(P) Lesson 3: Secondary Hemostasis Flashcards
(143 cards)
1
Q
Hemostasis is mainly triggered by what?
A
Tissue Injury
2
Q
This is a physiological process that maintains blood in liquid state.
A
Hemostasis
3
Q
Rearrange the following steps of hemostasis
A. Platelet Adhesion
B. Platelet Plug Formation
C. Platelet Aggregation
D. Fibrin Stabilization
E. Vasoconstriction
F. Fibrin Dissoloution
A
E, A, C, B, D, F
4
Q
All are part of Primary Hemostasis EXCEPT?
A. Vasoconstriction
B. Platelet Plug Formation
C. Platelet Aggregation
D. Fibrin Dissolution
A
D
Both fibrin stabilization and fibrin dissolution are part of secondary hemostasis.
5
Q
Fibrin dissolution is also known as?
A
Fibrinolysis
6
Q
What are the three (3) important functions of hemostasis?
A
- Stop bleeding
- Localize the site of injury
- Tissue repair
7
Q
If an individual has a problem with the sequence of hemostasis, it results in what?
A
Unbalanced hemostasis
8
Q
An unbalanced hemostasis can result in which two (2) phenomena?
A
- Excessive bleeding (hemorrhage)
- Pathological clotting (thrombosis)
9
Q
Pathological clotting means there is problem with an individual’s what?
A
Dissolution
10
Q
What is the goal of primary hemostasis?
A
To form a primary platelet plug
11
Q
What is the goal of secondary hemostasis?
A
To form a stable fibrin clot
12
Q
The formation of a stable fibrin clot is triggered by what?
A
Tissue injury
13
Q
Stable fibrin clots are formed with the help of what?
A
Plasma proteins
14
Q
Also known as:
* Procoagulants
* Clotting Factors
* Coagulation Factors
* Blood Clotting Factors
A
Plasma Proteins
15
Q
They promote the formation of fibrin clots.
A
Plasma Proteins
16
Q
T or F: Platelets do not have roles in secondary hemostasis.
A
False
17
Q
- Proteins in nature (produced in the liver)
- Named by their numerical designation based on the year of discovery
- Has 16 in total but only 14 have a direct effect on secondary hemostasis
A
Plasma Proteins
18
Q
Clotting factors must be written properly in what form?
A
Roman Numerals
19
Q
T or F: There are 16 plasma proteins in total that have an effect on an individual’s secondary hemostasis.
A
False
There are 16 in total, but only 14 have an effect on secondary hemostasis.
20
Q
The numerical designation of the clotting factors are based on what?
A
Their year of discovery
21
Q
What are the four (4) exceptions to the naming of clotting factors with their numerical designations?
Clue: Those more commonly known using their common name.
A
- Factor I - Fibrinogen
- Factor II - Prothrombin
- Factor III - Tissue Factor
- Factor IV - Calcium
22
Q
These are the two (2) clotting factors that have no numerical designations.
A
Pre Kallikrein (PK) and High Molecular Weight Kininogen (HMWK)
23
Q
When you are deficient in clotting factors, you are more prone to problems in what?
A
Bleeding
24
Q
If a person is deficient in clotting factors, why are they more susceptible to problems with bleeding?
A
They have unfinished secondary hemostasis.
25
This clotting factor has no recorded incidence of deficiency.
| Essentially, it is **impossible** to be deficient.
Factor III (Tissue Factor)
26
This clotting factor is the reason why secondary hemostasis can be triggered regardless of the site of injury.
Factor III
27
This non-existent clotting factor was removed because it was discovered to just be a subset of Factor V.
Factor VI
28
This clotting factor has several other nomenclatures and is often found attached to VWF.
