Hemostasis & Thrombosis

Question 1

cessation of blood flow from an injured blood vessel; maintaining blood in a fluid state

Answer 1

hemostasis

Question 2

what are the 2 parts of primary hemostasis?

Answer 2

vasoconstriction
platelet activation

Question 3

what are the 2 parts of secondary hemostasis?

Answer 3

coagulation cascade
antithrombotic control mechanisms

Question 4

what occurs in primary hemostasis?

Answer 4

platelet plug formation

Question 5

what occurs in secondary hemostasis?

Answer 5

formation of fibrin clot (thrombus)

Question 6

what occurs during fibrinolysis of the hemostasis process?

Answer 6

plasmin breaks down fibrin clot, limits the size of the clot so it becomes normal tissue

Question 7

what process is caused by proteins from activated PLTs and injured endothelial cells?

Answer 7

vasoconstriction

Question 8

during primary hemostasis, damaged endothelial cells produce vWF, tissue factor, expose collagen, secrete plt-activating factor, and release plasminogen activator inhibitor to inhibit fibrinolysis. what is this process called?

Answer 8

thrombogenesis

Question 9

what produces platelets?

Answer 9

megakaryocytes in bone marrow

Question 10

what is the lifespan of platelets?

Answer 10

7-10 days

Question 11

what are the 3 roles of platelets in primary hemostasis? (AAA)

Answer 11

adhesion
activation
aggregation

Question 12

what acts as the glue for optimal platelet-collagen binding?

Answer 12

von Willebrand factor

Question 13

how long does aspirin inhibit platelet function?

Answer 13

life of platelet

Question 14

platelet recruiting and attachment to adjacent platelets to form a mesh network

Answer 14

aggregation

Question 15

the PLT-PLT cross linkage is stabilized by what?

Answer 15

thrombospondin

Question 16

in the coagulation cascade, which pathway overrides?

Answer 16

intrinsic pathway

Question 17

anticoagulant protein that inhibits early phases of extrinsic response to neutralize factor VIIa

Answer 17

tissue factor pathway inhibitor (TFPI)

Question 18

serine protease inhibitor made by the liver that binds thrombin and factor Xa, neutralizing their activity

Answer 18

anti-thrombin

Question 19

what enhances anti-thrombin activity?

Answer 19

heparin released by endothelial cells

Question 20

serine protease produced by the liver that degrades factors Va and VIIa

Answer 20

protein C

Question 21

what does protein C depend on?

Answer 21

vitamin K

Question 22

protein made by the liver, endothelial cells, and PLTs that serves as a cofactor to protein C activity to neutralize factors Va and VIIa

Answer 22

protein S

Question 23

what does d-dimer find?

Answer 23

fibrin degradation products (FDP) that are still attached to factor XIII

Question 24

what do defects in hemostasis result in?

Answer 24

abnormal bleeding or clotting

Question 25

what are some examples of conditions that present with thrombocytosis? (5) HIMMS

Answer 25

Hemorrhage Infection Myeloproliferative disorder (MPD) Malignancy Splenectomy

Question 26

what are some conditions that present with thrombocytopenia? (3) BAL

Answer 26

Bone marrow disorders Autoimmune disease Liver disease

Question 27

pinpoint, flat and small, purplish spots

Answer 27

petechiae

Question 28

red, dark blue localized to one area; do not blanch with pressure

Answer 28

purpura

Question 29

what does generalized purpura indicate?

Answer 29

systemic problem (meningitis, lupus)

Question 30

deep collections of blood under the skin that changes color

Answer 30

ecchymosis

Question 31

what is the most common reason platelet function changes?

Answer 31

medications (aspirin or clopidogrel)

Question 32

time required to build a stable platelet plug and obtain full occlusion, reported in seconds

Answer 32

closure time

Question 33

when could closure time be abnormal?

Answer 33

if PLT count or HCT is low

Question 34

measurement of PLT aggregation to various activators in vitro; recorded by a light transmission aggregometer

Answer 34

PLT aggregation studies

Question 35

what is the gold standard in PLT function testing?

Answer 35

platelet aggregation studies

Question 36

two incisions made and the time for clotting to occur is recorded

Answer 36

bleeding time

Question 37

measures extrinsic and common pathways to evaluate liver function

Answer 37

prothrombin time (PT)

Question 38

what is the method of choice to monitor coumadin (warfarin) therapy?

Answer 38

INR

Question 39

what does an increase in INR indicate?

Answer 39

increased anticoagulation

Question 40

measures intrinsic and common pathways to monitor heparin therapy and evaluate liver function

Answer 40

activated partial thromboplastin time (APTT)

Question 41

measures conversion of fibrinogen to fibrin in common pathway and is sensitive to circulating anticoagulants like heparin

Answer 41

thrombin time (TT)

Question 42

measures protein concentration, and is used in the diagnosis of hypo or dysfibrinogenemia, disseminated intravascular coagulation (DIC), and primary fibrinolysis

Answer 42

fibrinogen

Question 43

what assay is most commonly performed for fibrinogen?

Answer 43

clauss assay

Question 44

what do FDP cause in thrombin time test?

Answer 44

visible agglutination

Question 45

what does a positive D-dimer indicate?

Answer 45

clot has formed and is breaking down

Question 46

what are 4 conditions that cause high D-dimer levels? PMSH

Answer 46

pregnancy surgery malignancy heart disease

Question 47

inhibits carboxylation of vitamin K dependent coagulation factors (II, VII, IX, X)

Answer 47

MOA for warfarin

Question 48

how long does warfarin take to reach therapeutic levels?

Answer 48

4-5 days

Question 49

what do we use to monitor warfarin?

Answer 49

PT/INR

Question 50

inhibits thrombin activation of platelets (thrombin, V, VIII, IXa, and Xa)

Answer 50

MOA of heparin

Question 51

what do we use to monitor heparin?

Answer 51

APTT

Question 52

what is a complication of heparin?

Answer 52

heparin-induced thrombocytopenia (HIT)

Question 53

inactivates Xa but less effective in inactivating thrombin

Answer 53

LMW Heparin

Question 54

what do we use to monitor LMWH?

Answer 54

factor Xa inhibition assay