Hemostasis Exam 2: Electric Boogaloo Flashcards
(97 cards)
1
Q
Surface damage activates _____ of the _____ pathway.
This factor activates _____, then _____, then _____.
Trauma activates _____ of the _____ pathway. This factor activates _____.
A
Factor XII (converted to XIIa), Intrinsic
Factor XI, Factor IX, Factor X
Factor VII, Extrinsic, Factor X
2
Q
Which pathway do Factors XII, XI, IX, X belong?
Which pathway do Factors VII and X belong
A
Intrinsic pathway (contact activation) Extrinsic pathway (trauma)
3
Q
_____, _____, and _____ –> Active Protein C
Active Protein C halts the reaction _____.
A
Protein C
Thrombomodulin
Protein S
V –> Va
4
Q
Upon activation of X to Xa, prothrombin can be converted to _____.
Another factor that can perform this reaction is Factor _____.
A
Thrombin
Va
5
Q
Thrombin activates Factors _____, _____, and _____ and also activates _____.
A
V, VIII, XIII, platelets
6
Q
Thrombin converts _____ to _____.
This forms a _____.
A
Fibrinogen to fibrin.
Cross-linked fibrin clot.
7
Q
Antithrombin prevents two conversion reactions. What are these reactions
A
X –> Xa
I –> Ia
8
Q
TFPI prevents _____ from becoming _____.
A
VII, VIIa
9
Q
Serine proteases
A
All activated factors except factor XIIIa
10
Q
Transaminases
A
only XIIIa
11
Q
Fitzgerald factor
A
HMWK
12
Q
Fletcher factor
A
Prekallikrein
13
Q
Contact Proteins
Protein C and S are _____.
A
XII, XI, Prekallikrein, HMWK
Inhibitors
14
Q
Vitamin K Dependent Factors
Which of these has the shortest 1/2-life
A
2, 7, 9, 10
7 has shortest 1/2-life
15
Q
Coumarin, Coumadin, and Warfarin inhibit
A
Vitamin K-dependent factors
16
Q
What test monitors Coumadin (oral coagulant) therapy?
A
PT
17
Q
Fibrinogen or thrombin sensitive proteins
A
I, V, VIII:C, XIII
18
Q
Which factors does PT measure?
A
I, II, V, VII, X
19
Q
What factors are measured in the APTT test?
A
Intrinsic: VIII, IX, XI, XII
extrinsic: I, II, V, X
20
Q
How is fibrinogen measured?
A
With thrombin agent
21
Q
Intrinsic pathway factors
A
8, 9, 11, 12
22
Q
Extrinsic pathway factors
A
7
23
Q
Common pathway factors
A
1, 2, 5, 10 (and 13 too, aka, Fibrin stabilizing factor)
24
Q
APTT is used to monitor
A
heparin therapy
25
Serum factors
7, 9, 10, 11, 12
Intrinsic + Extrinsic + Common (10)
Fibrinogen has been exhausted
26
Adsorbed serum
1, 5, 8, 11, 12
| Missing 9
27
Which factor is missing from stored plasma?
Factor V
Labile Factor
Accelerin
28
What are the factors in stored plasma?
1, 2, 7, 9, 10, 11, 12
| Includes all the "important" ones
29
Adsorbed serum contains
11, 12
30
Fibrinogen reference range
150-400 mg/dL
31
PT reference range
11.5-14.0 seconds
32
APTT reference range
20-45 seconds
33
Affected by tissue factor
Factor VII
34
Activation of Factor II creates positive feedback for which factor in which pathway?
Factor XI of the intrinsic pathway
35
Factor _____ is needed for for IX to activate X
Factor VIII
36
Extrinsic pathway activation involves what two factors?
III (TF) and VII (Stable factor)
37
What reagents are used to test the extrinsic pathway?
Ca++ and thromboplastin
38
How does TF begin the extrinsic pathway?
TF provides a phospholipid surface for activation
39
What is the key enzyme in fibrinolysis?
Plasmin – breaks polymer bonds & releases FDP’s
40
How is plasmin activated?
Results from the cleavage of inactive form (zymogen) - plasminogen by either of two pathways: Extrinsic pathway activation: TF3 and fibrin as cofactor. Intrinsic pathway activation: involves Factors XIIa, kallikrein, or HMWK
41
Are plasminogen activators exogenous or endogenous and where are they found?
Endogenous.
It's present in the blood & other tissues. Primary source of activators are in the blood vessel endothelium.
42
Primary activator of plasminogen in the genitourinary system?
Urokinase
43
If a patient shows no increase in t-PA, what are they at an increased risk for?
DVT
44
Where are the coagulation factors active/inactive and what is their overall purpose?
Blood – inactive state
Once activated – interact to form fibrin clot
Purpose – reinforces platelet plug
45
Where are the coagulation factors produced?
Liver
46
Factor I is also called
| Factor II is also called
Fibrinogen
| Prothrombin
47
Factor III
Tissue factor or tissue thromboplastin
48
What is the name for factor IV?