Factor VIII (Antihemophilic Factor -AHF)
29
# Match the preferred name to the clotting factor.
1. Fibrinogen
2. Proaccelerin
3. Proconvertin
4. Stuart-Prower Factor
5. Hagemen Factor
A. V
B. VII
C. XII
D. X
E. I
1. E
2. A
3. B
4. D
5. C
30
# Match the preferred name to the clotting factor.
1. Calcium
2. Prothrombin
3. Plasma Thromboplastin Component (PTC)
4. Fibrin-Stabilizing Factor
A. II
B. IV
C. XIII
D. IX
1. B
2. A
3. D
4. C
31
# Match the preferred name to the clotting factor.
1. Tissue Factor
2. Antihemophilic Factor (AHF)
3. Plasma Thromboplastin Antecedent
4. Fitzgerald Factor
5. Fletcher Factor
A. III
B. XI
C. VIII
D. HMWK
E. Pre Kallikrein
1. A
2. C
3. B
4. D
5. E
32
This clotting factor is involved mostly in primary hemostasis.
VWF (Von Willebrands Factor)
33
Platelet Factor 3 is a **procoagulant** also known as what?
## Footnote
Give the **preferred name.**
Phospholipid Phosphotidylserine
34
What is the clotting factor that has several nomenclatures?
Factor VIII
35
# Nomenclature of Factor VIII
* Refers to the **entire molecule present in the plasma**
* The entire molecule as it circulates in the plasma
* Composed of **VIII:C** and **VIII:vWF**
VIII/vWF
36
# Nomenclature of Factor VIII
* Found in **platelet adhesion** in primary hemostasis
* Portion of molecule responsible for **binding to endothelium** and **supporting normal platelet adhesion and function**
* Tested by **bleeding time**
VIII:vWF
37
# Nomenclature of Factor VIII
* Found in **secondary hemostasis**
* Portion of molecule acting in intrinsic system as **cofactor to factor IXa (with Ca2+)** in the conversion of factor X to Xa
* Tested by **APTT**
VIII:C
38
* Used in serological testing **concerning factor VIII**
* Antigenic property of **procoagulant portion** as measured by immunologic monoclonal antibody techniques
VIIIC:Ag
39
# Nomenclature of Factor VIII
* Used in serological testing concerning **vWF**
* Factor VIII-related antigen, which is a propert of the **large vWF portion of the molecule** and measured by immunologic techniques of Laurell rocket or immunoradiometeric assay
VIIIR:Ag
40
# Nomenclature of Factor VIII
* A **differentiation test** used to assess if the patient has a factor VIII deficiency or vWF deficiency
* **Ristocetin cofactor activity**, which is a factor VIII-related activity required for aggregation of human platelets with ristocetin in in-vitro aggregation studies
VIII:RCo
41
An antibiotic no longer used therapeutically
Ristocetin
42
What are the three (3) different classifications of clotting factors based on their **functions?**
1. Substrate
2. Cofactor
3. Enzyme
43
# Enumerate what clotting factors are under the category stated.
Substrate
1. **Factor I** - Fibrinogen
44
# Enumerate what clotting factors are under the category stated.
Cofactor
1. **Factor III** - Tissue Factor
2. **Factor IV** - Calcium
3. Factor VIII
4. Factor V
45
The **enzyme** category of clotting factors is further separated into what two (2) subcategories?
1. Transaminoglutamase
2. Serine Proteases
46
# Enumerate what clotting factors are under the category stated.
Transaminoglutamase (Enzyme)
