Module 2.7 Hemostasis

Question 1

Heparin reversal agent

Answer 1

Protamine Sulfate

Question 2

Where does heparin act in the coagulation path

Answer 2

Inhibits Factor X to produce fibrin formation.

Question 3

Which pathway does PTT measure?

Answer 3

Intrinsic (Play Table Tennis Inside)

Used to measure heparin effect

Question 4

Which pathway does PT measure

Answer 4

Extrinsic (Play tennis outside)

Used to measure Warfarin effect.

Question 5

How is platelet function measured

Answer 5

Bleeding time test.

Question 6

3 phases of restoring hemostasis

Answer 6

1. Vessel Spasm
2. Formation of platelet plug.
3. Blood Coagulation or development of an insoluble fibrin clot.

(Spazz, plug, clot)

Question 7

Vessel spasm in hemostatic restoration

Answer 7

Spasm is transient (minutes-hours)

Mechanically slows blood flow to the area.

Question 8

What initiates vessel spasm

Answer 8

cytokines

Prostaglandins (Thromboxane A2, Prostacyclin)

Question 9

Thromboxane A2

Answer 9

causes constriction

Question 10

Prostacyclin

Answer 10

Causes dilation, inhibits platelet aggregation in normal uninjured vessels

Question 11

Half life of platelets

Answer 11

8-12 days

Question 12

What produces platelets

Answer 12

megakaryocytes

Question 13

Listen at 7:30

Answer 13

Listen at 7:30

Question 14

Vitamin K is soluble in

Answer 14

fat only

Question 15

Requirements for clotting

Answer 15

Platelets
Von Willebrand Factor
Clotting Factors

Question 16

Where is Von Willebrand factor generated

Answer 16

by the vessel endothelium

Question 17

Where are clotting factors synthesized

Answer 17

in the Liver using Vitamin K

Question 18

Antithrombin III

Answer 18

Contains naturally occurring heparin

Protects against uncontrolled thrombus formation

Question 19

Protein C

Answer 19

Plasma protein

Acts as anticoagulant by inactivating factors V and VIII

Question 20

Intrinsic Pathway

Answer 20

Slow

Question 21

Extrinsic Pathway

Answer 21

Fast

Trauma response

Question 22

Where do the intrinsic and extrinsic pathways become the same

Answer 22

Activation of Factor X

Question 23

Describe the activation of the coagulation pathway after factor X

Answer 23

Xa activates prothrombin to thrombin

Thrombin activates fibrinogen to fibrin

Question 24

Listen to 13:50 Mark)

Answer 24

Listen to 13:50 Mark)

Question 25

Listen to khan academy vid on clotting

Answer 25

Listen to Khan Academy vid on clotting

Question 26

Protein S

Answer 26

Accelerates the action of protein C

Question 27

Negative feedback systems in clotting cascade

Answer 27

Proteins S and C Plasminogen > Plasmin breaks down fibrin mesh into fibrin degradation products Thrombin stimulates anti-thrombin production

Question 28

Anti-thrombin action

Answer 28

inhibits conversion of prothrombin to thrombin | By inhibiting activation of factor X (which is the common pathway!!)

Question 29

Warfarin MoA

Answer 29

Affects vitamin K and therefore dependent factors NOT IMMEDIATELY REVERSABLE

Question 30

Heparin MOA

Answer 30

Affects factor X without other clotting factors IMMEDIATELY REVERSIBLE

Question 31

Heparin is measured with

Answer 31

PTT

Question 32

Warfarin (Coumadin) is measured with

Answer 32

PT

Question 33

What may also decrease vitamin K levels other than Coumadin

Answer 33

Antibiotics (kills bacteria needed for absorption) | Clofibrate

Question 34

Conditions that cause increased platelet function

Answer 34

``` Atherosclerosis Diabetes Smoking HLD and high cholesterol Pregnancy (estrogen increases coagulation) Protein S and C deficiency ```

Question 35

Leiden mutation

Answer 35

Factor V mutation Decreased Protein C effect Hypercoagulability

Question 36

Virchow's Triad

Answer 36

Vessel Injury Stasis Hypercoagulable state

Question 37

Antiphospholipid syndrome

Answer 37

IgG antibodies directed against phospholipids Recurrent venous and ARTERIAL thrombi DVT's, arterial thrombosis in coronary, renal and peripheral arteries Recurrent pregnancy loss TIA's

Question 38

Risk factors for hypercoagulability states

Answer 38

``` Pregnancy and puerperium Oral contraceptives (estrogen) Post-surgical state Virchow's Triad/immobility Congestive Heart Failure Malignant diseases ```

Question 39

Thrombocytosis

Answer 39

>1,000,000 platelets/uL | Due to increased thrombopoietin production

Question 40

Primary thrombocytosis

Answer 40

bone marrow disorders - increased platelet production. Often dysfunctional platelets.

Question 41

Secondary Thrombocytosis

Answer 41

Disease states causing more platelet production ``` Post-op Infection cancer CHRONIC INFLAMMATORY CONDITIONS Myeloproliferative disorders. ```

Question 42

Arterial thrombi are associated with

Answer 42

turbulent blood flow.

Question 43

Venous thrombi are associated with

Answer 43

stasis

Question 44

Thrombocytopenia

Answer 44

<150,000 platelets/uL | clinical issues really start at <100k though.

Question 45

Causes of thrombocytopenia

Answer 45

Decreased platelet production secondary to decreased thrombopoietin. Increased sequestration of platelets in spleen. Decreased Platelet survival Impaired platelets function

Question 46

Types of thrombocytopenia

Answer 46

Drug induced Immune thrombocytopenia purpura (ITP) Thrombotic hrombocytopenia purpura

Question 47

Immune thrombocytopenia purpura (ITP)

Answer 47

autoimmune increased platelet antibody formation usually follows viral infections in children DOESN'T INVOLVE CLOTTING FACTORS

Question 48

Manifestations of thrombocytopenia

Answer 48

Bleeding (nose, mouth, GI Petechiae - pinpoint purple-red spots Purpura - PURPLE areas Splenic enlargement in ITP due to sequestration. Possible Splenectomy.

Question 49

Vitamin K deficiencies

Answer 49

Antibiotics - kill bacteria needed for absorption | Impaired fat absorption (bile salts!)

Question 50

Hemophilia A

Answer 50

Factor VIII deficiency (30% of new cases are new mutations!!!) X-linked recessive ayyyy 8

Question 51

Hemophilia B

Answer 51

Factor IX deficiency | X-Linked Recessive

Question 52

Von Willibrand Disease

Answer 52

Autosomal Dominant (type 1 and 2) Autosomal recessive for type 3 (rare) Normal platelet count Increased bleeding time

Question 53

Hemorrhagic Telangiectasia

Answer 53

Autosomal Dominant | thin walled vessels, dilated capillaries and arterioles

Question 54

Cushing Diseases

Answer 54

protein wasting and loss of vessel tissue support due to increased cortisol

Question 55

Vit. C Deficiency

Answer 55

Scurvy | Poor collagen synthesis and failure of endothelial cells to cement together

Question 56

Senile Purpura

Answer 56

old person bruising

Question 57

Disseminated Intrvascular Coagulation (DIC)

Answer 57

Consumptive process. System wide clotting cascades via INTRINSIC system. All components of cascade wiped out. Severe Hemorrhage occurs. Caused by some other disease or injury.

Question 58

Causes of DIC

Answer 58

``` Gram negative sepsis Obstetric complications Any trauma Hypoxia Shock Hypotension ```