Ionized calcium
49
Factor V
Labile factor or proaccelerin
50
Factor VI
Clearly the most important factor.
51
Factor VII
Stable factor (Serum prothrombin conversion accelerator SPCA). Proconvertin
52
Factor VIII
Antihemophilic factor
53
Factor IX
Christmas factor
Plasma thromboplastin component
Antihemophilia factor B
54
Factor X
Stuart-Prower factor
55
Factor XI
Plasma thromboplastin antecedent
56
Factor XII
Hageman factor
| Contact factor
57
Factor XIII
Fibrin stabilizing factor
58
Main substrate
Fibrinogen
59
Which factors are cofactors?
- Factor V (labile factor)
| - VIII:C (antihemophilic factor (AHF))
60
What measures prothrombin activity in serum following coagulation?
Prothrombin consumption
61
A screen for all types of circulating anticoagulants based on the ability of normal plasma to correct an abnormal clotting time with a factor deficiency
Mixing studies
62
commercially prepared concentrate to the vitamin K dependent factors in lyophilized form, used to treat some hemorrhagic disorders
Prothrombin complex
63
Inherited deficiency of factor VIII:C
Hemophilia A
64
VIII:C
procoagulant portion of factor VIII complex
65
Stypven time
Test used to distinguish between factor VII and factor X deficiency
66
Substance used to delay or prevent clotting
Anticoagulant
67
system that contains factors XII, XI, IX, and VIII, leads to the common pathway and is surface (contact) activated
Intrinsic
68
Factor IX deficiency
Hemophilia B
69
Single donor therapeutic plasma product containing all clotting factors
Fresh frozen plasma
70
Acquired inhibitors of normal coagulation, directed against a specific factor or a complex of factors
Circulating anticoagulant
71
Factor VIII:C
Antihemophiliac factor
72
Factor V deficiency
parahemophilia
73
"Easy" bleeder, mostly men
Hemophiliac
74
Process of stopping blood flow from a wound
Coagulation
75
Trait with moderate bleeding diathesis in which PT is normal, APTT is slightly prolonged and is not corrected by incubation and levels of all known coagulation factors are normal
Passovoy
76
Factor that stabilizes the soluble fibrin gel
FSF
77
Deficiency of this, primarily found in Ashkenazi Jews and sonsanguineous relationships, causes hemophilia C
PTA
78
Process by which body controls clotting and bleeding
Hemostasis
79
Measures intrinsic system activity, examples are Lee-White and Hemochron
Whole blood clotting time
80
Substance which, in the presence of ionized calcium, converts factor VII to VIIa
Tissue thromboplastin
81
Disorder in which fibrinogen is qualitatively abnormal
Dysfibrinogenemia
82
Factors II, VII, IX, and X are dependent on sufficient quantities of this for production in the liver
Vitamin K
83
disorder manifesting decreased levels of fibrinogen
Hypofibrinogenemia
84
presence of this may lead to thrombosis
Lupus anticoagulant
85
Test monitoring the extrinsic system
PT
86
substance extracted from the venom of a snake Bothrops atrox; used in coagulation procedure to resolve discrepant results when the thrombin time is prolonged due to heparin
Reptilase
87
Thrombin time
Test that monitors the conversion of fibrinogen to fibrin
88
Fletcher factor
Prekallikrein
89
Substance used as a surface activator in APTT testing
Kaolin
90
Substance that acts as a contact activator causing the release of PF3 and the activation of the intrinsic system
Celite
91
What are the general characteristics of Plasminogen Activator Inhibitor – 1?
- Synthesized by blood vessel endothelium & released in an inactive state
- An acute phase reactant
- Primary substrate is t-PA = thus regulation of fibrinolysis is dependent on the interaction of t-PA w/ PAI-1
- Excess of this inhibitor associated with thrombotic disease
92
How does plasmin limit the coagulation process?
Limits coag process by cleaving & rendering inactive FV & FVIII, XII & GPIb (vWF receptor)
93
What is the primary plasmin inhibitor and what is its overall effect?
- alpha 2-antiplasmin inhibitor
| - Overall effect – plasmin activity is limited to area of fibrin deposition
94
What are the indications for fresh frozen plasma use?
- Significant coagulopathy
- A significant coagulopathy results when the PT > 3 sec., INR >1.5 sec. And the patient has
- An active bleed
- Anticipated invasive procedure
95
What is cryoprecipitate?
Cryoprecipitate:
Is prepared by taking FFP and thawing it slowly between 1-6oC. The white
precipitate that forms at the bottom of the bag is the cryoprecipitate… so it
is the cold, insoluble portion of plasma.
96
What are the indication of use for cryoprecipitate?
Control bleeding associated with a deficiency of FI or FXIII
2nd choice therapy for management of Hemophilia A & vWD (when FVIII concentrates are not available)
Source of surgical fibrin sealant
97
What are the adverse effects of cryoprecipitate?
Hemolytic or febrile transfusion reactions are possible because this is a human product
Allergic reactions
Septic reactions