1. Factor XIII
47
# Enumerate what clotting factors are under the category stated.
Serine Proteases (Enzyme)
1. Factor II
2. Factor VII
3. Factor IX
4. Factor X
5. Factor XI
6. Factor XII
7. PK
8. HMWK
48
What are the three (3) different classifications of clotting factors based on their **physical/physiological properties?**
1. Fibrinogen Group
2. Prothrombin Group
3. Contact Group
49
# Classification based on their Physical Properties
* Largest molecular weight
* Thrombin-sensitive *(reacts directly with thrombin)*
* Totally consumed in coagulation
* Absent in serum samples
* Calcium-dependent
* Vitamin K-independent
Fibrinogen Group
50
# Classification based on their Physical Properties
What clotting factors are classified under the **fibrinogen group?**
1. Factor I
2. Factor V
3. Factor VIII
4. Factor X
5. Factor XIII
51
# Classification based on their Physical Properties
* Vitamin K-dependent
* Calcium-dependent
* Adsorbable in plasma
Prothrombin Group
52
# Classification based on their Physical Properties
What are the clotting facrors classified under the **prothrombin group?**
1. Factor II
2. Factor VII
3. Factor IX
4. Factor X
53
This is needed for **gamma carboxylation** which allows for the **binding of the factors to their cofactors.**
Vitamin K
54
# Classification based on their Physical Properties
* **Glass-sensitive group:** in vitro, they are activated immediately upon coming into contact with glass
* Vitamin K and Calcium independent
Contact Group
55
# Classification based on their Physical Properties
What are the clotting factors classified under **contact group?**
1. Factor XI
2. Factor XII
3. PK
4. HMWK
56
* First coagulation pathway to be discovered
* Discovered by **Paul Morrawitz**
Classical Pathway of Coagulation
57
# Classical Pathway
What are the only two (2) clotting factors involved in the classical pathway?
1. Factor II (Prothrombin)
2. Factor I (Fibrinogen)
58
# Classical Pathway
Prothrombin is converted to thrombin by what?
Thrombokinase
59
# **Classical Pathway.** Fill in the blanks.
1. ____ is converted to thrombin by ____
2. Thrombin is then converted to ____
3. ____ is then converted to a ____, which is the end product of the classical pathway
1. **Prothrombin** is converted to thrombin by **thrombokinase**
2. Thrombin is then converted to **fibrinogen**
3. **Fibrinogen** is then converted to a **fibrin clot**, which is the end product of the classical pathway
60
The coagulation pathway wherein you have **a clotting factor that activates another clotting factor** and so on
Cascade/Domino Effect/Waterfall Pathway
61
What are the three (3) components of the cascade pathway?
1. Extrinsic Pathway
2. Intrinsic Pathway
3. Common Pathway
62
The **extrinsic pathway** is triggered by what?
Release of tissue factor (Factor III)
63
# **Extrinsic Pathway.** Fill in the blanks.
1. The release of ____ triggers the activation of the extrinsic pathway and the activation of ____
2. The activated form of ____ forms a complex with its cofactor ____, Calcium (Ca2+) and Platelet Phospholipids
1. The release of **tissue factor** triggers the activation of the extrinsic pathway and the activation of **Factor VII**
2. The activated form of **Factor VII (VIIa)** forms a complex with its cofactor **Factor III (Tissue Factor)**, Calcium (Ca2+) and Platelet Phospholipids
64
This is the complex formed by the **extrinsic pathway** and is considered as its end product.
Extrinsic Tenase Complex
65
# **Extrinsic Pathway.** Match the following terms to their definition.
1. Cofactor of Factor VII
2. Cofactor of the entire complex
3. Secondary cofactor of the complex once the Ca2+ attaches to the complex
4. Prothrombin Group
A. Calcium (Ca2+)
B. Platelet Phospholipid
C. Tissue Factor
D. Factor VIIa
1. C
2. A
3. B
4. D
66
The **intrinsic pathway** is triggered by what?
Collagen Exposure
67
# **Intrinsic Pathway.** Fill in the blanks.
1. The exposure of ____ leads to the activation of ____
2. The activated form of ____ binds to HMWK which activates ____
3. ____ then activates Factor IX
4. The activated form of ____ then forms a complex with its cofactor ____, Calcium (Ca2+), and platelet phospholipids.
1. The exposure of **collagen** leads to the activation of **Factor XII**
2. The activated form of **Factor XII (XIIa)** binds to HMWK which activates **Factor XI**
3. **Factor XI** then activates Factor IX
4. The activated form of **Factor IX (IXa)** then forms a complex with its cofactor **Factor VIII**, Calcium (Ca2+), and platelet phospholipids.
68
This is the complex formed by the **intrinsic pathway** and is considered as its end product.
