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Clinical Pathology > Lecture 8: Platelets and coagulation II: secondary hemostasis and fibrinolysis > Flashcards

Lecture 8: Platelets and coagulation II: secondary hemostasis and fibrinolysis Flashcards

1
Q

What occurs during secondary hemostasis

A
  1. Coagulation system activation and platelet activation at injury
  2. Fibrin clot
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2
Q

most coagulation proteins are synthesized by the __

A

liver

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3
Q

what would factor X be called in active form

A

Xa (add “a” for active form)

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4
Q

what are the vitamin K dependent coagulation factors

A

X, XI, VII, II

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5
Q

what are the key players in extrinsic coagulation pathway

A
  1. Tissue factor/factor III
  2. Factor VII
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6
Q

what lab test do you use to evaluate extrinsic pathway (VII and III)

A

PT- prolonged if factors deficient

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7
Q

in extrinsic pathway: in presence of tissue factor, ___ is activated to __

A

VII activated to VIIa

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8
Q

in extrinsic pathway: VIIa in presence of __ and __ activates factor __ to __ to begin common pathway

A

TF and Ca2+, activates X to Xa

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9
Q

what does the common pathway generate

A

thrombin—> fibrin clot

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10
Q

what are the key players in intrinsic coagulation pathway

A

XII, XII, IX, VIII

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11
Q

what lab test do you run to test intrinsic pathway

A

PTT—> prolonged if factors XII, XI, IX, and VIII low

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12
Q

In intrinsic pathway: thrombin generated by extrinsic pathway activates __ into __ and __ into __

A

XI to XIa and VIII to VIIIa

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13
Q

in intrinsic pathway: factor XIa with ca2+ cleaves __ into __

A

IX and IXa

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14
Q

In intrinsic pathway: IXa with Ca2+ and accessory factor VIIIa cleave __ into __ to start common pathway

A

X into Xa

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15
Q

common pathway begins with activation of factor __ via intrinsic and extrinsic pathways

A

factor X

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16
Q

in common pathway there is conversion of__ into __

A

fibrinogen (factor I) into fibrin (factor Ia)

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17
Q

fibrin Ia polymerizes with other fibrin monomers to form __

A

soft clot

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18
Q

XIIIa (needs ca2+) crosslinks with fibrin stands of soft clot to form __

A

hard clot

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19
Q

what is Fibrinolysis and what does it prevent

A

breakdown of fibrin clots formed at tissue injury
Prevents thrombosis

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20
Q

Fibrinolysis initiated concurrently with __

A

fibrin production during vessel injury

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21
Q

the fibrin clot is removed by the proteolytic action of __

A

plasmin

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22
Q

what is inactive precursor of plasmin

A

plasminogen

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23
Q

plasmin lyses fibrinogen and fibrin into fragments known as __

A

fibrin degradation products (FDPs)

