the following be in - DIC ``` bleeding time TT PT APTT fibrinogen ```
``` bleeding time - inc TT - inc PT - inc APTT - inc fibrinogen - dec ```
84
what would the levels of the following be in - thrombocytopenia ``` bleeding time TT PT APTT fibrinogen ```
``` bleeding time - inc TT - n PT - n APTT - n fibrinogen - n ```
85
for disorders of 1ry and 2ry haemostasis - where is the site of bleeding?
1ry - mucous membranes, skin 2ry - soft tissue, joints, tissues
86
for disorders of 1ry and 2ry haemostasis - ??bleeding after minor cuts??
1ry - yes 2ry - not usual
87
for disorders of 1ry and 2ry haemostasis - ??petichae
1ry - present 2ry - absent
88
for disorders of 1ry and 2ry haemostasis - ??echymoses
1ry - small superficial 2ry - large, palpable
89
for disorders of 1ry and 2ry haemostasis - ??haemarthrosis, muscle haematomas
1ry - rare 2ry - common
90
for disorders of 1ry and 2ry haemostasis - bleeding after surgery
1ry - immediate, mild 2ry - delayed, severe
91
where would you find white clots - fibrin and platelets?
arteries
92
where would you find red clots - RBCs and fibrin?
veins
93
what are the 3 mechanisms of thrombophilia that are inherited?
1 - deficiency of anticoags - antithrombin, protein C/S 2 - abnormal proteins - FV leiden, FII, dysfibrinogen 3 - inc. procoagulant - prothrombin, FVIII
94
how long would you give warfarin for with PE?
3/12 if clear cause | 6/12 if no clear cause
95
what ECG changes would you see with a PE?
prominent S1, Q3, T3 new RBBB - indication strain on the RHS of heart

DISEASE - endocrine and haem (5 decks)

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