Intrinsic Tenase Complex
69
# **Intrinsic Pathway.** Match the following terms to their definition.
1. Cofactor of Factor IX
2. Cofactor of the entire complex
3. Secondary cofactor of the complex once the Ca2+ attaches to the complex
4. Prothrombin Group
A. Platelet Phospholipid
B. Calcium (Ca2+)
C. Factor IXa
D. Factor VIII
1. D
2. B
3. A
4. C
70
# Intrinsic Pathway
What are the two (2) main functions of the complex **Factor XIIa + HMWK?**
1. To proceed to the kinin system
2. Continue the secondary hemostasis by activating Factor XI
71
# Intrinsic Pathway
One of the reasons why there is inflammation after tissue injury.
Kinin System
72
The **common pathway** is triggered by what?
The **extrinsic tenase complex** and **intrinsic tenase complex**
73
# **Common Pathway.** Fill in the blanks.
1. The ETC and ITC activates the ____
2. The activated form of ____ then binds with its cofactor ____, Calcium (Ca2+), and platelet phospholipids
1. The ETC and ITC activates the **Factor X**
2. The activated form of **Factor X** then binds with its cofactor **Factor V**, Calcium (Ca2+), and platelet phospholipids
74
This is the complex formed by the **common pathway** and is considered as its end product.
Prothrombinase Tenase Complex
75
The **prothrombinase tenase complex** activates what?
**Factor II** (Prothrombin) to **Factor IIa** (Thrombin)
76
This activated form of a clotting factor has a **procoagulant function** which allows it to finish the coagulation pathway and revert back to the classical pathway.
**Factor IIa** (Thrombin)
77
Fibrin is a ____ in nature
Glycoprotein
78
What are the three (3) polypeptides of fibrin?
1. Alpha
2. Beta
3. Gamma
79
The **alpha and beta polymers** constitute ____ which is cleaved by the thrombin.
Fibrinopeptides
80
What is cleaved from the fibrinopeptides and is considered a **very weak bond** in order to form fibrin monomers?
Hydrogen bonds
81
Fibrin clots are also called as?
Fibrin monomers
82
Thrombin also activates this clotting factor in order to stabilize the fibrin clot (fibrin monomers).
Factor XIII (XIIIa)
83
How does Factor XIIIa stabilize the fibrin clot?
Converting the hydrogen bonds to covalent bonds
84
When a fibrin monomer's hydrogen bonds are converted to covalent bonds, it is now known as what?
Cross-linked Fibrin
85
**T or F:** Cross-linked fibrin is regarded as the stable fibrin clot.
True
86
**T or F:** All pathways in secondary hemostasis happen sequentially.
False
## Footnote
These processes (pathways) happen **simultaneously.**
87
# Match the following.
1. In vivo
2. In vitro
A. Cell-based Coagulation
B. Coagulation Pathway (Extrinsic, Intrinsic, Common)
1. A
2. B
88
Where does **cell-based coagulation** happen?
On a specific cell membrane
89
What are the three (3) phases of cell-based coagulation?
1. Initiation
2. Amplification (it is no longer used in the latest edition of Rodak's)
3. Propagation
90
# Initiation Phase
1. ____ is always combined with its loyal cofactor ____ which will activate small amounts of ____ and ____
1. **Tissue Factor** is always combined with its loyal cofactor **Factor VII** which will activate small amounts of **Factor IX (IXa)** and **Factor X (Xa)**
91
# Initiation Phase
____ has a higher binding capability to its cofactor.
Factor X (Xa)
92
# Initiation/Amplification Phase
1. ____ binds with its cofactor ____ to form a small amount of thrombin
2. The thrombin then activates the ____, separates the ____ from the ____, and produces a small amount of ____ and ____
1. **Factor X (Xa)** binds with its cofactor **Factor V** to form a small amount of thrombin
2. The thrombin then activates the **platelets**, separates the **Factor VIII** from the **vWF**, and produces a small amount of **Factor V (Va)** and **Factor XI (XIa)**
93
The **propagation phase** of the cell-based coagulation happens where?
On platelet membranes
94
The platelet membranes in the propagation phase are sourced from which three (3) sources?