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24
Q

___ are FDPs specifically from degredation of hard clot

A

d-dimers

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25
increased plasma levels of ___ indicate increase Fibrinolysis, secondary to increased clotting and is __
FDPS, pathological
26
what is the major control of inhibiting coagulation to prevent thrombosis
antithrombin
27
antithrombin is produced by __
liver
28
acquired antithrombin deficiency can occur due to __ or ___
increased consumption (DIC), or increased loss (protein losing nephropathy)
29
what blood tube is used to evaluate hemostasis
blue top
30
what would a prolonged PT test indicate
1. deficiency in extrinsic factors- typically VII 2. Deficiency in common pathway factors: fibrinogen, thrombin, V, X
31
what would a prolonged PTT test indicate
1. Deficiency in intrinsic factors- XII, XI, IX, VIII 2. Deficiency in common pathway factors 3. Increased concentrations of inhibitors (heparin therapy)
32
what is the PIVKA test
proteins induced by vitamin K antagonism/absence
33
what is PIVKA test used for
indicator of vitamin K deficiency—> decrease X, IX, VII, II
34
increased FDP’s or d-dimers indicates excessive __
fibrinolysis
35
D-dimer tests are most specific and sensitive for ___
lysis of hard clot
36
will D-dimers increase or decrease with DIC and thrombosis
increase
37
what are some signs of coagulopathies
1. Excessive hemorrhage after trauma or sx 2. Ecchymoses and purpura 3. Hematomas 4. Hemarthrosis 5. Hemorrhage into body cavities
38
What are the causes of coagulopathies and which most common
1. Most common: decreased production of coagulation factors 2. Increased consumption or loss of factors 3. Production of abnormal molecules
39
isolated deficiencies in factor __ and __ can be asymptomatic or cause mild bleeding problems
XI, XII
40
deficiencies in factors __, __ or __ cause more severe problems
VIII, IX, or common pathway
41
what is the most common inherited coagulopathy
hemophilia A
42
what causes hemophilia A
deficiency or defective factor VIII
43
what species most commonly gets hemophilia A
dogs
44
Who is clinically affected by hemophilia A: males or females
sex linked recessive Males clinical Females carriers
45
what are results of PTT, PT, and factor VIII: coagulant activity for hemophilia A
1. Prolonged PTT 2. Normal PT 3. Decreased factor VIII: coagulant activity
46
what is cause of hemophilia B
deficiency or defective factor IX
47
what are PTT, PT and factor IX: coagulant activity for hemophilia B
1. Prolonged PTT 2. Normal PT 3. Decreased factor IX: coagulant activity
48
what is tx for hemophilia A and B
transfusion of fresh plasma, fresh-frozen plasma, cryoprecipiate or cryosupernatant for acute bleeding episodes
49
what is the most common inherited factor deficiency in cats
Factor XII deficiency
50
t or f: cats with factor XII deficiency are asymptomatic
true
51
what is PTT and PT for factor XII deficiency
1. Prolonged PTT 2, normal PT
52
what are the causes of acquired coagulopathies
1. Liver disease 2. Toxins: vitamin K rodenticides 3. Venom 4. DIC
53
how does hepatic disease cause acquired coagulopathies
1. Decrease production of clotting factors 2. Decrease vitamin K recycling 3. Decrease FDP and coagulation inhibitor clearance 4. Decrease bile acid secretion
54
decreased FDP and coagulation inhibitor clearance in hepatic disease predisposes to __
DIC
55
how does decreased bile acid secretion in hepatic disease cause coagulopathies
decreased vitamin K absorption—> inactive clotting factors
56
what are the causes of vitamin K deficiency/ antagonism
1. Anticoagulant rodenticide 2. Moldy sweet clover
57
what are the results for PT, PTT and PIVKA for vitamin K antagonism/ deficiency
1. Prolonged PT first 2. Followed by prolonged PTT 3. Prolonged PIVKA
58
DIC results in increased __ of coagulation factors
consumption
59
t or f: DIC is primary disease
false- always secondary to systemic disease
60
what is pathophysiology of DIC
1. Early DIC: hypercoaguable state 2. Late DIC: hypocoagulable state
61
what is net result of DIC
hemorrhage and combined risk of thrombosis
62
what are the causes of DIC resulting in hemorrhage and thrombosis
1. Coagulation factor depletion—> hemorrhage 2. Fibrinogen depletion—> hemorrhage 3. Inhibition of platelets by FDPs—> hemorrhage 4. Excessive antithrombin depletion—>thrombosis
63
to dx DIC you must have 3 of the following:
1. Thrombocytopenia 2. Decreased fibrinogen 3. Increased FDPs or D-dimers 4. Decreased antithrombin 5. Prolonged PT, PTT, and ACT
64
what are the RBC morphology changes on blood smear associated with DIC
associated with fragmentary injury: keratocytes, schistocytes, +/- acanthocytes
65
define thromboembolic disease
Thrombus forms and continues unabated by mechanisms that usually cause dissolution of plug after its served its purpose
66
what are some causes of thromboembolic disease
1. Infectious (heart worm) 2. Cardiac disease 3, neoplasia 4. Protein losing nephropathy, protein losing enteropathy, hepatic disease (decrease AT)
67
what are some clinical signs of thromboembolic disease with saddle thrombi, pulmonary thromboembolism and renal infarct
1. Rear limb weakness= saddle thrombi 2. Dyspnea= pulmonary thromboembolism 3. Hematuria= renal infarct
68
what is most consistent finding for thromboembolic disease
decreased antithrombin
69
case 1: 3yr Doberman hx of continued vaginal bleeding 8 weeks post parturition. PE: petechia on MM. following labwork. Classify erythron, leukon, bleeding disorder tests, and what are next steps
Erythron: microcytic, hypochromic anemia—> iron deficiency anemia—> chronic hemorrhage Leukon: Inflammatory leukogram with concurrent stress Prolonged BMBT- with platelet count WNL—> VWD- do antigen test
70
case ex: 2yr, FS, mixed breed with hx of severe dyspnea, depression, dog has free run on farm at night. PE: muffled heart sounds, decreased lung sounds ventrally, weak pulses and hematomas noted on chest. Following blood work: characterize erythron, leukon, blood disorder tests and likely dx
erythron: Normocytic, normochromic, non-regenerative anemia Leukon: WNL Prolonged PT and PTT, normal platelet count and FDPS—> ddx: anticoagulant rodenticide
71
with DIC how is platelet count, BMBT, PTT, PT FDPs or D- dimers on blood work
1. Platelet count: decreased 2. BMBT: increased 3. PTT and PT: increased 4. FDPS and D-dimers: increased
72
with thrombocytopenia how is platelet count, BMBT, PT, PTT, and FDPs and D-dimers appear on blood work
1. Platelet count decreased 2. BMBT increased 3. PTT, PT, FDP or D- dimers: WNL
73
with thrombocytopathy how is platelet count, BMBT, PTT, PT, and FDPs or D-dimer son blood work
1 platelet count: WNL 2. BMBT: increased 3. PTT, PT, FDP, D-dimers: WNL
74
with vWD how is platelet count, BMBT, PTT, PT, FDPs or d-dimers on bloodwork
1. Platelet count: wNL 2. BMBT: increased 3. PTT, PT, FDPs or D-dimers: WNL
75
With liver disease how is platelet count, BMBT, PTT, PT, FDPS or d-dimers on blood work
1. Platelets count: WNL 2. BMBT: WNL 3. PTT and PT: increased 4. FDPs and D-dimers: WNL
76
with vitamin K deficiency how is platelet count, BMBT, PTT, PT, FDP or d-dimers on blood work
1. Platelet, BMBT, and FDP or d-dimers: WNL 2. PTT and PT: increased

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