1. Platelet activated by thrombin
2. Platelets from primary hemostasis **(priority)**
3. Platelet activated from collagen
95
The platelet membranes that are known to be the **sites of propagation** are also known as what?
COAT Platelets
96
All materials used in the propagation phase of cell-based coagulation comes from where?
The initiation and/or amplification phase **(basically, what thrombin has produced)**
97
# Propagation Phase
1. Factor VIII will serve as a cofactor to ____
2. Factor V will serve as a cofactor to ____
3. ____ serves as the cofactor that activates Factor IX for binding
1. Factor VIII will serve as a cofactor to **Factor IX**
2. Factor V will serve as a cofactor to **Factor X**
3. **Factor XI** serves as the cofactor that activates Factor IX for binding
98
What are the two (2) complexes formed in cell-based coagulation that forms thrombin?
1. Factor Xa + Factor V
2. Factor IXa + Factor VIII
99
This happens due to the many sources of thrombin.
Burst of thrombin or thrombin burst
100
What are the three (3) classifications of the functions of thrombin?
1. Procoagulant Function
2. Anti-coagulant Function
3. Tissue Repair Function
101
On its own, thrombin has a ____ function.
Procoagulant
102
In order for thrombin to possess the anti-coagulant function, it must bind with other agents such as ____ and ____
AT-III and thrombomodulin
103
# Identify the classification of functions of thrombin.
* Induces platelet activation and aggregation
* Activates cofactor VIII to VIIIa
* Activates factor XIII to XIIIa
* Converts prothrombin to thrombin via autocatalysis
Procoagulant Function
104
# Identify the classification of functions of thrombin.
* Binding of AT-III to inhibit serine proteases
* Binding to thrombomodulin to activate protein C
* Promotion of endothelial cell release of t-PA (Tissue Plasminogen Activator)
Anti-coagulant Function
105
# Identify the classification of functions of thrombin.
* Induces cellular chemotaxis and stimulation of proliferation of smooth muscle and endothelial cells
Tissue Repair
106
# Inhibitors of Coagulation
* Main inhibitor of blood coagulation
* Its activated form is a strong anticoagulant that degrades factors Va and VIIIa
* Stimulates fibrinolysis by inactivating plasminogen activator inhibitors
Protein C
107
# Inhibitors of Coagulation
Cofactor with protein C
Protein S
108
# Inhibitors of Coagulation
How many percent of Protein S is free form and active? How about those bound to complement C4 binding proteins and are inactive?
**40%** - free form and active
**60%** - bound to complement C4 binding proteins and are inactive
109
# Inhibitors of Coagulation
* Main inhibitor of thrombin that is enhanced by heparin
* Logic behind the green (heparin) tube
Antithrombin C (AT-III)
110
# Inhibitors of Coagulation
Inhibits thrombin
Heparin Cofactor II
111
# Inhibitors of Coagulation
Forms a complex with thrombin, kallikrein, and plasmin and inhibits their activity
Alpha-2-Macroglobulin
112
# Inhibitors of Coagulation
* Also known as **lipoprotein associated coagulation inhibitor**
* Inhibits the VIIa-tissue factor complex
Extrinsic Pathway Inhibitor (EPI)
113
# Inhibitors of Coagulation
Main inactivator of factor XIIa and plasma kallekrein.
C1-Inhibitor
114
# Inhibitors of Coagulation
Weak inhibitor of thrombin and factor Xa and XIa
Alpha-1 Anti-trypsin
115
# Inhibitors of Coagulation
Inhibits the activity of protein C
Activated Protein C Inhibitor
116
# Inhibitors of Coagulation
Modifies the action of thrombin to act more as inhibitor by inactivating protein C
Thrombin + Thrombomodulin (Endothelial Surface)
117
Occurs when plasminogen is converted to plasmin, which dissolves the fibrin or fibrinogen into smaller fragments termed as FDP/FSP
Fibrinolysis
118
What is the main goal of fibrinolysis?
To digest fibrin clots as they are formed in order to keep the vascular system free of deposited fibrin and fibrin clots *(maintains/retains blood flow)*
119
# Fibrinolysis
Single chain glycoprotein found in the plasma in concentration of **20 to 40 mg/dL** and in all other fluids in a lesser amount
Plasminogen
120
# Fibrinolysis
* Has a direct role in lysing fibrin clot physiologically
* Serine protease that systematically digests fibrin polymer by the hydrolysis of arginine-related and lysine-related peptide bond
Plasmin
121
# Fibrinolysis
Capable of digesting plasma fibrinogen, factor V, factor VIII, and fibronectin
Free plasmin or free form plasmin
122
What does FDP mean?
Fibrin/Fibrinogen Degradation Product
123
What does FSP mean?
Fibrin/Fibrinogen Split Product
124
# Fibrinolysis - Fibrinogen
* The **fibrinogen (fragment X)** is split into what two (2) fragments?
Fragment D and Fragment Y
125
# Fibrinolysis - Fibrinogen
* **Fragment Y** is further split into what two (2) fragments?
Fragment E and Fragment D
126
What is always he end product of fibrin/fibrinogen dissolution?
Fragment E and D
127
# Fibrinolysis - Fibrin Clot
The cross-linked fibrin is also known as?
Fragment DXnD
128
# Fibrinolysis - Fibrin Clot
* The **fibrin clot (DXnD fragment)** is separated into what two (2) fragments?
Fragment DD/E and Fragment DXY/YXS
129
# Fibrinolysis - Fibrin Clot
* **Fragment DXY/YXS** is further separated into what two (2) fragments?
Fragment DD/E and Fragment DXY/YY
130
# Fibrinolysis - Fibrin Clot
* **Fragment DXY/YY** is further separated into what two (2) fragments?
Fragment DD/E and Fragment YD/DY
131
# Fibrinolysis - Fibrin Clot
* **Fragment YD/DY** is further separated into?
Two Fragment DD/E
132
# Fibrinolysis - Fibrin Clot
* All the **Fragment DD/E** produced are then separated to what two (2) fragments?
Fragment E and D-dimers (DD fragments)
133
Serves as a basis if **something is a problem with primary or secondary fibrinolysis** and if we are dealing with **either fibrin or fibrinogen**
D-dimers
134
# Primary or Secondary Fibrinolysis
* Excessive amount of plasminogen activator from damaged cells or malignant cells
* E.g. malignancy-like prostatic carcinoma
* No d-dimer, fibrin monomer, and fibrin polymer
* Normal platelet count
Primary fibrinolysis
135
# Primary or Secondary Fibrinolysis
* DIC (uncontrolled)
* Inappropriate formation of fibrin within the blood vessels
* E.g. Infection and HTR
* Has d-dimer, fibrin monomer, and fibrin polymer
* Decreased platelet count
Secondary Fibrinolysis
136
What are the four (4) plasminogen activators?
1. Intrinsic Factors
2. Tissue Type Urokinase
3. Therapeutic Activators
4. Tissue Plasminogen Activator
137
# Plasminogen Activators
Factor XIIa, Kallikrein, and HMWK
Intrinsic Factors
138
# Plasminogen Activators
Secreted by the kidney and activated plasminogen
Tissue Type Urokinase
139
# Plasminogen Activators
* E.g. Treatment for thromboemboli
* Streptokinase, urokinase, tissue-like PA
Therapeutic Activators
140
What are the six (6) inhibitors of fibrinolysis?
1. Alpha-2 Antiplasmin
2. Alpha-2 Macroglobulin
3. Thrombosponin
4. Plasminogen Activator Inhibitor 1 (PAI-1)
5. Plasminogen Activator Inhibitor 2 (PAI-2)
6. Alpha-1 Antitrypsin
141
# Inhibitors of Fibrinolysis
Primary inhibitor of plasmin
Alpha-2 Antiplasmin
142
# Inhibitors of Fibrinolysis
Released by the platelets and inhibits the activation of fibrin-bound plasminogen
Thrombospondin
143
Congrats, nasurvive niyo si Ma'am TJ this week. <3
Tulog na lods mwa
